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040802550 Z z� CITY OF CUPERTINO BUILDING DIVISION PER CONTRACTOR tN�`�•)R11���Ny BUILDING ADDRESS: SOUTH BAY CONSTRUCTION CO "T "%4080255 OWNER'S NAME: PERMIT ISSUE DATE HUNTER PROPERTIES 511 DIVISION PHONE: SANITARY NO. CONTROL NO. (408)379-0400 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is imfull deffeet. ON-SITE DEVELOPMENT PACKAGE �eClassLic. N License Class Date Contractor ARCHITECTS DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason. (Section 703 1.5, 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 Contractor's Liccnsc Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $1500000 that he is exempt therefrom and the basis for the alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, , Required Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law docs 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 improvement 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.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law docs not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contraclor(s) licensed purs nt to the Contractors License Law. ❑ I am exempt declarations: ❑ 1 have and will maintain a Certificate of Consent to self -insure for Workers Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this psrmit is issued, 1 shall not employ any person Exemption, you should become subject to the Worker's Compensation p4ovisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed 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.) Lender's Name Lender's Address i 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 and state laws relating to building construction. and hereby authorize 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 I liabilitics,judgmenis, costs and expenses which may in any way accrue against said City ' in consequence' of thq,granting of This permit. APPLICAN-I' UNDtRSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date f - Re -roofs Si rfaturc of Applicant/Cdntraclor - ( Datc/ HAZARDOVS`MATERIALS DISCLOSURE 7 Type of Roof 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 25532(a)? Code ,S-1Yes All roofs shall be inspected to any roofing material being installed. ❑ Yes r-1 No prior If a roof is installed without first obtaining an inspection, I agree to remove 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 all new materials for inspection. District? ❑ Yes ❑ No 1 have mad the haz2rdous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505.25533 and 25534. I understand that if the building docs not Certificate of Occupancy. ,�' � �-- .. / Signature of Applicant Date All roof coverings to be Class "B" or better Own r at authorized agent Date