07100158 CITY OF CUPERTINO ` � h �7
BUILDING DIYISION PERMIT ������� ����� �
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PERMIT NO.
BUILD ►��a�o�g.ES HENEY CREEK PLACE TBD - TC) BE DETERMINED 07100158 �
.i
PERMIT ISSUE DATE
.�ER'S NAME: .
DARRELL RINERSON 10/29/2007
SANITARY NO. CONTROL NO.
PHONE:
BUtLDING PERMI7' iNFO
ARCHiTECT/ENGINEER: BLDG ELECT PLUMB MECH
� � � �
� p � LICENSED CONTRACTOR'S DECLARATION JOt1 DeSCT1pL10O
'� C 1 hcrcby a(Grm that I am licensed undcr provisions of Chaptcr 9(commcncing
�Z,�� w i i hS c cuon70(w)otDivision3oCihcBusincssandProfcssiansCodc.andmyiiceRSCis REVISIOIJ DECK SUPPORTS #07040118
>> y in full force an d clCec� ��� q o Z 3
� � ? Licenu Ciu a L�. �
� F � Datc /D� 2� f G7 Conuacmr/Y/RTt al[,LC� t.urrST � n i'•�/
� ARCHITECi'S DECLARATION
i a a I undcrstand my plans shall Ix uscd az pubiic rcconis
)aU
' a y Liccnsed Prufcssional
: � a OW NER-BUILDER DECLARATION
j a� I hcrchy alTirm ttiat 1 am cxcmpt Crom thc Conlractor's Liccnsc Law for thc
. p o following reason. (Scc6on 703I.5, Business and Profccsions Codc: Any ciry or rnunty
�,°, Fi which requires a pertnit to cnnswc4 a1�r. improve. demolish, or repair any stn�cture
� Z� prior ui i�s issuancc, also rcquires thc applicant (or such permit to filc a signcd suicmcn� �, Ft. Floor Area Valuation
�_ � that hc is liccnscd pursuant to �hc provisions of thc Contruwr's Li�ronsc Law (Ch�Ptcr 9 � � O
u F� (commcncing with Scction 7000) of Division 3 oC Ihc Busincss and Profcssions Cadc) ar
,, � .. that he is exempt themtrom and the basis Cor �he a�Icgcd exempdon. Any violation of OCCIiPaIIC}� Type
Section 7031.5 by azry applicant Cot a permit subjccu ihe applicant w a civil penalty of 2 4 2 4 8 0 2)�� Number
not more than 6vc hundred dollars (5500).
❑ I, as owner oC tt�e property, ar my employca wiN wages az their solc compentatian,
wilidothework.andfhesuuctumisnatir.tendedoratfe�A Required Inspections
and Professions Cadc: 1he Conuxmr's Lianse Law docs not apply w an owner af
prapeny who 6uilds or improves thercon, and who dxs sucA work himulf ar Uuough his
own emplayccs. provided tAat such improvemen�s are not imm�ded or ottered Cor sale. lC.
however, thc building or improvemeni is sold within one year oC complerion, ihe owner
builder will have Uu burdee oC proving �Aat he did noi build ar improve for purpose of
satc.).
❑ I. as owner of the property. am ezclusively conhacting wilh licensed conuactors w
constnut the projen (Sec. 7044. Businas and Pro[essions Code:) The Con�raetor's Li-
cense Caw docs aot apply �o an owner of propeny who builds or improves Ideeeon. and ,
who contncls for suc6 p�ojecLS with a convutor(s) licensed pursuant m the CaavattaCs
� �cense Law.
' am ezempt under Sec. . B de P C fw �his �casan
vwner Dale _ .
WORKER'S COMPENSATION DECLARATION
I hereby all'icm under penalty of pery'ury ane o( the lolbwing declAnnn
I hsve and will mainuin a Cenificate of Consenl to self-insure (or Workcfs Comprn-
satian, vidcd for by Section 3700 of the Labor Code, for tAc performanoc of tlk
work for which U�is pertnit is issued.
❑ I havc and will main�ain Worker's Compensation Insuronce. as �cquircd by Scaion ,
3700 oC Urc Labar Codc, for the performancc of thc work Cw which this permit is issued•
My Worker's Compensation Insurance carticr and Poliry number arc:
Carrier. Poliry No.:
CERTIFICATE OF EXEMFI'[ON FROM WORKERS'
COMPENSA'f10N INSURANCE
(fhis sectian necd not bc complctcJ if the permit is Cor anc hundtcd dollacs (5100) ,
or Icss)
I cenify that in tdc performancc of thc work for which �his pertnit is issuc0. I shall nac
employ any person in any man�r so to comc su�'est ta lhe Workcrs' Compcnsauon
Laws of Califo '
Applicant
NOTICE TO PC.ICA : If, atYcr making this CcniGn�e of Excmpuon, you shou�d
become subjcct to rkcr's Compcnsation prorisions of �he La6or Code, you muu
� O forthwith comply with such provisions or this permit shall bc dccmcd rewkcd.
z "" CONS7'RUCI70N LENDING AGENCY
[� � I hcreby affirm Ihat ihcre is a consuuction knding agcncy Cor thc perfortnarkc of -
p�., � ihc work Cor which this pertmt is issucd (Scc. 3097, Civ. C.) ,
W A Lcndcr's Namc
� z LendersAddress
l certi(y Ihat t havc read lhis applieation and statc ihat �hc aAovc infamalion is
� O cortcct. I agree to comply wiUi all city and county orelinances and sute laws relating w
� U building conswction. and he�cby authori�e representatives of ihis city to emer upon Nc
� a ahovc-mcntiuncd property (or inspcction pur�wses.
(Wc) agree to sare, indcmni(y and kecp harmlcss ihe City of Cupenino agtinst
�� liabiliucs, judgmcnts, cosu and expcnscs which may in any way accruc against said Gry / �/-
V z in conuquence oC �he granting of �his permit. Date ! CJ�"� t �
►�+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by
SOU LATI
� Re-roofs `'��
���� u��co��� o "` T e of R oof
HAZARDOUS MATERIALS DISCLOSURE YP
Will ihc applicant or futurc building occupant storc or handlc ha•rardous matcriil
eflned by lhe Cupenino Municipal Codc. Chaptcr 9.12. and thc Hplth and Safcty
..ak. Scction 25532(a)? �� All roofs �hall be inspected prior to any roofing material being installed.
� Y� '
�II ihc applicant or futurc building accupant usc cquipment or dcviar which
If a roof i� installed without first obtaining an inspecUOn, agree to remove
cmit harardous air conuminan�s u dcfincd Ay the Bay Arca Air Qualiry ManaS�«� all new rc aterials for inspecrion.
Disvict? �.
❑ Ycs
l havc rcari Ihe ha�ardcws ma�crials requiremcn�t unAcrChap�cr 6.95 of �hc Ca6for-
nia Hcalih & Safcry Codc. Secuaas 25505, 25533 and 25534�t wdcrstand �hat if thc buildin6
docs no� curtenUy havc a tcnant, that it is my rcsponsiAdiq�a noul'y Ihc occupant nf Ihe
rcyuirements w ich m be me 'or to issu ce of � fidate of Occupar�y S ignature of Applicant " Date
- All roof coverings to be Class "B or better
Owncr ory�tf orii.c enl �a� J