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02090102CITY OF CUPERTINO BUILDING DIVISION PERMIthe CONTRACTOR INFORMAT10414 Required Inspections 104 - REBAR BUILDING ADDRESS: SILVERCREEK DEVELOPMENT CO PERMITNO. 10440 SERRA STREET PLUMBING 02090102 8 3 1 3 3 8- 4 3 3 7 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: 510 BUILDING PERMIT INFO PLANNING 511 BLDG ELECT PLUMB MECH OZ Z LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busin sq s Zd Profcssions Code, and my license is n full force of ect. !� License Class Lic. M DateContractor RCHITECT'S D 1 undcrstand my plans shall be used as .blit mco d. GC Licensed Professional OWNER -BUILDER DECLARATION I hcrchy affirm that I am exempt from the Contractor's License Law for the rollowing reason. (Section 7031.5, Busincss and Profcssions Codc: 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 Codc) or that he is exempt therefrom 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 (SSW). ❑ 1, 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 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.). ❑ 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 does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sec. , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, 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 Worker's Compensation Insurance, as required by Section W of the Labor Code, for the performance of the work for which this permit is issued. My z_ CERTIFICATE OF EXEM OM WORKERS' UR COMPENSATION SANCE (Chis section need not he completed if the permit is for one hundred dollars ($100) or less.) 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as uo become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should 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 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.) Lender's Name Lender's Address 1 certify that 1 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 liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT E STV4 ND WILL COMP Y NON -POINT Signature ol'Applicart ontractor Dale HAZARDOUS MAT I S DISCLOSURE Will the applicant or future buildin upant 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 XNo 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 Dislricl? ❑Yes ANo I have read the hazardous materials requirements under Chapter 6.95 of the Califon nia Health&S ode, Sectio s 25505, 25533 and 25534. understand thatif the building docs not cu ntl a a at it is my responsibi ' to notify the occupant of the rcqui , ficate'0[Ocy6aancy. 1�6wner or authorized gen D Job Description SWIMMING POOL/GARAGE BEAM (#02090101 FOR PLAN CHK --IN HOUSE USE ONLY) Sq. Ft. Floor Area $95000 APN Number 34259014.00 103 - UFER Required Inspections 104 - REBAR 107 - POOL/BONDING 301 - ROUGH PLUMBING 304 - ROUGH ELECTRICAL 502 - FINAL PLUMBING ENERGY 503 - FINAL MECHANICAL ENERGY 506 - GAS TEST 510 - FINAL PLANNING 511 - FINAL POOL 516 - FINAL BUILDING I I �-- . Re -roofs Type of Roof 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 "B" or better CITY OF CUPERTINO BUILDING DIVISION PERMIT �Cll�i'FRA�TOR INFOR. UTIQN BUILDING ADDRESS: PERMIT N0. 10440 29RRA STREET 03070183 OWNER'S NAME: PERMIT ISSUE DATE PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH L -i o 0 0 LICENSED CONTRACTOR'S DECLARATION 1 harsh 1 licensed Chapter 9 Job Description affirm that am under provisions of (commencing ' with Sec n )) of Division 3 of the Business Professions Code, and my license is in full ford cffe xx Lie.« 'y p REVISION (STEPS/WALLS) D=nsc c"olioCLOT ORIGINAL PERMIT 02090102 RCHITECT'S DEA N 1 understand my plans shalt he used as public records IN HOUSE ONLY Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the following reason. (Section 703 L5, 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 rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chap(er 9 Sq, Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom 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 APN Number Occupancy Type P not more than five hundred dollars ($500). Y YP ❑ 1, as owner of the property, or my employees with wages as their sole compensation, 34259014.00 will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business Required Inspections 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, 103 — UFER 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 104 - REBAR sale.). 107 - POOL/BONDING ❑ I, 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- 301 — ROUGH PLUMBING cense Law does net apply to an owner of property who builds or improves thereon, and 3 0 4 - ROUGH ELECTRICAL who contracts for such projects with a conuaclor(s) licensed pursuant to the Contractor's License Law. 5 02 - FINAL PLUMBING ENERGY ❑ 1 am exempt under Sec. , B & P C for this reason 503 - FINAL MECHANICAL ENERGY Owner Date WORKER'S COMPENSATION DECLARATION 506 - GAS TEST 1 hereby affirm under penalty of perjury one of the following declarations: 510 — F I NAL PLANNING ❑ Ihave and will maintain aCertificate ofConsenitoself-insure for Worker'sCompcn- 511 — FINAL POOL sation, as provided for by Section 3700 of the Labor Cnde, for the performance of the 516 - FINAL BUILDING work for which this permit is issued. ❑ I have and will maintain Worker's Com nsation Insurance, as required by Section 3700 of the Labor Code, for the performance f the work for which this permit is issued. My CERTIFICATE OFEXEMPTI FROMWORKERS' COMPENSATION -INSURANCE (This section need not be completed if the permit is for one hundred dollars(Sloo) or less.) 1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manners" as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Lahnr 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 1'nr the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lenders Address I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and slate laws relating to building construction, and hereby authorize representatives of this city to enter upon the ahove-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 in any way accrue against said City Q in consequence of the granting of this permit. -1/ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date ate HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupantstorc or handle hazardous material as defined by the Cupertino Muni a Code. Chapter 9.12, and the Health and Safety Code, Se 25532(a)? All roofs shall be inspected prior to any roofing material being installed. )i s ❑ Ycs No If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or lure building occupant usC 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 hazardrma5leri5als requirements under Chapter 6.95 of the Califor- nia Health &Safety Code, Sec, 25533 and 25534.1 understand that if the building s no I have a tenant that it is responsibility to notify the occupant of the ".,cn Signature of Applicant Date All roof coverings to be Class "B" or better Owner or prizedt Date