B-2019-0710BUILDING PERMIT
CUPERTINO
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS:
OWNER'S NAME: ALAN YOUNG
OWNER'S PHONE: Not Provided
CONTRACTOR: OWNER - BUILDER
CONTRACTOR PHONE:
DATE ISSUED 11 /6/2019 2:47:16 PM
ISSUED BY: JARCHBOLD
VALUATION: $0
JOB DESCRIPTION
GARAGE AND LAUNDRY BACK TO ORIGINAL CONDITION AND REMOVE SPIRAL STAIRS TO ATTIC (320 SF); CONVERT ATTIC SPACE BACK TO
THE 1986 COUNTY PERMIT #61 138.
CONVERT THE ILLEGALLY CONVERTED
ORIGINAL CONDITION; FINALIZE
OWNER -BUILDER DECLARATION
two declarations:
as
with licensed
two declarations:
self -insure
this permit
of
revoked.
their role compensation, will do the work, and the structure
contractors to construct the project (Sec. 7044,
is not intended or offered for sale (Sec. 7044, Business
I hereby
affirm under penatly
I, as owner of the property,
Code).
of perjury one of the following
or my employees with wages
am exclusively contracting
of perjury one of the following
certificate of consent to
Worker's Compensation Insurance,
of the work for which
If, after making this certificate
this permit shall be deemed
le
& Professions
Business & Professions Code).
I, as owner of the property,
affirm under penatiy
I have and will maintain a
for which this permit is issued.
I have and will maintain
I certify that in the performance
laws of California.
with such provisions or
I hereby
for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the
le
work
as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
is issued, I shall not employ any person in any manner so as to become subject to the Worker's
exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith
issued.
Compensation
comply
HAZARDOUS MATERIALS DISCLOSURE
Chapter
Health
as
Code, Sections
for
6.95 of the California Health & Safety Code. Sections 25505. 25533. and 25534. I will maintain compliance
I have read the hazardous materials requirements under
the Cupertino Municipal Code, Chapter 9.12 and the
V
with
equipment
Municipal
& Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use
defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino
25505, 25533, and 25534.
this project.
Firm Certification No:
or devices which emit hazardous air contaminants
Code, Chapter 9.12 and the Health & Safety
An EPA Lead -Safe Certified Renovator will be responsible
Firm Name:
No EPA Lead -Safe Certified Firm is required for this project.
Certified
v
CONSTRUCTION LENDING AGENCY
lending agency for the performance of the work which this permit is issued (Section 3097, Civil Code).
Lender's Address:
I hereby
Yes
affirm
under penalty of perjury that there is a construction
No
V
Lender's
Name:
APPLICATION CERTIFICATION
and state that the
representatives of this
against liabilities, judgements,
will comply with all non -point
above
city to
costs,
source
C—.
011
.