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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
COATCTt?Y2IN'OR��ON,
BUILDING ADDRESS:
2ngnn HOMESTEAD ED RLDr, 3 A—_R
WEST BUILDERS, IN(-
PERMIT NO,
nt;04nitio
OWNER'S NAME:
PERMIT 0911E DATE
PHO
A A 0. CONTROL NO.
nADMAT
510 525-9378
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
9
Job Description
1 hereby affirm that I am licensed under provisions of Chapter (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effect.
REVISE: NEW BUILDING AT MAIN ENTRANCE TO PROJECT
License Class Lie. #
Date Contractor
OFF OF HOMESTEAD RD . ARCHITECTURAL CHANGE ADD
ARCHLTECTS DECLARATION
I understand my plans shall be used as public records
TOWERS AT STOOPS TO BUILDING # 2 & # 3 .
Licensed Professional
OWNER -BUILDER DECLARATION
I 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 Contractor's License taw (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
10 0 0 0
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy 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 ($500).
32609056 AB
❑ I. as owner of the property, or my employees with wages as their sole compensation,
.3
Required Inspections
will do the work, and the structure Is notinlended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractors License Law does not apply to an owner of
property who builds or improves thereon, and who does such work 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 build or improve for purpose of
sale.),
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li.
tense law does not apply to an owner of property who builds or improves thereon, and,
who contracts for such projects with a coamctnr(s) licensed pursuant to the Contractor's
ense Law.
KLi
I am exam B & P C for this reason
Owner Date % 7� l JcfJ
WO ER'S MPENSATIONDECL.ARATION
I here nder penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self-insum 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.
❑ I 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 Workers Compensation Insurance carrier and Policy number ate:
Cartier. Policy No.:
CERTIFICATE OP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foranc 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 man cr o,�s,lyq ov%t subject to the Workers' Compensation
Laws of CalLfoml — 'mil
.
Applicant
NOTICE 10 APPLI . after making this Certificate of Exemption, you should
become sub ct to the pprker's Compensation provisions of the Labor Code, you must
forthwith comply -with sdch provisions or this permit shall be deemed 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.)
Lender's Name
Lender's Address
I certify that I 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 authorize representatives of this city to enter upon the
above -mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
Iiabilides,judgmenLs, costs and expenses which may in any way accrue against said City
consequence of the granting this permit.
(>
A PPLICA UNDERSTANDSS AND WILL COMPLY WITH ALL NON -POINT
ISSlled by: Date
SOURCER G�AFIO]VS-?1 LZ��
l
C
Re -roofs
Type of Roof
Si nature of p IicanU nlractor Date
ARDOUS MATERIALS DISCLOSURE
W' 1 the a licant or future building occupant store or handle hazardous material
as defined by a Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
[I Yes I�No
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes 'KNa
I have read the hazardous materials requirements under Chapter 6.95 of the Cali for-
niaHealth &S etyCode, Sections 25505,25533and 25534.1understand that ifthe building
does not curcn y have a tenan a is my responsibility to notify the occupant of the
requi w et prior to issuance of a Certificate of Occupancy,
� rZ e_ t
Signature of Appl icant Date
/rr err
All roof coverings to be Class . or better
Dam '
Owner or uLorizs cn