05100045CITY OF CUPERTINO
BUILDING DIVISION PERMI
BUILDING ADDRESS:
18631 CYNTHIA AVE
OWNER'
18631 CYTHIA AVE
PERMIT ISSUE DATE
03/27/2006
PHONE: SANITARY NO, CONTRO NO,
BUILDING PERMIT INFOARCHITECT/ENGINEER:
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will do lhe work.. and lhe slrUclure is not intended or offered for sale (Sec. 7044, Business r • d I .
and Professions Code: The COnlr.leIOr'S License Law do~ not apply '0 an owner of ReqUire nspectJons
propeny who builds or improves thereon, and who does such work himsel( or through his
own employees. provided that such improvements are nol intended or offered (or sale. If.
however. me building or improvement is sold within One year af completion, the owner-
builder will have the burden of proving thai he did nOI build or improve for purpose of
sale.).
g"(as owner of the properlY, am exclusively contracting with licensed contractors La
consuuct lhe project (Sec. 7044. Business and Professions Code:) The Contraclor's li
cense Law docs not apply to an owner o( propcny who builds or improves lhereon. and .
who contracts (or such projects with a conlractor(S) licensed pursuaRlIO the Conuactor'S
License Law.
D I am ••em
I hereby affinn under penally of perjury Clne o( the following declaralions:
o I h6. ....e and will mainlBin a Cenificale of Consent 10 self-insure for Worker's Campen
.arion, as provided for by Seelion 3700 of lhe Labor Code. for lhe ~rfonnancc of Ihe
work. (or which lhis pennit is issued.
o I have and will maintain Worker's Compensalion Insurance. as ~uircd by Section'
3700 o(!he Labor Code, (oc lhc perfonnanee of the work (or whieh lhis ~mil i. issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier: Policy No.: .,..,.,====-__
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed i(thc permit is for one hundred dollars (SIOO)
or less.)
I certify th:u in thc performance of the work ror which this permil is is...ucd. I shall not
employ any person in any ncr to be c SUbject la the Workers' Compensalion
Law. of Californii Dale;.....,,.L...........F-"""',g.<-----------__
Applieanl .-j. .-' ~
NOTICE plion, you shnul~
become sUbje to the Worker'! Campcnsalian provisions o( the taoor Code. you must
(orlhwith comply wilh such provisions or Ihis permit shall be dccmed revoked.
CONSTRUCTION LENDING AGENCY
1hereby amrm lhal there is a construclion lending agency for the performance u(
lhe work:: (ur which this permil is issucd (Sec. 3097, Civ. C.)Lender's Name _
Lender'sAddrcss _
llXl1ify that I have read !.his application and state Ihal the above in(onnalion is
correct 1 agree 10 comply Wilh all city and county onJina.nces and state laws relating lO
building construction. and hereby authori7.e rcpresenlatives o( this city 10 cnlcr upon the
above-mentioned property (or inspection purposes. fJfiiIi}
(We) agree '0 save. indemnify and keep harmless lhe CilY of Cu~rtino againS! 0
liabililies, judg
ill Lhe applicant or fulure building occupaRl slore or handle ha.,..ardous malerial
as defined by lhe Cupertino Municipal Code. Chap'er 9.12, and lhe Heallh and Safely
Code. Seclion 25532(a)? ./
All roofs shall be inspected prior to any roofing material being installed.OY~ IZINu
If a roof is installed without first obtaining an inspection, I agree to remo
Will the applicant or future building occupllnl usc equipment or devices which
emit hll.,.ardous air conUlminanlS as dcfincl1 hy the Bay Area Air Quality Managcment all new materials for inspection.
Dislrict? _ /
DYe. urNu
I havc read the ha7.arl1uus materials requirements under Chapter6.950(thc Califor
nia He.llb & SafclyCode, Sections 25505. 25533 and 25534. Iunderslall<llM( iflhe huilding
docs not c rrcntly ha~..i! ten~m .. !.hal it is my responsihility to noliry the occupant o( the
requircm .J1U whic.:h must be me.9prior to is llMCC or a Cc:rtificate of O:cc~pan~i1 6
Signature of Applicant Date04/1...." ..L: J -7.. 7 -0 ~ All roof coverings to be Class "B" or betterOwnf:}oc' .101 orjzcl1 ai!cC DaLe
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm thal I am liccn.'iCd under provisions of Chapler 9 (commencing
wilh Sec lion 7(00) of Division 3 orlhe Business and Professions Code. and my license is
in full force and crfect.License Class Lie. H _
Dale ARCHlTEci?;lg~~~A"""R""AT=IO"N"'--------
I understand my plans shall he used as puhlic records
Licensed Pro(essional
OWNER-BUILDER DECLARATION
1 hereby alTIrm mal I am exempt from Lhe COnlr3CIOr's license Law for Lhe
following reason. (Section 7031.5. Business and Pro(e.'\.lr;ions Code: Any cily or counlY
which requires a pcnnit to construct, alter. improve, demolish, or repair any slructure
prior to ilS issuance. also requires lhe applicant (or such pcrmillo file a signed 51alemenl
thai he is licensed pursuanllo thcfllOvisions of the COntfilclor's License Law (Chapter 9
(commcncing wilh Section 7000) of Division 3 o( the Business Ill1d Pro(cssions C~c) ar
lhat he is uempl lhcrdrom and me basis far Ihe alleged exemplion. Any violation o(
no' more lban five hundred dollars ($500).
BLDG ELECT PLUMB MECH
CJ c:J c:J c:J
Job Description
ADD-328'-2ND ATTACH UNIT 966 1 /GARAGE 440'
REMODEL BED/BATH/REROOF/DEMO CARPORT
SANITARY-SUNNYVALE
Sq. Ft. Floor Area Val~'1i&~ 2 0