03070204f/
CITY OF CUPERTINO
BUILDING DIVISION PERMA
BUILDING ADDRESS:
R I FINCH AV
SHADE STRUCTURES INC
PERMIT No03070204
OWNER'S NAME:
350 KALMUS
DR
PERMIT ISSUE DATE
BETHEL LUTHERAN
PHONE:
(714)427-6981
SANITARY NO. CONTROL NO.
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 myllicense is
in full force and effect.
SHADE-,
License Class Lie. N
'
Date Contractor
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 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 repairanystructure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuanLlo the provisions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area Valuation
(commencing with Scclion 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
10 8 5 0
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
five
APN
Number OCCU anC
Occupancy Type
not more than hundred dollars ($500).
0 I, as owner of the property, or my employees with wages as their sole compensation,
37503022.00
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
q p
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,
101
— FOUNDATION
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
102
— PIERS
sale.)'
y .
103
— UFER
1, as owner of the property, am exclusively contracting with licensed contractors to
10 4
REBAR
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
10 5
— ANCHOR BOLTS
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law,
106
— SEWER & WATER
0 1 am exempt under Sec. , B & P C for this real
(4 Date $ i5 of
202
— UNDERFLOOR PLUMBING
���
JJ WORK O MOPE,S O bECLARATION
203
— UNDERFLOOR MECHANICAL
204
— UNDERFLOOR FRAME
I hereby affin» under penalty of perjury one of the following declarations:
plhave and will maintain aCertificate ofConsent toself-insure for Worker'sCompen-
205
— UNDERFLOOR INSULATION
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
301
— ROUGH PLUMBING
work for which this permit is issued.
302
— TUB & OR SHOWER
0 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.
303
— ROUGH ME CHAN I CAL
My workers compensation Insurance carrier and Policy number am:
304
— ROUGH ELECTRICAL
Carrier: Policy No.:
305
— FRAME
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
306
— HOLDOWNS
(This section need not hecompleted if the permit is for one hundred dollars ($ I W)
307
— INSULATION
or less.)
3 8
'
SHEETRDCK
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
309
— EXTERIOR LATH
Laws ofCalifornia. Date
310
— INTERIOR LATH
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
311
— SCRATCH COAT
become subject to the Worker's Compensation provisions of the Labor Code, you must
ROOF
forthwith comply with such provisions or this permit shall be deemed revoked.
313
— NAIL
'
501
— FINAL ELECTRICAL ENERGY
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency tort the performance of
502
— FINAL PLUMBING ENERGY
the work for which this permit is issued (Sec. 30I7, civ. ca
) Lender's Name'
503
— F I NAL MECHANICAL EN GY
Lender 's
504
— FINAL BUILDING ENER Y
1 certify that 1 have read this application and state that the above information is
505
— FINAL ELECTRICAL
' 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
GAS E S T
ahove-mentioned property for inspection purposes.
0 7
F I
(We) agree to save, indemnify and keep harmless the City of Cupertino against
I liabilities, judgments, costs and expenses which may in any way accrue against said City
5
I CAL
' in consequence of the granting of this permit
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by:5
Date
SOURCEREGULATIONS.
_)/111 i 0.3
' l `
.
ignaturc of Applicant/Contractor Date'
Re -roofs 54
—INAL PUBLIC WORKS
HAZARDOUS MATERIALS DISCLOSURE
Type of Roo
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)?
All roofs shall be
inspected prior to any roofing material being installed.
❑ Yes 5�I`10
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?
F1 Yes 'Leo
I have' read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534. ]understand that if the building
docs not currently have a tenant, that it is my responsibility to nofil'y the occupant of the
requirements which must be mel prior to issuance of a ertificate of occupancy.
Signature Of Applicant
Date
-owneL,afauthorized agent Date'
All roof coverings to be Class "B" or better