09060020CITY OF CUPERTINO
Ht ram" s
BUILDING DIVISION PERNUT
BUILDING ADDRESS:
PERMIT NO.
10100 N STELLING RD
HAMMOND HOMES ENTERPRISES
09060020
OWNER'S NAME:
PERMIT ISSUE DATE
YAY&AY Ad- CONTROL NO.
(408)255-9994
ARCHrIEcT/ENGINEEI :
BURRING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full fora and effect.
TEMP PERMIT, SIESMIC UPGRD, NEW FIRE SPRNKLRS,
Licte Class Lk.. Contractor Da
Date
HANDICAPPD ACCESSBLTY UPGRDS; PERMIT GOOD THRU
ARCHrfECrS DECLARATION
Iundcrsandmyplans "Ibeused aspublic =or&
7/3/9; NO INSPECTIONS AFTER 7/3/9;ORIG #Q9010082
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors Lcense Law for the
following reason. (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
Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
Sq.
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
5 0 0 0 0 0
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (M).
32631019 .00
❑ L as owner of the property, of my employees with wages as their sole compensation,
Required Inspections
win do the work and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractors Liana° Law does not apply to an owner of
property who builds or improves thereon, and who does such word himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner.
builder will have the burden of proving that he did not bdld or improve for purpose of
SaIeJ.
L as owner of the property. am exclusively contracting with licensed contractors to
tollstruct the project (Sec. 7044, Business and Professions Code:) The Contractors Li-
cense Law does not apply to an owner of property who builds or improves thereon, and ,
who contracts for such projects with a contractor(s) licensed pollutant to the Contractors
Lkatse Law.
❑ 1 am exam
COMPPNSA77ON DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 hx+c and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is Issued.
My Workers Compe nsatiou Insurance carrier and Policy number are:
Carrier. Policy No.:
CEUIFICATE OF 15(EMPrION FROM WORKERS
COMPENSATION INSURANCE
0-his sectlon need rot be completed if the permit b for one hundred dollars ($100)
Of less)
I certify that in the performance of the work for which this permit is issued, I .shall not
employ any person in any manne��ect to the Workers' Compensation
Laws of California Date
Applicant
NOTICE TO APPLICANT: If, after making this Ceaifieata of Exemption, you should
become subject to the Woeues Compensation provisions of the Labor Code, you mew
forthwith comply with such 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 (See. 3097, Civ. Q
Landers Name
,
Lenders Address
1 certify that 1 have read this application and state that the above information is
cmrecl I agree to comply with all city and county ordinances and state Iva relating to
building construction, and hereby authorim representatives of this city to enter upon the
above -mentioned property for inspection purposes
(Weil agree to Save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, coats and expenses which may in any way acne against said City
in consequence of
DISCLOSURE
WiB the applicant or future building occupant store or handle hrnrdous material
as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code, semi25532(a)?
X.-
All roofs shall be inspected prior to any roofing material being installed.
El Yeses
If a roof is installed without first obtaining an inspection, I agree to remove
Wi11 the applicant or future building occupant are
pp g pa equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes o
I have read the hamaterials requirements under Chapter 6.95 of the Califor-
nia Hcahh & Safety Code Sectiexa 25505, 25533 and 25534.1 undcmard that if the building
nsibility m notify the occupant of dueooracenlra�cm
does not Cummiffak ■ mhuu, that2-
Date
(� D
All roof coverings to be Class'%" or better
Date
Owner or authoriad agent