07090192Ern
U .7a.
CY OF CUPERTINO
BUILDING DIVISION PERMIT
nut a Fka(MIrno
AN FERNANDO CT TBD - TO BE DETERMINED 01090192
SANITARY NO. CONTROL NO.
ARCHITECUENGiNEFR: I I BUILDING PERMIT INFO
1 hereby afrum that I am liwused under provisions of Chapter 9 (commencing
with Section 7000) of DivWon 3 of the Busines and Profcasions Codo. and my license is
in full force and effect.
License Class Lic. t
Date Contractor
ARCHrrTCfS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's Liccme Law for the
following reason. (Section 7031.3, Business and Professions Code: Any city or county
which requires a permit to construct. alter, improve, elmnoltsh, or repair any structure
prior to its issuance, also requires the applicant for such permit to fik a signed statement
that he is licensed pursuant to the provisions of the Contractor's license Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that be is exempt therefrom and the bads for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
out mors than five hundred dollars WOO).
❑ L as owner of the property. or my employees with wages a their sole cmapenagdon,
will do the wort. and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code The Contractors License Law does not apply to an owner of
property who builds or improves thmoon, and who does such work himself or thromgb his
owm employees, provided that such Improvements ere not intended or offered for ale. lf.
however, the building or improverima is sold within one year of completion. the owaer-
bullder wM have the bmdes of proving that be did not build or improve for purpose of
ale.).
apr'. or of the property, w exclusively eonM.W.S with ficen. contractors to
zonstracttthe project (Sec. 7044. Business and Professions Coda) The Contractors Li-
cense Law does not apply to an owner of property who builds or improver thereon, and
who contracts for rich projects with a contractor(s) licensed ptumamt to the Contractors
Lit=- Law.
❑ 1
one of the following declarations
❑ 1 haft and will maintain a cartificato of Consent to self-lssum for Workers Compen-
sadon, 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 Im w&=, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is iamcd
My Workers Compensation Insurance carrier and Policy number am:
Cornier: Polley No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cntu section need not be completed 1f the permit is far arc hundred dollars ($100)
or leis.)
1 certify that in the performance of the work for which this permit is issued l dull nes
employ any person In any masncrso as to become subject to the Workers' Compensation
Laws of California
AppllatI a 4 2f�
NOTICE TO APP CANT. IL alter making this Certificate of Exemption, you should
become abject to the Workers Compensation provisions of the Labor Code. you mug
forthwith comply with such provisions or this permit shall be deemed mvokcd.
CONSTRUCTION LENDING AGENCY
1 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 Nuns
Lmiders Address
I certify that I have read this application and state that the above Information is
correct 1 agree to comply with all city and county ordinances and sate laws rutting to
building conansction. and hereby authorize representatives of this city to enter upon the
above-mentioned property for Inspection purposes.
(We) agree to ave, indemnify and kap harmless the City of Cupestirw apisat
Oablildes, judgments, cow and expert which may In any way accrue against said Qty
in consequence of the granting of this permiL
Dato// Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant gore or handle haardom material
as defined by the Cupertino Municipal Code, Chaptor 9.12, and the Health and Safety
Code, Section 23332(x)7
❑ Yes Pit
Will the applicant or future building occupant use equipment or devices which
emit harsrdons air contaminants as defined by the Bay Area Air Quality Management
DWrict7
❑ m 8<0
I ham mad the harardous materials requimnrms under. Claptc6.95 of the Califor-
nia Hcalthh SafelyCodc, Sectfan 25505, 23533 and 23334.1 understand that If do buiku g
does
Date
Job Description
SFDWL-2 STORY 3,717' GARAGE 4101,DECK/PATIO 1000'
Sq. Ft. Floor Area Valuation
$1200000
3 5 712 011.``f Number
Required Inspections
Issued by:
Re -roofs
Type of Roof
Type
Date �" l & - & -
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'%¢'' or better
Building Permit Cancellation Request
September 22, 2010
Susan Winslow
City of Cupertino Building Department
RE: 22080 San Fernando Ct., Cupertino, CA 95014
Dear Ms. Winslow:
SEPI
3y
We would like to request cancelling our building permit #08010149 and get appropriate
refund. Thank you very much for all your help.
Sincerely,
Alexander Anonuevo & Lily ong`�-
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