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08020016Op U� M resin U �y ;W ny ,off Vl joo rm� .Z< jSp 0z z0 P C/) W> aQ �z UO W F. OU Fa Uz BUILDING DIVISION PERMIT THWbREENLEAF CT LOT 1 OWNER'S NAME: CUPERTINO GREENLEAF LLC ARCHTTECT/ENGTKEER: NEXGEN BUILDERS, INC 225 DEMETER ST (650) 322-5800 PERMIT NO. 08020016 PERMIT ISSUE DATE 03/06/20b8 SANITARY NO. CONTROL NO. BUMMING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTORS DECLARATION Job Description I hereby affirm that I an licensed under provisions of Chapter 9 (commencing with Section 700MofDivision 3ofthe Business and Profcssiow tor" REVISED FLR PLANS,SETBACKS, ARCHITECTURAL-ORG# in LicelnseC1 andesl Lic.n1 07020037-NO NEW PERMIT.ORIG APN 32633107.01-NEW Dam ARCHTIEG'�CS DECLARATION APN # 3 2 6 5 6 0 2 9. 01 1 understand my plans dull be used as public retorts 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 Code: Any city or county which requires a permit to constrict, altar, improm demo" or repair any structure prior to is issuance. also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the Provisions of the Contractors License law (Chapter 9 (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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S5(10). ❑ 1, as owner of the property, or my employers with wages as their sale compensation. will do the work. and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code The Contractors License Law does not apply to an owner of property who burlda a imptoves thereon, and who doessuch wort himself or through his town employees, provided that stch improvemems are not intended or offered for sale. If. however. the building or improvement is sold within one year of completimn. the owner. builder will have the Garden of proving that he did not Gild or improve for purpose of sale.). ❑ L as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Bushes and Profesdom Code:) The Comracmrs Li. cense law does not apply to an owner of property who Guilds or improves thereon, and . who contracts for such projects with a contractor(s) licensed pmsaant to the Conractors License Law. ❑ fun exempt under Sec. . B h P C for this reason owner Data WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Conant to self -insure for Worimrs Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the west for which this permit is issued ❑ 1 bare and will maintain Workers Compensation Insannnce. as required by Section 3700 of the Labor Code:, for the performance of the wart for which this permit is irsaued My Worker' erwl n hssu a carrier and Policy man b are:6,1D Carrier. O a' Policy No.: CERTIFICATE OF © PIION FROM WORKERS' COMPENSATION INSURANCE Crisis section need not be completed if the permit is for one hundred dollars (S 100) or Ices.) I certify that in the performance of the work for which this permit is issued. 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, aft¢ making this Cenifiotc of Exemption, you should become subject to the Wof es Compensation provisions of the labor Code- you muse forthwith comply with such provisions or this permit shall be dinned revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that arm is a construction lading agency for the performs of the work for which this permit is issued (Sec. 3097. Civ. Q L.endcrs Name Lenders Address I certify that I have rand this application and sum 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 upnn the ahovc-mentioned property for inspection purposes (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities. Judgmernts.c and expenses which may in any way accrue against said City in consequence of the ring of this iL AP U STANDS AN WILL COMPLY WITH ALL NON -POINT S CE G ONS. .3 ^6'O Si o artt/Contrxctor Bate HAZARDOUS MATERIALS DISCLOSURE WIII the applicant or future building occupant store or handle h2nrdoos material as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety Code, Section 25532(a)7 ❑ Yes `la No Will the appy mnt or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑Yes �No Sq. Ft. 3 2 6 5 6 027 Aff Number Issued by: Re -roofs Type of Roof $0 Required Inspections Occupancy Type Date 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 all new materials for inspection. I have rcpo the lunrdous main 'als'immems under Chapter 6.95 of the Califor- nia [{calth k Cade Sccti 5.25533 and 25534.1 understand that if t e building does not c dy have a tenon t it is my responsibility to notify the occupant ofthe hick must or to issuance of a Certifiatc� IlancY•' or authorized a Signature of Applicant Date Date . I All roof coverings to be Class "B" or better