090901650
CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR: MIKE ROVNER PERMIT NO: 09090165 CONSTRUCTION INCBlqSb;Dp~~~~~d:~~~BIJq g OWNER'S NAME: THE IRVINE COrvtPANY 1916 DUNCAN ST DATE ISSUED: 11/10/2009 PHONE NO: (408) 453-6070 OWN~R'S PHONE: 9497205514 SIMI VALLEY, CA 93065 ~ LICENSED CONTRACTOR'S DECLARATION rBUILDING PERMIT INFO: BLDG r ELECT r PLUMB License Class-L-Lic. # 79->:7 '2 C; r r MECH RESIDENTIAL r COMMERCIAL Contrnctor 1r\Jtf RvclJ.-iJ( C/O~ T Date II/ /rJ//J 9 JOB DESCRIPTION:REMODEL STAIR, WALKWAYSY & PRIV ATEI hereby a;J;rm that I am licensed under the provisions'Chatter 9 DECK(commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. REPAIRS(4000SQ); NO RE-ROOF; MIKE ROVNER CONSTRUCTION PD FOR BUS LIC 9/22/9 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 Insurnnce, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this Valuation: $300000 permit is issued. Sq. Ft Floor Area: APPLICANT CERTIFICATION APN Number: 31606037.BLD9 Occupancy Type: 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR grnnting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. IDr:;.Issued~~'~ Date: / fSignature ~~ Date t!/;o/tJ Cj
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OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for I, as owner of the property, or my employees with wages as their sole compensation, inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code) Signature of Applicant: Date:
I, as owner of the property, am exclusively contrncting with licensed contIactors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BEITER
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, forthe I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurnnce, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material. Section 3700 of the Labor Code, for the performance of the work for which this
Additionally, should I use equipment or devices which emit hazardous airpermit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued, I shall maintain compliance ".vith the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health & Safety Code, Sections 25505, 25533, and 25534.
Compensation laws ofCalifomia. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked. Date: ~~ lJ/!O/gJ
CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address
costs, and expenses which may accrue against said City in consequence of the
grnnting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional