090901640
CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR: MIKE ROVNER PERMIT NO: 09090164 CONSTRUCTION INC BI~~~lroAD9(~~~(~~t~:;f~;~DG~d ~ f? OWNER'S NAME: THE IRVINE c6MPANY 1916 DUNCAN ST DATE ISSUED: 11/10/2009 O~R'S PHONE: 9497205514 SIMI VALLEY, CA 93065 PHONE NO: (408) 453-6070 LICENSED CONTRACTOR'S DECLARATIONf1' r rBUILDING PERMIT INFO: BLDG r ELECT PLUMB License Class & Lic. # (9572.9r MECH RESIDENTIAL r COMMERCIAL r Contractor(htiKt Date~I!t( (J>~'t7: lt4/f!a? JOB DESCRIPTION:REMODEL STAIR, WALKWAYS &PRIVATE DECKI hereby affirm that I am licensed under the provisions!of C;pter 9 REPAIRS(4000); 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.BLD8 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 Issuedb~r~~-Date: //../11/9.18.~ '? Signature o."JJ!4il
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first 0 btaining 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 ofthe property, am exclusively contracting with licensed contractors to
ALL ROOF COVERINGS TO BE CLASS"A" OR BETTERconstruct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
HAZARDOUS l\IATERIALS DISCLOSUREdeclarations:
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 airSection 3700 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 pennit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued, I shall Health & Safety Codp, Sections 25505, 25533, and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws ofCalifomia. If, after making this certificate of exemption, I ~t: 1become 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 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