07100130 CITX OF CUPERTINO = `
BU►LDING DIVISION PERIVIIT �C�.3�'�'R���CC'l�.I��R��T�4�N :'
BUIL n1r��qD�es� PORTAL AVE RUNNINC ELECTRIC 07100130 .
-R'S NAME: PERMIT ISSUE DATE
,3ECKER ROBERT A AND LINDA L 935 HILLCREST DR � 10/17/2007
PHONE: SANiTARY NO. CONTROL NO.
(831) 335-9024
ARCHITECT/ENGiNEER: BUILDING PERMTCINFO
BLDG EI.ECT Pl.UM6 MECH
� � 0 0
i p � LICENSED CONTRACTOR'S DECLARA7'ION JOIJ DeSCflp$OTl
%� C I hcrcby �rm that I am IiccnsM undcr provisions oC Chapicr 9(commencing
•. z Z � wi�h Scction 7000) of Division 3 of thc Busincss and Profcssiuns Codc and my Iiccnsc is K I T L I C HT I NG S& REC E PTAC L E S
�� y �n r�u ro�ce ana �rr«� /� gq�,�
� v� Z Licensc Class Lic. �Y
+ F � Datc / a—/ Conuoctor �; f `-�'
� • ARCHITECI'S DECLARATION
7 o�e a I undcrstand my plans shall 6c used as public records
)yU
' u. y Liccnsed Profcssiona�
� y � OWNER-BUILDER DECLARATION
� a� 1 hcrcby alTirm tha� 1 am cxcmpt Gom ihc Contractors Liccnsc Law for thc
y p O following rcason. (Scction 7(13I.5, Business and Profcssions Catc: Any city or caunty
�,°, � which requires a permit to conswct, altcr, improvc, dcmolish, or repair any swcmrc
° Z } prior w i�s issuancc, also rcquires �hc applicant for such permit ta filc a signed sutcmcnt
< that hc is IiccnscJ pursuant to �hc pmvisions ot thc ConuacWr's Liccnsc Law (Chaptcr 9 Sq. Ft. Floor Area � Valuation
>= 4792
u F$ (commencing wi�h Scction 7000) o( Division 3 of ihc Busincss and Profcssions Codc) ur
y �.. �hat he is exempt theic(rom and the basis for the alleged exemption. Any violauon af
Section 7031.5 by arry applicant for a peimit subjecu the applicant to a civi] penalty of 316 3 0 0 3 0�� Number Occupaney Type
not more ihan fivc hundrcd dollars (5500�
❑ I, as owncr o( ttie property, ar my cmploycm with wages as their solc campensation.
wili do thc wark, and �he suuawe u not intendcd or affered for salc (Sec. 7044, Business Re v ired Ins CCt10I1S
and ProCessions Code: The Conuactors License Law does not apply w an owner of 9 P
propeny who builds or improves �hereon, and wha does such wort himsel[or thcough his
own employces, providcd that such improvements are noe intended or allered Cor sala If.
however, the building or improvement is sold within ane year of completion, tl�e ownerv
buildec will have the burden o[ proving Wat he did mi build or improvc for pmpose of
salc.).
❑ I, as owner of the propcny, am exclusively conlracting wi�h licensed rnnvactors a
construct the pcojett (Sec. 7044. Business and ProCessions Code:) The Contractors Li-
cenu Law docs not apply w an owncr of propeny who builds ar improves Ihemon, and .
who con�racu for such pmjects with a conuactor(s) licensed pursuan[ w the Conuutor's
License Law.
❑ 1 am ezempt under Sec . B 8c P C fw Ihis rcason -
er Dale _.. _
WORKER'S COMPENSA'I70N DECLARATION
1 dereby affim� under penalty o[ perjury one of �he (ollowing declarations:
❑ I hsve and will maintein a Cenificam of Consent lo self-insurc for Workers Compcn-
sation, as provided for by Section 3700 ot elu [.abor Code, far the performance af �he
woric for whicd Ihis pertnit is issucd.
❑ I luvc and will maintain Workcr's Compcnsation Insurance, u �cquired by Scction
3700 of the Labor Code, Co� the performance of �he work for which this pertnit is issued.
My Worke�s Compensauon Insurance cartier and Policy number are:
Cartier. Policy No.:
CERI7FlCATE OP EXEMPI'[ON FROM WORKERS'
COMPENSATION INSURANCE
(ihis scction necd no� bc completcd if the permit is for onc hundrcA daUaca (SlUO)
or Icss) '
1 ceni[y th�t in thc performancc of Wc work for which ihis permit is issued.l shall not
employ any persan in any manner so as w become mbject lo the Worlcers' Compensation -
Laws of Califomia. Datc
Applicant
N017CE TO APPLICAM: If, aftcr making this CcrtiCicatc of EzcmpGon, you shoulJ
become subjcct a thc Warker's CompcntAtion provisions of the Labor Codc, you must
� O forthwith comply with such provisians or this permi� shall bc dccmcd 2wokcd.
z ""' CONSTRUCCION LENDING AGENCY
F + ►�—� 1 hcre6y �rm that thcm is a consuuctian Icnding agcncy Cor thc performance uf
p�., � thc work Cur which �his permit is issucd (Sec:. 3097, Civ. C.)
W� Q Lendcr's Namc '
� z Lcnder's Address
J � 1 certify ihal 1 havc rcad Ihis application and sialc that �hc abovc infortnauun is
w�" cortect. 1 agrce �o comply with all city and county arelinances and sea�e laws relating to
O U building conswetion, and heroby authori�e repreunutives of Uiis city to en�cr u�n thc
� W above-menUOned property for inspecuon purposes.
a (We) agree �o save, indcmni(y and kecp harmless ihe Ci�y o[ Cupcnino against
�,F"„� � liabilitiu, judgmcnts, costs and expcnscs which may in any way acccuc agains� said City
V z in contequencc o[ U�c granung of Ihis permit. Date
►'" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
�D� � 7 Re-roofs
s�� oc�u�uco�u.� �
HAZARDOUS MATERIALS DISCLOSURE Type of F.00f
wll the applicant or futurc building accupantstorc or har�dle harardous mucrial
u defincd by thc Cupenino Municipal Codc. Chap�cr 9.12. and the Heal�h and Safcty
�, s�o� us3zca�� All roofs shall be inspected prior to any roofing material being installed.
❑ Ycs � No
wll thc applicant or (uture building occupant usc cyuipmcnt or dcvices which If a roof i s installed without first obtaining an inspection, I agree to remove -
cmii haiardous air con�aminan�s as dcfincd by the Bay A�ca Air Quality Managcmcn� all new n.aterials for inspection.
o�s����
❑Yu QNu
I havc rcad the ha�ardous mauerials requircmcn�s undcr Chaptcr6.95 of ihe Cali(or-
nia Flcal�h & Safc�y Codc. Scctioas 25505, 25533 and 25534. I undcrs�ind ihat iC�hc building
docs not curt'cntly have a tcnant, Ihat it is my responsiAiliry w notify thc occupant nf ihc
ccyuiremcn�s which must bc met prior tu �ssuancc o�a CcniGca�c o�Occupancy. S1gI11tll?e Of APPIlCaI][ Date
Ownerorauthori�cdagcm p,� � All roof coverings to be Class ��8�� or better