07080152CITY OF CUPERTI
BUILDING DIVISION
PERMIT y.
C Z
00
zul
� y
C
too
aV
0
0
N j
cm
C�
m
2a
ti�
�m
0z
Z 0
V' BUIL.DN8B,ESSSCOFIELD DR D & D CONSTRUCTION PERMIT07080152
OWNER's NAME: PERMIT ISSUE DATE
1447 HAMPTON DR 10/17/2007
PHONE: (408)666-5298 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEEW. BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t hereby affirm that I am licensed under provisions of Chapter 9 (commencing
vith Section 7OD0) of Division 3 of the Business and Professions Code, and my license is
n full force and effect QQ
1cense a — Lic. N h 6 7
hem �g� �'7 I , e. Contractor
'ARCHITF=S DECLAR I
1 understand my plans shall be used as public records
-iccnsed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
following mason. (Section 70315, Business and Professions Code: Any city or 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 Conuacmr's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption Any violation of
Section 70315 by any applicant for a permit subjects the applicant to a Civil penalty of
not more than five hundred dollars (S500).
❑ I, 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, Burner
and Professions Code The Contractor's License Law does not apply to an owner of
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 sale If.
however, the building or improverment 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.).
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractors Li -
cc= Law does not apply to an owner of property who builds or improves thereon, and .
who contracts for such projects with a contractors) licensed pursuant to the Contractors
License Law.
❑ 1 am exempt under Sec , B & P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations
❑ I have and will maintain a Certificate of Consent to self -insure for Workds 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 Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers Compensation Insurance a Policy
m
.��
WORKERS'
COMPENSATION INSURANCE
(This section need not he completed if the permit is for one hundred dollars ($100)
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be dccrmd 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.)
Lenders Name
Lender's Address
I certify that 1 have read this application and state that the above information is
correct 1 agree to comply with all City and county ordinances and state laws relating to
building construction. and hereby authorize represenuatives of this city to enter upon the
about-mcntioncd property 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
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS.
Signature of ApplicamfContracmr — Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Yes ❑ No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
❑Yes ❑Nu
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 the building
does not currently have a tenant, that it is my responsibility to notify the occupant of the
requiremcnu which muss a Cartificate of Occupancy.
�0% ,
Job Description
SFDWL-2 STORY 3445' GARAGE 508'
q. Ft. Floor Area $ 7 6 714 5 Valuation
35909009t
Required Inspections
Issued by:
Re -roofs
Type of Roof
Date
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant
Date
All roof coverings to be Class "B" or better