07120209BUILDING DIVISION PERNUT
BUILDING ADDRESS: - PERMIT NO.
1024 BUBB RD TBD - TO BE DETERMINED 07120209
OWNER'S NAME: PERMIT ISSUE DATE
04/25/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHIIECTIENGTNEER: BUILDING PERMIT INFO
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LICENSED CONTRACTORS DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 7001p of Division 3 of the Business and Professions Code, and my license is
in full foss and effect -
License Class Lic s
Date Contractor
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER-BUMDER DECLARATION
I hereby affirm that I am exempt from the Contractors License law for the
following reason. (Section 703IS, Business and Professions Code: Any city or county
which requires a permit to construct, alter. 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
(commencing with Section 7000) of Division 3 of the Businesa and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 70315 by M' applicant for a permit subjects the applicant to a civil penalty of
not more thaw rive hundred dollars (S500).
❑ L as owner of the property, or my employees with wages as their sole compensation,
win do the work. and the structure is not intended or offered for mie (Sec. 7044, Business
and Professions Code: TLe Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such wort 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.).
CUits owner of the property. am exclusively connoting with licensed contractors to
construct the {reject (Sec. 7044, Business and Professions Code:) The Connetoes Ll-
ccuse Law does not apply to an owner of property who builds or improves thereon, and,
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ 1 am exempt under Sec, , B & P C for this mason
Owner Date
ORK17t5 COMPENSATION Dr�LARA7ION
1 hereby affirm under penalty of perjury one of the following deciandons:
❑ I have and will maintain &Certificate of Consent to self -insure for Worter'sComperr
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation insurance, as required by Section
3700 of the Labor Code, for the performance of the wort for which this permit is issued
My Workers Compensation Insurance carrier and Policy number are:
Policy No.:
c5rr iCATE OF EXEMPTION FROM WORKERS
COMPENSATON INSURANCE
(This section need not be completed lithe permit is for one hundred dollars (S100)
or Ims.)
1 certify that in the performance of the work for which this permit is Lutred, I shall not
employ any person io any manner so u to Irecoroc sat t to the Workers' Compensation
Laws of Cadiforrda. Date�,�� �-
Applicant
NOTICE TO APPLICANT: If. after mating this Certificate or Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code. you mew
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUC7ioN LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
the wort for which this permit Is issued (Sec. 3097, Civ. C)
Lender's Name
Lenders Address
I certify that I have sad 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 authorise representatives of this city to enter upon the
above -mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments. costs and expenses which may in any way acesve against said City
In consequence of the granting of this permiL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Signature of Applicaml/Contraaor Date
HAZARDOUS MATERIALS DISCLOSURE
WIII the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Codc. Chapter 9.12. and the Health and Safety
Cade, Section 25532(a)?
❑Yes 9.0
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as den d by the Bay Area Air Quality Management
District?
❑ Yes o
I have read the hazandous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25305.25533 and 25534.1 understand that if dre building
does not currently have a tenant drat It is my responsibility to notify the occupant of the
requirements which must be met prior to issuance of a Ccnikatc of Occupancy.
Owner, or suthorbrd aunt Date
Job Description
ADD NEW KITCHN,FAM RM, MSTR BDRM & BTHRM=835SQ
ADDTN &CNVRT KTCHN AS BDRM
Ft. Floor Area
36204021. P Number
Issued by:
Re -roofs
7pe of Roof
$100000 Valuation
Required Inspections
Occupancy
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.
Signature of Applicant Date
All roof coverings to be Class 'A' or better