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08040231inU �Z �ii�CC a 7qU u0 N ❑ ��pr 0 �m t7 z0 z `w C � C �z UC � L �a Uz CITY OF CUPERTINO BUILDING DIVISION PERMIT l�.OkRt1C1�'`IE�1`„` BUILDING ADDRESS: PERMIT NO. 20800 HOMESTEAD RD, BLDG 30A- WEST BUILDERS, INC. 08040231 OW R'SNAME. PERMIT ISSUE DATE VS II A CALIFORNIA LIMITED 1608 4TH ST STE 120 05/05/2008 PHON]Ft omr r SANITARY NO. CONTROL NO. (510) 525-9378 ARCHrIECr/ENGiNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing effecDivision 3ofthe Business and ProfcssiomCode, and my"cerscis UNDERGROUND WATER PIPE ONLY FOR NEW WATER HEATERS in full force and effect inwith full orcean License C�pss G' �� R• 9i C DOES NOT INCLUDE GAS OR ACUTAL WATER HEATER NEEDS f) Contr Den Contractor Da ^� • ARCHITECTS DECLARATION SEPERATE PERMIT 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the following reason. (Section 7031.5, Business and Professions Cork: Any city or county which requires a permit to construct after: 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 Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Sccdon 70DO) of Division 3 of the Busincasand Professions Code) or $15 0 0 0 that he is exempt therefrom and the basis for the alleged exemption. Any violation of APNlimber M Occu anC Type p y yp Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). 3 2 6 0 9 0 5 6. ❑ I, as owner of the property, or my employees with wages as their sole compensation, e Required iced Inspections will do the work, and the structure is not intended or offered for sale (Sec. Business Contractor's Lice and Professions Code: The License Law does mot Apply to an owner of Q p property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended oroffered 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 build or improve for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractnes Li- ccrse Law does not apply to an owner of property who builds or lmproves thereon, and. who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. ❑ 1 am exempt under Sec , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations ❑ ( have and will maintain a Certificate of Consent to self -Insure for Worker's 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 Wor s Compensation Insurance carrier and Policy number are: , Carrier 0 Policy No.: CERTIFICATE OF EXEMPTION FROM WORKE ' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compematon Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code- you must forthwith comply with such provisions or this permit shall be domed revoked. CONSTRUCTION LENDING AGENCY I 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.) Lenders Name Lenders Address 1 certify that 1 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 authoria 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 Iiabiliti s,judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permiL APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOUR ONS. Re-roofs Type of Roof / 5•9-Ak Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle haardous material as defined by the Cupertino Mrmicip Code. Chapter 9.12, and the Health and Safety Code, All roofs shall be inspected prior to any roofing material being installed. E]Yen2553z(a)? ❑ Yes ❑ If a roof installed without first obtaining an inspection, I agree to remove Will the applicant or future boiling occupant use equipment or devices which .is emit hazardous air contaminants as ned by the Bay Area Air Quality Management all new materials for inspection. District? ❑ Yes o I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534. I understand that if the building does not/���,,,rtrtrtcccndy have a5Ehaft is my responsibility to notify tan occupant of the refit or to issuance of a Certif(caic of Occupancy. Signature of Applicant Date (1 sr' 6 88 All roof coverings to be Class "B" or better owner or an,hnrined anent none '