05090157 CITY OF CUPERTINO
BUILDING DIVISION PERMIT SGAlV'rRACTUIt T1VI+,U �„A r TpN f;
BUILDING ADDRESS: WELKIN INTERNATIONAL IND ffe"ITNO'05090157
OWNER'S NAME: PERMIT ISSUE DATE
19925 STEVENS C 01/06/2006
E; SANITARY NO. CONTROL NO.
(406) 252-3396
ARCHI7ECTIENGINEER: BUILDING PERMR INFO
BO ELECT PLUQMB 0
306 LICENSED CONTRACTORS DECLARATION JbDescrition
1 hereby affirm that 1 am licensedo
d under provincesof Chapter 9(cammc.In{ P
with Section 7")of Division 3 of dee Busiaeu ant ProfeWmu Coca.Mal my license is
in full to"andenat NEW 2-STORY SFDWL (3575 ' -LIV. )
'h z unman elan. 'k g
Dem ContGARAGE-660 '
DECLARATION ARCHfIECrS DECLARATION
i? I undA arind my plana Nal to used as Public records
aD Licensed Professional
H OWNER-BUILDER DECLARATION
I family affirm that I am exempt from the Commune,License Law for the
C O o following won.(Section 701.3.Business and ProfessiuM Code:Any city or county
which requires a permit to convect.alter.Improve.demaltsh.ar repair any nmctom
_ZY prior In is issuance.also requires the applicant for such Permit to rile a signed suemcm
Met W is licensed pursuant to Ne provisions of the Conamcmrs License Law chapter Sq.F[. Floor Area Val IBIi3 5 8
�g (commencing with Section7")of Division 3 of the Business and Professions Code)or
that he is exempt therefran and tie hula far the alleged exemption.Any violation of
Sacdon 7031.5 by any applicant for a pemth objects the applicant to a civil .It,of APN Number Occupancy Type
not mase than live buadmd dollars ISSUE. 32630104 . 00
0 1,As owner of the property,w my employers with wages u deb sets competition.
will do the work..ed the auueturei not mmnded mance it far sale(Sec.7044,Business Required Inspections
and Profession Cade:The Contractors License Law does set apply to e an owner of q P
propeny who builds or Im prows thereon,and who does such work himael f or through his
awn employees.Provided thaauch improvements art not intended cronered forsale.if.
however.the building or improvement B sold within ane year of eompledon.Ne owner.
builder will have the burden of Proving that M did not build or improve for purpose of
Ic.).
1,a owner of the property,am exclusively contracting with licensed contractors to
ostmct Ne project(Sec.7044.Business and Professions Cade:)The ComractoM1 U.
cc=Law dace sea apply to an owner of propeny who builds or Improves Nercon,and
who contracts for such projects with a contruer(s)licensed pursuant to the cemracmb
Liceti Law.
❑I am exempt under See. B A,P C for this tested
der Data^�9-"�'av""Sa'^
—WORKERS COMPENSATION DECLARATION
1 hereby&(Ilan under penalty of perjury one of the fallowing declarations:
1 have and will maintain aCenlRate of Consent to selGinsime for WorkersCamper.
don,es provided for by Section 3700 of the Lebo,Code.for the performance of the
weak for which this permit is issued.
❑1 haw and will maintain Walker's Competition Inserunce,ax required by Section
3700 of the Labor Cods,for Ne performance of the work for which this permit is issued.
My Workers Compessatlon Insurance carrier and Policy number arc:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This ecedom=it not to,ewnplemd If de Permit Is far..hundred dollars(3100)
or Ins)
I unify that in Ne performance of the work for which this Permit Is issued.l shat not
employ any Person in any manner"'u m barydee subf(FI to the Workers'Competition
laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after matin{this Certificate of Exemption,you should
become subject w Ne Workers Competition provisions a the LAW Code.you most
.7 O fanhwith comply with such provisions or Nu Permit"I be domed awaked.
„ze 5; CONSTRUCTION LENDING AGENCY
f+ I hereby AMM that dere is a Construction lending agency for the plfamoree of
LL' the work fa which this permit is issued(Sal.3097.Civ.C.) '
94 Lenders Name
CL D Z Lender.Address
U0 I certify that I have read this Application and sum Nat the show information ts
f" conecn I agree to comply with all city and county oadieunces and s e laws relating to
0C.7 building construction.and hereby authodeerepresentatives ofNiecity tocoder upon the
W shove-mentioned property for inspection pugwea
py (We)agree to Save,indemnify and keep harmless the City of Cupertino against
In liabilities,judgments.casts and expenses which may in any way smue against said City
U in...quence of Ne granting of this Pencil.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date oor— a Ci
SOURCE REGULATONS.
Re-roofs -
Signature of ApplianuCantractor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicator futum building oceupunutem or handle havardow material
as dented by the Cupertino Municipal Cade,Chapter 9.13,and the Heath and Safety
Ade,Sea
ttoa U533(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yon �Na
Will the aPpl::. of future building accupam tie equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hhxsrdmm air conuminanu u de(ned by the Bay Arta Air Quality Management all new materials for inspection.
used?
0 Ye. (kNo
1 haw mW the htirNml macriaisicqulmments undirChaperd.95 ofthe Califon
nia HCal"SarctyCadc.Sections 35505,35533 wW 25534.1 understand thallf the Wilding
dons not currently have a count,Nat It is my responsibility m rosy the occupant of Ne
requirements which must to met ' m Wmanaofaeenlncateofoccuplacy _ Signature Of Applicant Date
Owner or euthodmd agent Dam All roof coverings to be Class"B" or better �'