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B-2016-3176 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3176 18831 ARATA WAY CUPERTINO,CA 95014-3670(375 12 032) APEX DEVELOPMENT GROUP LLC SAN JOSE,CA 95124 OWNER'S NAME: DMJ HOME SOLUTIONS LLC DATE ISSUED:03/17/2017 OWNER'S PHONE: PRONE NO:( LICENSED CONTRACTOR'SDECLARATION BUILDING PERMIT INFO: License Class B Lie.#01 33748 Contractor APEX DEVELOPMENT GROUP LLC Data 12/3V2019 X BLDG ELECT_PLUMB I hereby affirm that I am licensed under the provisions of Chn ter 9(cnnrmencMECH X RESIDENTIAL COMMERCIAL inb with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: CONSTRUCT NEW 2 STORY HOME WITH BASEMENT(1947 S.F.); I hereby affirm under penalty of perjury one of the following five declarations: ATTACHED GARAGE(413 S.F.);PORCH(21 S.R);PATIO(166 S.F.) t. I have and will maintain a certificate of consent to self-insure for Worker's 07-11-2017-DEFERRED 41 FLOOR AND ROOF TRUSS-ISSUED Q�Compensation,as provide]for by Section 3700 of the Labor Code,for the 7/1 g/2017 (4� performance ofthe work 1'or which this permit is issued. REV#I LANDSCAPE PLAN-ADD IRRIGATION PLAN-05/17/2018 2. 1 have will will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Flmu Area:2360 Valenti an:$600000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information Is correct.I agree to comply with all city and county ordinances APN Namher: Oceupancy Type: and stale laws relating to building construction,and hereby authorize 375 12 032 R-3(Custom),R-3(Cuslnin),U(Private Gar/Ag Bldg),U representatives of this city to enter upon the above mentioned property for (Private Ger/Ag Bldg) inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. PERMIT EXPIRES IF WORK IS NOT STARTED Additionally,the applicant understands and will comply with all non-point WITHIN 1$0 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code,Section 9.18. } Issued by:AbbyAAyende OWNER-BUILDER DECLARATION Date:03/17/2017 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE-ROOFS: c. 1,as owner of the property,c r my employees with wages as choir sole All roofs shall be inspected prior to any roofing material being installed.If a roof is ompensation,will de the work,and the structure is not intended or offered for installed without first obtaining air inspection,1 agree to remove all new materials for sole(Sac.7044,Business&Professions Code) inspection. 2. 1,as owner of the property,am"elusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). Signature of Applicmd: Daze:05/17/2018 1 hereby affirm under penalty of perjury one of the following three declarations: r. 1 have and will maintain a Certificate of Consent to self-insure For Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Compensation,as provided for by Section 3700 of the Labor Code,for the perfmnancc of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance,as provided for by HAZARDOUS MATERIALS DISCLOSURE Section 3700 of the Labor Code,for the performance of the work for which this 1 have rend the hazardous materials requirements under Chapter 6.95 of tire permit is issued. California Health&Safety Code,Sections 25505,25533,anti 25534.I will s. I certify that in the performance of the work for which this permit is issued,1 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the shall not employ any person in any manner so as to become subject to the Health&Safety Code,Section 25532(x)should I store or handle hazardous mitern.Additionally,should 1 ase equipment or devices which emit haz:wdous Worker's Compensation laws of California.If,after looking this certificate ofonu nninents as defined by the Bay Area Ali-Qunllty Management District I exemption,I become subject to the Worker's Compemsetion to of the willmaintaincompliance with(he Cupertino Municipal Code,Chapter 9.12 and Labor Code,l must forthwith comply with such provisions or this permit shall the Health&Safety Code,S •tions 25505,25533,and 25534• be deemed revoked. APPLICANT CERTI PICATION Owner or authorized agent: I certify that I have read this application and state that the above information Is Date:05/17/2018 correct.I agree to comply with all city and county ordinances and state laws CONSTRUCTION LENDING AGENCY relating to building construction,and hereby authorize representatives of this city I hereby affirm that there Is a construction lending agency for the performance to enter upon the above mentioned property for inspection purposes. (We)agree of work's for which this permit is issued(Sec.3097,Civ C.) to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands Lender's Address and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date 05/17/2018 Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3176 18831 ARATA WAY CUPERTINO,CA 95014-3670(375 12 032) APEX DEVELOPMENT GROUP LLC 2059 Camden Ave SAN JOSE,CA 95124 OWNER'S NAME: DMJ HOME SOLUTIONS LLC DATE ISSUED:03/17/2017 OWNER'S PHONE: PHONE NO:( LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic.