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07100156 CIT�' OF CUPER'�INO ' ` BUILDING DIVISIOt� PERMIT C��RR�►�C?K I�����If�N: ;: : __ _: .; ., :. PER M IT NO. BUIL t � n �� , � o � ES �OMESTEAD RD #202, 204 DR.AEGEI: CONSTRUCTION INC 07100156 . PERMTT ISSUE DATE .JBR'S NAME: HOMEOWNERS ASSOCIATION 605 COPiMERCIAL ST 10 19 2007 PHONE: SANITARY NO. CONTROL NO. BUILDING PERMIT lNFO ARCHI'IECT/ENGINEER: REMV & REPLACE LIKE FOR LIK BLDG ELECT PLUMB MECH � � 0 �� i p p LICENSED CONTRACTO[i'S DECLARATION � Job Description � V � I hcrcby affirm that I am licenscd unJcr provisions oC Chaptcr 9 (commencing ^' . " '^ ^ _ . ^ ^ ^' . . ; Z� witti Scction 7000) of Division 3 of thc Busincss and Profcssions Codc, and my liccnsc is ;� y in full Coccc and cf Cect (� ��� � v� Z Licensc Class � L�. � : F , � Da�c �.�0�_q ' `� 7 Contrac�or � ARCHI7ECTS DECLARA ON 7� a I undcrstanJ my plans shali bc uscd as public rcconLs >aU ' a y Liccnsed PmCcssional � y � OWNER-BUILDER DECLARATION 1 hcrcby alTirtn tha� 1 am excmQt Crom ihc Contractor's Liccnu Law for thc � p O following rcuon. (Sccuan 7031.5, Busincss and Profcssioas Ca1c: Any ciry or county �,° �i which requires a petmit w wnswc4 $��r, impmve, demolish, or repair any swcwre � Z} prior u� i�s issuancc, alw rcquires thc applicant for such pertnit io Glc a signcd statcmcnt Valuation �_ � that hc is liccnxd pursuanl to thc provisions of thc Contractor's Liccnse Law (Chaptcr 9 iq. Ft. Floor Area x F- (commencing wiih Scction 7000) of Division 3 of lhc Busincss and Profcssions Codc) or y�� that he is ezempt thcccfrom and the basis Cor t6e allegcd exemption. Any violation o( Section 7031.5 by arry applicant for a pennit subjecu ihe applicant W a civil pcnalty of APN Number Oeeupaney Type not morc �an five hundred dollars (SS00). � I, as owner oC ttie property, or my cmployces with wages u their solc compensation, will da �hc work, and �he swctuee is notintended or ollered for salc (Sec. 7044 a�;�g Re uired Ins ections and Professions Code: 7Le Conuactor's License Law docc not apply w an owner of � p propeny who builds or impcoves �hereon, and who does such work himsel[ or Uwugh his own employces. providcd U�at such improvements are not in�ended or offered for sale. If, however. �he building or improvement is sold within one year of complc6on, the owner- builder will have the burden of proving �a� he did not build or improvc for purpau of sale.). �[, as awner of the propeny, am exclusively conuacting wiW licensed rnnvactors 10 wnstruct the project (Sec. 7044. Business and ProCessions Cade:) The Coauacmr's Li• ccnse Law docs not apply to an owner of propeny who builds or impraves tAereon, and , who conuac�s for such projects with a comraaor(s) liansed pursuant to ihe Convaciar's � rense I.aw. 1 am exempt under Sec. , B& P C fw this reaton .+ner Date _... _. WORKER'S COMPENSATION DECLARAI'ION , 1 hercby affirm uader penalty of pe�jury rnie of the fallowing decfarations: ❑ I haoe and will maintain a CertiGcam of Conunt to sel(-insure (or Workc�s Compen- sation, u pravided for by Secuon 3700 af ehe Labor Codc, for the perfarmancc a[ the woric for which this permit is issued. ❑ I have and will maintain Worker's Compensatian Insurance, ac required by Section 3700 oC ihe Labor Code. Cor the pecformance of the work tor which this peemit is issued. My Workc� , Compe aGon [nsunnFc cartict and Policy number a�s: �� � Carrier. v�`� � Poliey No.: ���. t I� �� CERTIPICATE OF EXEMPIION FROM WORKERS' COMPENSATION [NSURANCE (Th�s section necd not bc compleud i[ the permit is for onc hundred dollazs ($100) or Icss.) i cenify Wct in thc performance of thc work for which ihis permit is iscucd, 1 shall not employ any person in any manncr so as ta bccomc subject ta the Workcrs' Compensation Laws of Califomia. Datc Applicant NOTICE TO APPLICAM: If, aftcr making ihis Ccnifica�c of Excmption, yau should become subjcct to the Worker's Compcnsation provisions o( Wc Labor Codc, you must � O forNwith eomply with sueh provisions or this pcami� shall6c dccmcd revoked. z ""' CONSTRUCTION LENDING AGENCY F r�-� 1 hcrcby affirtn Wat thcre is a constructinn lcnding agcncy 1'or thc perfortnan�r o[ . p.! � thc work fur which this permit is issucd (Scc. 3097, Civ. CJ W� A Lendcr's Namc � � z l,cnder's Address V � t cenify ihat 1 havc rcad this application and s�atc ihu thc abovc infocmatiun is w ►-� cortcct. I agrce to comply witA all ciry and county ontinances and staie laws rclating to � U building conswction, and hc�cby authoriie represcntativcs of this city �o cntcr uFmn Nc � W abovc-mcntioncd properry for inspccuon purposes. a (Wc) agree to save, indcm�i(y and kecp harmless Ihc City of Cupertino against �� liabilitiu,judgmcn�s, costs and expcnscs which may in any way accruc againsl said City �} ,'� ia co uence oC gnnting o( Ihis permit. �./ �/ .�, �+ APPLI NT U ERSTANDS AND W1LL COMPLY WI ALL I�ON-POINT Issued by Date v I � SOUR R G L TTONS. �� � I �� Re-roofs Sign of pplicanUConuxtor �a� T e of Roof HAZARDOUS MATERIALS DISCLOSURE yp Wilt the applicant or fucurc building accupantstorc or handlc ha•rardous matcrial iefincd by thc Cupenino Municipal Codc. Chaptcr 9.12, and Urc Hcal�h and SaCcty ,.xk. Scction 25532(a)? All roofs �hall be inspected prior to any roofing material being installed. ❑ Ycs ❑ No �11 the applicant or fuwrc building occupant use eyuipment or derices which If a roof i� installed without first obtaining an inspection, I agree to remove - cmi� harardous air contaminan�s az dcfincd by thc Bay Area Air Qualiry Managcmcm all new m aterials for inspecrion. District? ❑ Ycs ❑ Nu 1 havc rcaJ �he ha�arCcws materials requircmcn�s undcr Chap�er6.95 af thc Califor- nia Hcal�h & Safcty Codc, Sections 25505, 25533 and 25534.1 undcrstand Ihaz iC Ihc huilding Jocs nat rten�ly a tcnan4 �at it is my responsibility W notify �he occupant of Ihc rcyuirc n h' ust be met prior w issuance af a C 'fica�c of ���r. Signature of Applieant Date "'"� oa � . All roof coverings to be Class "B" or better wnc a nzc a�cn