090901630
CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR: MIKE ROVNER PERMIT NO: 09090163 CONSTRUCTION INC Brq~bDAD~~7~1:~t~~E~G 7 B 'd~ "I OWNER'S NAME: THE IRVINE C'6MPANY 1916 DUNCAN ST DATE ISSUED: 11110/2009 SIMI VALLEY, CA 93065 PHONE NO: (408) 453-6070 OWNyR'S PHONE: 9497205514 ~ LICENSED CONTRACTOR'S DECLARATION rBUILDING PERMIT INFO: BLDG r ELECT r PLUMB Licenseclass_b Lic. # 19 t; 77 9rMECH RESIDENTIAL r COMMERCIAL r Contractor V'1 ~ (L f 'f-ov¢f1. U!6TDateJr};t1 ()9 JOB DESCRIPTION:REMODEL STAIR, WALKWAYS &PRIVATE DECK I hereby affirm that I am licensed under the provision( 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 Sq. Ft Floor Area: Valuation: $300000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 31606037.BLD7 Occupancy Type: APPLICANT CERTIFICATION I certif'y 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 indemnif'y 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 /,?/tv~Issued by;/.-~-· Date: .9.18.~~_ .. Signatur J/(f()/ocr
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of
OWNER-BUILDER DECLARATION
installed without first obtaining an inspection, I agree to remove all new materials for
the following two reasons: inspection.
I, 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, Signature of Applicant: Date:
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
ALL ROOF COVERINGS TO BE CLASS "A" OR BEITERconstruct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE declarations:
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 &
Safety Code, Section 25532(a) should I store or handle hazardous material.I have and will maintain Worker's Compensation Insurance, as provided for by
Additionally, should I use equipment or devices which emit hazardous airSection3700 of the Labor Code, for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
I certif'y that in the performance of the work for which this permit is issued, I shall 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
become subject to the Worker's Compensation provisions of the Labor Code, I must ~ D.t,,~
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 work's
I certif'y that I have read this application and state that the above information is
APPLICANT CERTIFICATION
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
indemnif'y and keep harmless the City of Cupertino 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 .