#1033746 Contractor APEX DEVELOPMENT GROUP LLC Date 12/31/2019 X BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: CONSTRUCT NEW 2 STORY HOME WITH BASEMENT(1947 S.F.); I hereby affirm under penalty of perjury one of the following two declarations: ATTACHED GARAGE(413 S.F.);PORCH(21 S.F.);PATIO(166 S.F.) m. I have and will maintain a certificate of consent to self-insure for Worker's REV#2 REVISED BASEMENT LAYOUT TO INCLUDE LOUNGE- Compensation,as provided for by Section 3700 of the Labor Code,for the ISSUED 9/13/18 performance of the work for which this permit is issued. 07-11-2017-DEFERRED#1 FLOOR AND ROOF TRUSS-ISSUED 2. I have and will maintain Worker's Compensation Insurance,as provided for by 7/18/2017 Section 3700 of the Labor Code,for the performance of the work for which this REV#1 LANDSCAPE PLAN-ADD IRRIGATION PLAN-05/17/2018 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above Sq.Ft Floor Area:2360 Valuation:$600000.00 information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for APN Number: Occupancy Type: inspection purposes. (We)agree to save indemnify and keep harmless the 375 12 032 R-3(Custom),R-3(Custom),U(Private Gar/Ag Bldg),U City of Cupertino against liabilities,judgments,costs,and expenses which (Private Gar/Ag Bldg) may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR Date 09/13/18 180 DAYS FROM LAST CALLED INSPECTION. OWNER-BUILDER DECLARATION Issued by:Abby A,ej nde I hereby affirm that I am exempt from the Contractor's License Law for one of the Date:03/17/2017 following two reasons: m. 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 RE-ROOFS: sale(Sec.7044,Business&Professions Code) All roofs shall be inspected prior to any roofing material being installed.If a roof is 2. I,as owner of the property,am exclusively contracting with licensed installed without first obtaining an inspection,I agree to remove all new materials for contractors to construct the project(Sec.7044,Business&Professions Code). inspection. I hereby affirm under penalty of perjury one of the following three declarations: Signature of Applicant: m. I have and will maintain a Certificate of Consent to self-insure for Worker's Date:09/13/18 Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 2. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 3. I certify that in the performance of the work for which this permit is issued,I I have read the hazardous materials requirements under Chapter 6.95 of the shall not employ any person in any manner so as to become subject to the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Worker's Compensation laws of California. If,after making this certificate of Health&Safety Code,Section 25532(a)should I store or handle hazardous exemption,I become subject to the Worker's Compensation provisions of the material. Additionally,should I use equipment or devices which emit hazardous Labor Code,I must forthwith comply with such provisions or this permit shall air contaminants as defined by the Bay Area Air Quality Management District I be deemed revoked. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and APPLICANT CERTIFICATION the Health&Safety Code,Sections 25505,25533,and 25534. 1 certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws Owner or authorized agent: relating to building construction,and hereby authorize representatives of this city Date:09/13/18 to enter upon the above mentioned property for inspection purposes. (We)agree CONSTRUCTION LENDING AGENCY to save indemnify and keep harmless the City of Cupertino against liabilities, I hereby affirm that there is a construction lending agency for the performance judgments,costs,and expenses which may accrue against said City in of work's for which this permit is issued(Sec.3097,Civ C.) consequence of the granting of this permit. Additionally,the applicant understands Lender's Name and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Lender's Address ARCHITECT'S DECLARATION Signature Date 09/13/18 1 understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR. PERMIT NO:B-2016-3176 18831 ARATA WAY CUPERTINO,CA 95014-3670(375 12 032) APEX DEVELOPMENT GROUP LLC SAN JOSE,CA 95124 OWNER'S NAME: DMJ HOME SOLUTIONS LLC DATE ISSUED:03/17/2017 OWNER'S PHONE: PHONE NO:( LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO* License Class B Lic.