07060175CITY OF CUPERTINO
RMI
BUILDING DIVISION PENT
PERMIT NO.
BUILD N513 ESS:
N WOLFE RD
SAN JOSE CONSTRUCTION
07060175
PERMIT ISSUE DATE "
OWNER'S NAME:
ORBIT RESOURCES INC
,
1210 COLEMAN AVE
10/05/2007
SANITARY NO. CONTROL NO.
PHONE:
(408)986-8711
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section70D0)ofDivision3oftheBusinessandProfessionsCode.andmylicenscis
REVISE ALTERNATIVE METHOD FOR OCCUPANCY ALLOWANCE
in full force and effect.
License Class Lie. N
Date Contractor
! ARCHITECTS DECLARATION
i I understand my plans shall be used as public records
Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm Ihnl 1 am exempt from rho Contractors License Law for the
> following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
m prior to its issuance, also requires the applicant for such permit to file a signed statement
Law 9
SQ • Ft. Floor Area Valuation
= that he is licensed pursuant to the provisions of the Contractor's License (Chapter
$ 0
(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
31620 063 Aff Number Occupancy Type
not more than five hundred dollars (5500).
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is nothimnded or offered for sale (Sec. 7044, Business
Required Inspections
and Professions Code: The Contractor's 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 forsale. 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 or
sale.'
4, as owner of the property, am exclusively contracting with licensed contractors to
-
construct the project (Sec. 7044, Business and Professions Code:) The Contractors U.
cense Law does not apply to an owner of property who builds or improves thereon, and
,
who contracts for such projects with a contractors) licensed pursuant to the Com ctota
License Law.
❑ I am exempt and ec. , B & P C for this Ignop
Owner _ Date fid
WORT R'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 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 far which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
"
Carrier, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is forone hundred dollars ($100)
of less.)
I certify thatt in the performance of the work for which this permit is issued, 1 shall not
employ any person in any mann J as to become object o Workers' Compensadon
Laws of California. Date ,
Applicant----•-
NOTICE TO APOPtANKarter making this Certific crof-C'xBfiTori,you should W
become subject to the Worker's Compensation provisions of the Labor Code, you must
'z, forthwith comply with such provisions or this permit shall be deemed revoked.
O CONSTRUCTION LENDING AGENCY '
I hereby affirm that there is a construction lending agency for the performance of
Hthe work for which this permit is issued (See. 3097, Civ. C.)
A Lender's Name
Lender's Address
CI 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
W above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
in againstsaid City
liabilities, judgments, costs and expenses which may any way accrue
Z in consequence of the granting of dti rmil. .i
Date �1
►- APPLICANT NDERST A WILL COMPLY WITH ALL NO POI
Issued by:
SOUR ULAn
- (016310D Re-roofs
02=1�_•-�—
ApplinWCootractorDa
ignat oT-
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)7All shall be inspected prior to any roofing material being installed.
Yes
roofs
❑
If a To 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?
[3 Yes
I have read the ha72rdous materials requirements under Chapter 6.95 of the Califor-
nizHealth&SafelyCode, Sections 255tO 25533and25534.1understandthatifthebuilding
does not cu rte e a tenant, a is my responsibility to notify the occupant of the
requireme mhmustbcm ortossnanee La•Ecrt1`IracTl"eof euP,%1� Signature of Applicant Date
"B"
All roof coverings to be Class or better