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08050126CITY OF CUPERTINO w �x BUILDING DIVISION PERNIIT s TBD - TO BE DETERMINED HunTT4''TP INGTON LN PEItMrr NO 08050126 OWNER'S NAME: PERMIT IMUF DATE 07/14/2008 PHONE: SANrrARY NO. CONTROL NO. ARCHiIFCT'lENGINE13l: BUILDING PERMIT FNFO BLDG ELECT PLUMB MECH UCENSED CONTRACTORS DECLARATION Chapter 9 Description I p mencing I hereby affirm that I am licensed under provisions of (commencing wWaSection7000)ofD' n3ofthatBusiness and Professionscode, and myBeeneis ADD 831SQ 2NDFLR 3BD, 2BTH& RMDL 1,486 SQ mLicenfull se class�etfea. Lk.s 3 KTCHN, BATH, LAUNDRY, FAMILY/LIVING ROOM. NEEDS Dam /mil a/r _ a rrECCrSS DECLARATMN DEMO I understand my plans shall be used u public records PERMIT. L.K=sed Profesdauul OWNER -BUILDER DECLARATION I hereby affirm tbst I am exempt from the Contractors License Law for rho following reason. (Section 70313, Business and Professions Code: Any City Or county which requires a permit to castmct, alter. Improve, demolish, or repair any Wxr:oun prior to its inusoce. allso requires the applicant for such permit to flic a signed sulemem the he is licensed Pursuant to the povWm of the Contractors License I" (C'hwa 9 Sq. Ft. Floor Area Valuation (commencing with Section 70()0) of Division 3 of the Business and Processions Code) or $ 4 0 0 0 0 0 dot he is exempt therefrom and the basis for the alleged exemption. Any vlDWlaan or Section 7031.5 by any applicant for a permit smbjecu the applicant to a civil penalty of � '.p� Number Occupancy Type 3 6204 0 31 not more that few hundred dollars(15Wo .• d�V ❑ 1, u owner of the popaty, or my =Play= with raga as their sole compensation, will do the work, and Ibe sauctume is not Intended or offered for sile (Sat. 7044, Business Required Inspections and Professions Code: The Contnctces I kanse Law does et apply m an owner or property who builds or improves dtaeon, and who does such wort himself or throegh his own employees, Provided Chu such Improvements me not intended or offered for sale.14 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 impove for purpose of tab.). ❑ 1. as owner of the property. um exclusively contracting with licensed emtraeton to construct the projeci (Sat. 7044. Business Lod Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and, who conusets for such projects with a contractor(s) licensed pursuant to the Contracto's License Law. ❑ I son exempt under Sec B R P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following dedaratbsns ❑ I have and will maintain a Casniricam of Consent to self -insure for Workers Compen- sation. as Provided for by Section 3700 of the Labor Code, for the performance of the wort for which this permit is Issued ❑ 1 have and will maintain Workers Compensation Insursnnce, as required by Sectiau 3700 of the Labor Code, for the performance of the wort for which this permit is issued. d Policy number �� need not be completed if the permit is for one hundred dn0ata ($1011) or less.) I certify that In the performance of the worts for which this permit is issued. I shill not employ any person in any maser so as to became subject to the Worked Compensadon Laws or California. Dam Applicant NOTICE TO APPIJCANT: If, after making this Cadficue of Exemption. you should become subject to the Workers Compensation provisions of the Labor Code. you must forthwith comply with such pruvisbns or this pesoit shall be deemed revoked CONSTRUCTION LENDING AGENCY I hereby affirm that them is a constnaetae lending agency for the performance of the work for which this permit is issued (Sat. 3097, Civ. C.) Larders Nano Lender's Address I certify that I law read this application and state that the above information is correct I agree to comply with all city and county ordinances Lnd auto laws neWLtg to building construction. and hereby authorise representatives of this city to emu upon We above -mentioned p aperty for uupecdon purposes. (We) agree to eve, indemnify and beep harmless the City of Cupertino against Iablfitks.jodgmah�coustudo t6u� which may in anyway accrue agalnslaaki City consequence gun g permit APPLICANT UND ANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date OM. Re-roofs Signature or Of Roof Will the applicant or future building axvpaot sloe or handle haaudous mamrial as dellnod by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety Code , season 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑'�' If a roof IS installed without first obtaining an inspection, I agree t0 remove Win the appi ant or fuume building occupant use equipment or devices which emit hazardous air contaminants as defied by the Bay Area Air QualHy Management all new materials for inspection. District? ,,..,,((�� ❑Yes v2_ I have read the hasardous malcrisis requirements under Chapter 6.95 of the Califor. nia Health six Safety Code Sections 2550, 23533 and 2SM4. I understand that if the building does not currently have a trnwK Chu It is my responsibility to notify the occupant of the '°r"``""""ac`"i"L ` bSignature ofApplicant Date ��msgcbc All roof coverings to be Class'?r or better Dare