09090162CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR: MIKE ROVNER PERMIT NO: 09090162 BU1IqSGO~DRp~~~1~~d~~BL~ CONSTRUCTION INC 'BldCf W OWNER'S NAME: THE IRVINE COMPANY 1916 DUNCAN ST DATE ISSUED: 11110/2009 PHONE NO: (408) 453-6070 O~R'S PHONE: 9497205514 SIMI VALLEY, CA 93065 LICENSED CONTRACTOR'S DECLARATIONtti r rBUILDING PERMIT INFO: BLDG r ELECT PLUMB License Class '& Lic. # 79 r;729 rMECH RESIDENTIAL r COMMERCIAL rContract0tl~/( [ f4?Vtle;t (oMT. Date ¥it:)7 La 7 JOB DESCRIPTlON:REMODEL STAIR, W ALKWAYS &PRIV ATE DECK I hereby affirm that I am licensed under the provisio s of Chapter 9 REPAIRS(4000SQ); NO RE-ROOF; MIKE ROVNER (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. CONSTRUCTION PD FOR BUS LIC 9/22/09 I hereby affirm under penalty of perjury one of the following two 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 provided for by Valuation: $300000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 31606037.BLD6 Sq. Ft Floor Area: Occupancy Type: APPLICANT CERTIFICATION 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 construction, and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We) agree to save indemnifY and keep harmless the City of Cupertino against liabilities, judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs, and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18.~_ Issued~ Date/~(~CYt
Signature Date llItO/~? I (
0 OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
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.
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Signature of Applicant: Date:
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 ofthe Labor Code, for the performance of the work for which this
permit is issued.
I certifY that in the performance of the work for which this permit is issued, I shall
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code. Sections 25505, 25533, and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I ~~t:
become subject to the Worker's Compensation provisions of the Labor Code, I must Date:W
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certifY that I have read this application and state that the above information is for which this permit is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save Lender's Address
indemnifY and keep harmless the City ofCupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
ARCHITECT'S DECLARATIONgranting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date