#1033746 Contractor APEX DEVELOPMENT GROUP LLC Date 12/31/2019 X BLDG _ELECT _PLUMB MECH X RESIDENTIAL_COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9(commencing — with Section 7000)'of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION CONSTRUCT NEW 2 STORY HOME WITH BASEMENT(1947 S.F); I hereby affirm under penalty of perjury one of the following two declarations: ATTACHED GARAGE(413 S.F);PORCH(21 S.F);PATIO(166 S.F) 1. I have and will maintain a certificate of consent to self-insure for Worker's 07-11-2017-DEFERRED#1 FLOOR AND ROOF TRUSS-ISSUED CCompensation,as provided for by Section 3700 of the Labor Code,for the 7/18/2017 performance of the work for which this permit is issued. ,2: 'I have and will maintain Worker's Compensation Insurance,as provided for by U Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area:2360 Valuation:$600000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number Type: information is correct.I agree to comply with all city and county ordinances 375 12 um R-3Occupancy (Custom),U(Private Gar/Ag Bldg),U and state laws relating to building construction,and hereby authorize (Custom),R-3ivGarAg Bldg) representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. PERMIT EXPIRES IF WORK IS NOT STARTED Additionally,the applicant understands and will comply with all non-pointT WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code,Section 9.18. /- ( 180 DAYS FROM LAST CALLED INSPECTION /,Signature (.,�� /, Date 12/14/2017 C Issued by Abby Ayende OWNER-BUILDER DECLARATION Date:03/17/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons:werAll roofs shall be inspected prior to any roofmg material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole will do the work,and the structure is not intended or offered for installed without first obtaining an inspection,I agree to remove all new materials for compensation, inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). Signature of Applicant: Date:12/14/2017 I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self-insure for Worker's ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. HAZARDOUS 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the HAhazZARDOUS materials MATERIALSs LDISCLOSURE under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If,after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption,I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and Labor Code,I must forthwith comply with such provisions or this permit shall the Health&Safety Code,Sections 25505,25533,and 25534. be deemed revoked. ;1 / `---- - Owrier or authorized agent: _ . - % ./..-,,_ APPLICANT CERTIFICATION {Date:12/14/2017 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. I understand my plans shall be used as public records. Signature Date 12/14/2017 Licensed Professional e 2v',eK l?yi 7 (' ay76 ' r °� ) U1 y w(70111 1/1( t(€Ma1 eqy /1-ovie Re)1oval 'oyes ( Liee cse �t vela fi �� r � �o L 1 G�n ,� X � � � LG -�,fig20/ 47(--517b inulallaer 10 37 _ Tkari y�� Pef - CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-3176 18831 ARATA WAY CUPERTINO, CA 95014-3670 (375 12 032) BAY HOME RENOVATIONS INC SAN JOSE, CA 95123 OWNER'S NAME: DMJ HOME SOLUTIONS LLC DATE ISSUED: 03/17/2017 OWNER'S PHONE: PHONE NO: ( LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #101M Contractor BAY HOME RENOVATIONS INC Date 07/31/2018 X BLDG —ELECT —PLUMB — MECH X RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — _ with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: CONSTRUCT NEW 2 STORY HOME WITH BASEMENT (1947 S.F.); I hereby affirm under penalty of perjury one of the following two declarations: ATTACHED GARAGE (413 S.F.); PORCH (21 S.F.); PATIO (166 S.F.) 1. I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. C,,2: I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: 2360 Valuation: $600000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 375 12 032 R-3 (Custom),R-3 (Custom),U (Private Gar /Ag Bldg),U representatives of this city to enter upon the above mentioned property for (Private Gar /Ag Bldg) inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. PERMIT EXPIRES IF WORK IS NOT STARTED Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. -signature 3/17/2017 ' Issued by: Abby A, eennde. O R -B TH DER DECLARATION Date: 03/17/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: 1. I, as owner of the property, or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed. If a roof is compensation, will do the work, and the structure is not intended or offered for installed without first obtaining an inspection, I agree to remove all new materials for sale (Sec.7044, Business & Professions Code) inspection. 