07100194 PermitLLQ
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CITY OF CUPERTINO
DIVISION PERMIT
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PERMIT NO.U"T�YnEbLIVEWOOD
07100194
OWNER'S NAME:
PERIMISSUE DATE
ESSEX PROPERTY TRUST
02/04/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHI7ECr/ENGINEER:
BUILDING PERMIT INFO
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LICENSED CON7RACIIOR'S DECLARATION
Chapter 9
Job Description
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1 hereby affirm that I am licensed under provisions of (commencing
with Section 70oo)o(Divisi 3of the BusinessandProfessions Code, and myBeenseis
COMML T.I. 7 ADD BTHRM & STORAGE TO EXSTNG OFC FOR
in full f aef/bct Lk.N
R-1 OCCUPANCY
Dara Cootracrar
CHrrSCrS DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 70315, 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 signal statement
he is licensee to the of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that pursuant provisions
$30000
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
31643 003
Occupancy
Pane Y Type
Section 70315 by any applicant for a permit subjects the applicant to a civil penalty ofNumber
not more than five bundred dollars (S -WI.
0 L at owner of the property. or my employees with wages as their sok compensation,
Required Inspections
es
will do the work. and due swcture is not intended or offered for sale (s«. 7044. Business
and Professions, Codc: The ContractorLicense Law docs not apply to an owner of
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property who builds or improves thereon. and who does such wont himteJf or through bis
mvn employees, provided that such improvements are not intended or offered for sale. If.
however, the building or improvement 1s, sold within one year of completion, the owner -
builder wit have the burden of proving that he did not build or improve for purpose of
sale.).
D L as owner of the property. am exclusively cmuticting with licensed contractors to
construe the project (Sec. 7044, Business and Professions Code:) 7]s, Cotruactat's U.
eco 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 pursuant to the Contractor's
License Law.
D 1 am exempt under Sec B R P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self -insure for Workefs Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
Q 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 this permit is issued
My Worker's Comper"lion nmce carrier and Policy number ate:
Cartier Policy Na(oC"Ul-
35 —S'
CERTIRCATE F EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
t anis section need not be complemd 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 mennerso as to become subject to the Workers' Compensation
Laws of California Date
Applicant
NOTICE TO APPLICANT: If, after malting this Cenirieate 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 deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby alfimn that there is a conswction lending agency for the performance of
the work for which this permit is issued (Scc. 3097, Civ. C.)
Lender's Name
Lender's Address
I certify that 1 have read this application and state that the above infomtation is
correct. I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize repremmudves of this city to enter upon rhe
above-mentioned property for inspection purposes
(We) agree to save, indemnify and keep bamiless the City of Cupertino against
j liabilities, Judgments, costs 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
SO ULATIO
Re -roofs
Type of Roof
si urcorAppl' UCon or Date
HAZARDOUS MATERIALS DISCLOSURE
Wi applicant or future building occupant store or handle hm;ardons material
as dertned1by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, schen 25532(.)? �0 —
All roofs shall be inspected prior to any roofing material being installed.
❑Yes
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 haiardous sir contaminants as defined by the Bay Arca Ar Quality Management
all new materials for inspection.
District?
0 Yes Df o–
I have read the hazardous materials requirements under Chapter 6.95 of the Cahfor-
niaHealth RSafayCode, Sections 25505.25533and 25534.1understand that lrthe building
does n currently have a tenant, that it is my responsibility to notify the occupant of the
hichm ofaCetir or parley.
Signature of Applicant - Date
All roof coverings to be Class "B" or better
Da
Own or authoriZagent