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CITY OF CUPERTINO
BUILDING DIVISION PF+ RNII"
1'bM T MYON VISTA DR
(
PHONE:
ARCHITEC (ENGINEER:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business fessions ode, d y license
is in full force an ec
License lass Lic. #
"Date Contractor
ARCHITECT'S DECLAR TO
I un erstand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's 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 pursuCn( tci the provisions of the Contractors License Law (Chapter 9
(commencing s ith Section 7000),of Division 3 of the Business and Professions Code)
or that he is exempt therefrom and the basis for the alleged exemptibo. 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 ($500).
❑ 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.).
❑ 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
License Law does not apply to an owner of property who builds or improves thereon,
and who contracts for such pmject& with a contractor(s) licensed pursuant to the
Contractor's License Law.
❑ f am exempt under Sec. , B & P C for this reason
Owner
Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of,the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, 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 Workers a sation Insurance carrier and Policy number are:
6 Carver. ' y No.:
,
the permit is for one hundred dollars
($100) or less.)
I'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 to become subject to the Workers
Compensation Laws of California. Date
Applicant
NOTICE TO APPLICANT: if, after making this Certificate of Exemption, you should 1
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 for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Naive - - -
Lender's Address
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 cons"ction; 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 Cuperiino against
liabilities, judgments, costs and expenses which may in any way accrue against said
City in consequence of the granting of this permit:
APPLICA.\-I' UI;DERSTANDS AND WILL COMPLY WITH ALL NON-POLNT
SO
HAZARDOUS MATERIALS DISCLOSURE
Wdl 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 'Q No
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
California Health & Safety Code, Sections 25505.25533 and 25534. 1 understand that
ifthe building does not currently have a tenant, that it is my responsibility to notify the
occupant of the requirements which must be met prior to issuance of a Certificate of
or authorized agent
CONTRACTOR INFORMAT' 'N:
MAGGI CONSTRUCTION
1457 DONOHUE DR.
(408)251-3078
.RMIT60 9 015 0
PPLICATiQN�Eb) fE, 002 02
\MTARY NO, lJJ �� GG CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I- I F__I L__J L__J
BATHRM & KITCHEN°ham NY9(n &
ADD CAN LIGHTS
OFFICE
..._$100000
Sq. Ft.._Floot Area • ..:
Valuation
'35628'01-0'.-60"
APN Number
Occupancy Type
101 -
FOUNDATION
Required Inspections
103 -
UFER
104 _
REBAR - -..
105 -
ANCHOR BOLTS
106 -
SEWER & -WATER - -
202 -
UNDERFLOOR PLUMBING
20.3 -
UNDERFLOOR MECHANICAL
204 -
UNDERFLOOR FRAM -F,
205 -
UNDERFLOOR INSULATION
301 -
ROUGH PLUMBING
302 -
TUB & OR SHOWER
303 -
ROUGH MECHANICAL
304 -
ROUGH ELECTRICAL
305 -
FRAME
306 -
HOLDOWNS
_307 .-
-INSULATION --- :...:........_
3,09, -:
,SHEE`TROCK
_3.0 -9.
EXTERI OR_._LATH_ _.. _..
310'-
INTERIOR LATH
311 -
SCRATCH.. COAT. . .
313 -
ROOF NAIL . • � - '.
501 -
FINAL ELECTRICAL ENERGY
502 -
FINAL PLUMBING ENERGY
503 -
FINAL MECHANICAL ENERPY
504 -
FINAL BUILDING ENERGY-
505 -
FINAL ELECTRICAL
506 -
GAS TEST - -
507 -
FINAL PLUMBING
50 -
INA1 MECHANICAL
5 9 -
INAL G E
5 1-
INAL ANN
514 -
RKS
Issued by
Date
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. Applicant understands_ and will comply with
all non -point source regulations.
Signature of Applicant Date
All roof coverings to be Class `B" or better
OFFICE