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). Signature of Applicant: Date: 3/17/2017 1 hereby affirm under penalty of perjury one of the following three declarations: s. I have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by HAZARDOUS MATERIALS DISCLOSURE Section 3700 of the Labor Code, for the performance of the work for which this I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued, I Health &Safety Code, Section should I store or handle hazardous shall not employ any person in any manner so as to become subject to the sment or devices which emit hazardous material. Additionally, should I use e equipment Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety Code, Sections 25505, 25533, and 25534. be deemed revoked. or authorized agen APPLICANT CERTIFICATIONOwner I certify that I have read this application and state that the above information is C Date:13/ 7/2017 correct. I agree to comply with all city and county ordinances and state laws CONSTRUCTION LENDING AGENCY I hereby affirm that there is construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name judgments, costs, and expenses which may accrue against said City in Lender°s Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. I understand my plans shall be used as public records. Signature Date 3/17/2017 Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3176 18831 ARATA WAY CUPERTINO, CA 95014-3670 (375 12 032) BAY HOME RENOVATIONS INC SAN JOSE, CA 95123 OWNER'S NAME: DMJ HOME SOLUTIONS LLC DATE ISSUED: 03/17/2017 OWNER'S PHONE: PHONE NO: ( LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic. #1016029 Contractor BAY HOME RENOVATIONS INC Date 07/31/2018 X BLDG —ELECT —PLUMB MECH X RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: CONSTRUCT NEW 2 STORY HOME WITH BASEMENT (1947 S.F.); I hereby affirm under penalty of perjury one of the following two declarations: ATTACHED GARAGE (413 S.F.); PORCH (21 S.F.); PATIO (166 S.F.) 1. I have and will maintain a certificate of consent to self -insure for Worker's 07-11-2017- DEFERRED #1 FLOOR AND ROOF TRUSS - ISSUED Compensation, as provided for by Section 3700 of the Labor Code, for the 7/18/2017 performance of the work for which this permit is issued. 150/1 I have and will maintain Worker's Compensation Insurance, as provided for by 1 Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: 2360 Valuation: $600000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 375 12 032 R-3 (Custom),R-3 (Custom),U (Private Gar /Ag Bldg),U representatives of this city to enter upon the above mentioned property for (Private Gar /Ag Bldg) inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. PERMIT EXPIRES IF WORK IS NOT STARTED Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signat re _� Date 7/18/2017 ��� Issued by: JASMINE ARCHBOLD OWNER -BUILDER DECLARATION Date: 03/17/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE -ROOFS: t. I, as owner of the property, or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed. If a roof is compensation, will do the work, and the structure is not intended or offered for installed without fust obtaining an inspection, I agree to remove all new materials for sale (Sec.7044, Business & Professions Code) inspection. 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). Signature of Applicant: Date: 7/18/2017 I hereby affirm under penalty of perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by HAZARDOUS MATERIALS DISCLOSURE Section 3700 of the Labor Code, for the performance of the work for which this I have read the hazardous materials requirements under Chapter 6.95 of the permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will 3. I certify that in the performance of the work for which this permit is issued, I maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the shall not employ any person in any manner so as to become subject to the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety Code, Sections 25505, 25533, and 25534. be deemed revoked. APPLICANT CERTIFICATION Owner or authorized ag I certify that I have read this application and state that the above information is Date: 7/18/2017 correct. I agree to comply with all city and county ordinances and state laws CONSTRUCTION LENDING AGENCY relating to building construction, and hereby authorize representatives of this city I hereby affirm that there is a construction lending agency for the performance to enter upon the above mentioned property for inspection purposes. (We) agree of work's for which this permit is issued (Sec. 3097, Civ C.) to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Name judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands Lender's Address and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date 7/18/2017 Licensed Professional