08040203CITY OF CUPERTINO
BUILDING DIVISION PERNIIT
BUILDING ADDRESS:
PERMIT NO.
7400 TIPTOE LN
WOODCRAFT GENERAL
08040203
OWNER'S NAME:
PER?= ISSUE DATE
SAKKAS KOSTA G AND ALYSA R
07/09/2008
PHONE:
SANITARY NO. CONTROL NO.
(408) 379-1-494
ARCHITECT/ENGINEER
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRAC TOWS DECLARATION
9
Job Description
I hereby affirm that I am licensed under provisions of Chapter (commencing
with Section 7000) of Divialon 3 of the Business and Profession Cade. and my license is
REMODEL FIRE PLACE.
in full force and effect
License Class Lie. N
Date Contractor
ARCHITECTS DECLARATION
I understand my plan 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 7031.5. Business and Professions Cade: 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 Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 700M of Division 3 of the Business and Profession Cade) or
$1 0 0 0 0
m that he is exempt therefroand the basis for the alleged exemption. Any violation of
3 593 2061.)W Number
Occupancy
P Y Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (SSM
❑ L u owner of the property, or my employees with wages as their sale compensation,
Required Inspections
will do the work, and the structure is not intended or aflered for sale (Sec. 7044. BuaM..
an owner or
and Professions Cade: The Contractors License Law does not apply in in
ns
Q p
property who builds or improves thereon, and who does such wort himself or through his
row employees, provided that such improvements are not intended or offered far sale. If.
however. the building or improvement is sold within one year of completion, die owner -
builder will bare the burden or proving that he did not build or improve for purpose of
sale.).
asowner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec 7044, Business and Profession Cods) Mw Coniraetoes Li-
cense LJw does not apply to an owner of property who builds or improves thereon, and.
who contracts for such project/ with a cone actar(s) licensed pursuant to the Contractor's
License Lev
❑ 1 ionexemptt under Sec B Ile P C for this mason
Owner tj�� Date 7
COMPENSATION DECLARATION
1 hemby affirm under penalty of perjury one or the following declarations
❑ I have and will maintain a Certificate of Consent to self-kaurc for Workers Compen-
scion, as provided for by Section 3700 of the Iabor Code, for the performance of the
wart for which this permit is issued
'
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Cade, for the performance of the wart for which this permit is issued.
'
My Warker's Compensation htsurance carrier and Policy number are:
Cartier. Policy No.:
CEAnFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Olds section need not be completed if the permit is for arse hundred dollars (S 1011)
or less)
I certify that in the performance or the work for which this permit is iwucd. I shall not
employ any person in any manner stereo subject to the Wor(arY Compensation
Laws or Califon' o
Applicant
NOTICE NT. f, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provision of the Labor Code, you must
forthwith comply with such provision or this poanil 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
Lenders Address
1 certify that 1 have read this application and sate that the above information is
correct. 1 agree to comply with all city and county ordinances and state laws totaling to
building construction, and hereby authorize representatives or this city to enter upon tie
above -mentioned property for inspection purposes.
(We) agree io save, indemnify and keep harmless the City or Cupertino against
1017
liabilities, judgments, casts and expenses which may in any way accrue against said City
in consequence Of the RSTAgranting S the percent
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
.Z=12
Re- /Contract
Type of Roof
r Date
AZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant sore or handle hawdous material
as defined by the Cupertino Municipal Code. Chapter 9.17. and the Health and Safety
Code, Section 25532(a)?
All roofs shall be inspected to any roofing material being installed.
❑ Yes 34co—
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will We 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
I have read the hazardous materials requirements under Chapicrii.95 of the Califor-
nia Health Ile Safety Code, Soctian 25%5.25533 and 255M. I understand matif the building
dams not currently hove a tenant. that it is my responsibility to notify the occupant of the
requimmcna which must lic in , to issuance of a Certificate of
Signature
Sf i `C ` c f / " `�
All rnnF rnvorincc to No rl.ce vin" n,- 1—..—