07100156 CIT�' OF CUPER'�INO ' `
BUILDING DIVISIOt� PERMIT C��RR�►�C?K I�����If�N: ;:
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.; ., :.
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