09040151.)4
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CQI'ICRGTC'��Z.INEURMA`IQYY .
BUILDING ADDRESS:
PERMIT NO.
OWNER'S NAME:
PERMIT ISSUE DATE
PHO
A I CONTROL NO.
n T o mTT
510 525-9378
ARCHITECTIENGINEER:
BUILDING 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 force and effect
REVISE: NEW BUILDING AT MAIN ENTRANCE TO PROJECT
License Class Lic.H
Dam Contractor
OFF OF HOMESTEAD RD. ARCHITECTURAL CHANGE ADD
ARCHITECTS 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 reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alma 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 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
10 0 0 0
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
APN Number
QCCu anC
P Y Type
not more than five hundred dollars ($500).
3 2 6 0 9 0 5 6
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
.2AB
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
Required Inspections
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale./)
;'I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li.
cense Law does no pply to an owner of property who builds or improves thereon, and.
who contracts for projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ I am ex In. Sea , B & P C far is re on
Owner L Dam
it O KER'S COMPENSATION DECLARATION
-
I here y irm under penalty of perjury one of the following declaradons:
❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
'
My Worker's Compensation Insurance tamer and Policy number arc:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is forone hundred dollars ($I00)
or less.)
I certify that in the Orfiermance of the work for which this permit is issued, I shall not
employ any pers n mapper as to It n c subject to the Workers' Compensaton
Laws of Cali fo r D lc _ (U
Applicant
NOTICE TO AF: If, after making this Certificate of Exemption, you should
become subject ro the Worker's 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 affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lemices Name
Lenders Address
I certify that I have read this application and state that the above information is
'
correct 1 agree to comply with all city and county ordinances and stale laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
shove-mcnlio d property far inspection purposes
(We) ree to save, indemnify and keep harmless the City of Cupertino against
liabilides,j d ants, costs and expenses which may in anyway accrue against said City
in ;onseq c the granting of this permit.
AP1C U DERSTANDS AND WILL COMPLY WITH ALL NDN-POINT
Issued Y Date
SO RC E U TI
fX
_b -: - -- - --
Re -roofs
Type of Roof
Sigma o App' ant/Conitac[or Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Murder al Code, Chapter 9.12, and the Health and Safety
Coda,
Section 25532(a)?
All roofs shall be inspected to any roofing material being installed.
❑Yes o
prior
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 cfincd by the Bay Area Air Quality Management
all new materials for inspection.
DISirICt7
❑ Yc: a
Ihave read ardousmaterialsrequirements under Chapter6.95ofthe Califor.
niaHealth&Safety de, ctions25505,25533and25534.1understandthatifthebuilding
does not torte fly t ant, that it is my responsibility to notify the occupant of the
requiremen hi m st be et prior issuance ara Certiricate of Occu ancy.
Signature of Applicant Date
All roof coverings to be Class'¢��' or better
Owner or t Dee, •
aulh nit a