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07030118;oro iUV :Z I<H tv�z 3F"uDi is >A. :Wt ,yam joo i^y :Za :Sq t- i�l 0 r -a Q Z 0 r-. U W a fn Z r� CITY OF CUPERTINO <: BUILDING DIVISION PERMIT(ITR�C�R BUILD{ 5Qppl}.RSSGREENLEAF DR rI PERMIT NO. TBD O BE DETERMINED 07030118 ER''S(JN�AjMlE::j PERMrr ISSUE DATE 10/25/2007 PHONE: SANITARY NO. CONTROL NO. ARCHMCT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 � 0 LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing Job Description with Section 7000) of Division 3 of the Business and Professions Code, and my license is S FDWL - 2 STORY 3,791'/GARAGE 600' (1ST F LR in full force and effect. License Class Lie. 2 , 4 6 4 ' / 2ND F LR 1, 3 2 7 ') FEES Date Contractor r ARCHITECT'S DECLARATION PF 10/16/07 TO REOPEN EXPIRED PERMIT. SEE I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city mr County which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter9 ;>q. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $846504 that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of e Number Occupancy Type not more than five hundred dollars ($500). 3263017P. -RT P Y YP ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of Required Inspections property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sak u however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). � f• as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a contractor(s) licensed pursuant to the Contracufs License Law. ^ I am exempt under Sec B & P C for this reason ter Da 0 SATIO ECLARAMON I hereby affirm under penalty of perjury one of the following declarations ❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is formic hundred dollars ($100) or Icss) I cenifv that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so be c spb* to the Workers' Compensation Laws of California. fate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) L.endcr's Name Lender's Address 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned properly for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City inconsequence of the granting of this per 't. APPLICANT UNDERSTANDS A LL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATiQ / Type of Roof e46Re-roofs Si ore of Apph ntractor Date Ir HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material !cftncd by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety >c, Section 25532(a)? ❑Yes o �/l All roofs shall be inspected prior to any roofing material being installed. Will a roof is installed without first obtaining an inspection,agree to remove the applicant or future building occupant use equipment or devices whichIf .I emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new mat ;rials for inspection. District? ❑Yes 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534-1 understand that if Ute building does nal currently have a Lena at it is my responsibility to notify the occupant of the rcquiremcntswhic be tpn. issuance ofaCertir, mfac cy. Signature of Applicant Date wZ All roof coverings to be Class "B" or better g wncr or auth rixcd agent Dat; '