07050072 PermitBUILDING DIVISION PERMIT
BUILDING ADDRESS: PERMIT NO.
10335 WUNDERLICH DR TBD - TO BE DETERMINED 07050072
OWNER'S NAME: PERMIT ISSUE DATE
07/18/2007
PHONE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 70001 of Division 3 of the Business and Professions Code, and my license is
n full force and effect.
,icense Class Lie. N
)ato Contractor
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records
-icensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the
following reason. (Section 7031.5, 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 License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt thetefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (5500).
❑ 1, as owner of the property, or my employers with wages as their sole compensation,
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 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 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.).
ErIloas owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li-
ccase Law dors not apply to an owner of property who builds or improves thereon, and
who contracts for such pmjects with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ 1 am exempt under S , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following 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 tabor Code, for the performance of the
work for which this permit is issued.
❑ 1 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 Workers Compensation Insurance carrier and Policy number arc:
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 las.)
1 cerifv that in the performance of the work for which this permit is issued, I shall not
employ any person in any mannel all
Workcrs' Compensation
Laws of CalifgO
Applieanl
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you s ould
become subject to the Worker's Compensation provisions 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 fur which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lenders Address
1 certify that 1 have mad 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 concoction, and hereby authorizerepresentatives 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,judgmems, costs and expenses which may in anyway steric against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIrS. S
Signature of ApplicanUContraetor 9 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 lex
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 �No
I have read the hazardous materials requirements under Chapter 6.95 of the Cal ifor.
niaHeal th&SafetyCode, Sections 25505.25533 and 25534. 1 understand that ifthe building
doesriot currently have a tenant. that it is my responsibility to notify the occupant of the
requ'rmmenlrs which mu,9 be met prior to issuance of a Certificate of Occupancy.
Job Description
ADDITION 879' -LIVING RM,KITCHEN,DINING,
BEDROOMS,GARAGE 485'-REROOF & REMODEL ENTIRE
HOUSE. SANITARY IS SUNNYVALE'S JURISDICTION.
Sq. Ft. Floor Area
37516023. (� Number
Valuation
$300884
Occupancy Type
Required Inspections
Issued . ���
"
Re -roofs
Type of Roof
Date /�, A��
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.
of Applicant Date
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