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CITY OF CUPERTINO
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BUILDING DIVISION PEi',RMIr
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BUILDING
NO. CONTROL NO.
ARCHI I ECrfENGINEEA
BUILDING PERMIT INFO
B B M
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 7000)ofDivislon3oftheBusiness and Profcasions Code. and mylicerucis
SFDWL • 2923 ' GARAGE: 465 ' COVERED PORCH - 54 '
in full force and effect.
License Cass Lle.tl
54' 56 .38 X 465=26, 216 .70-38.51X54=2079 .54
to_ Contractm
ARCHITECTS DECLARATION
PERMIT
1 understand my plans shall be used as public records
APPL EXTENDED TILL 11/15/07 PER GREG.
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's license Law for the
following mason. (Section 7031.5. Business and Professions Code: Any city or county
which requires a permit to construct. alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$ 6 5 4 8 9 9
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy
P y TYpe
Section 7031.5 by any applicam for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (S500).
❑ L as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work, and the structure is not intended or offered for sale (Sec. 7044. Business
and Professions Code. The Contractor's License Law does not apply to an owner of
prey who builds or improves thereon, and who does such wort himself or through his
own employees, provided that such improvement& are not Intended or offered for sale. If,
however. the building or improvement is sold within one year of completion, the owner -
builder wIB have the burden of proving that he did not build or improve for purpose of
sale.).
L as owner of the property, am exclusively contracting with licensed contractors to
construct the project (See 7044, Business and Professions Code.) The Contractor's LJ-
cease Law does not apply to an owner of property who builds or improves themon, and ,
who contracts for such pmjects with a contractor(s) licensed pursuant to the Contractors
License Law.
❑ 1 am exempt under Sec B & P C for this mason
Owner Date (t
V4DRKERS PENSA-
penalty of perjury one of the following declarations:
❑ I have and will maintain a Cardli ate of Consent to self -insure for Worker's Compen-
sation, as provided for by Sermon 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which ibis permit is issued.
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My Worker's Compensation Insurance carrier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Phis section reed not be completed if the permit is for one hundred dollars ($100)
or lea)
I certify that in the performance of the work for which this pe it is issued. I shall not
employ any person in any manner so as to becorgc subject t e Compensation
Laws of California Dale
Applicant
NOTICE TO APPLI . l , afro maki g this Certificate of Exemption, you should
become subject to the orkces Compensation provisions of the Lather Coda you must
forthwith comply wiLhInich provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C)
Lendex's Naae
Lzrider's Address
I certify that I have read this application and sate that the above information is
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cormeL I agme to comply with all city and county ordinances and sate 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, toss and expenses which may in any way accrue against said City
in consequence of the grandng of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
L
SOURCE
-roofs
Type of Roof
Sign of A trac Iica VContor Dale
HAZARDOUS MATERIALS DISCLOSURE
ill the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9A Z and the Health and Safety
Code, section 25532(a)7
Yes �o
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,agree to remove
Will the applicant or future building occupant use equipment or devices which
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emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
DisuictT
Yes Pfo
I have read the hazardous materials requirements under Chapter 6.95 of the Califor.
nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenant. that it is my responsibility to notify the occupant of the
requ6cmens which must be met . issuance of a Certificate of Ocetr
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Signature of Applicant Date
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All roof coverings to be Class "B" or better
owner authed agent Dam