07060110BUILDING DIVISION PERMIT
NE CT LOT 1
:
ARCHITECT/ENGINEER:
c Zp LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 70(10) of Division 3 of the Business and Professions Code, and my license is
y in full force and effect
Z License Class Lie. a
Date Contractor
ARCHITECTS DECLARATION
= < I understand my plans shall be used as public records
>yU
Licensed Professional
0 11 OWNER -BUILDER DECLARATION
t 2 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
. p Oe� following mason. (Section 7031.5, Business and Professions Code: Any city or county
q li which requires a permit to construct. alter. improve. demolish, or mpnir any structure
r — y prior to its issuance, also requires the applicant for such permit to file a signed statement
i ? 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 arty applicam for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (ssilm-
❑ 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 sale (Sec. 7044. Business
and Professions Code: The Contractors Ucrnse 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 arc not itimnlied 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 riot build or improve for purpose of
We.).
❑ 1, as owner of the property, am exclusively contacting with licensed contractors to
construct the project (Sec 7044. Business and Professions Code:) The Contractor's Li-
ccase 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 Contractors
License Law.
❑ I am exempi under Sec B & P C for this reason
Owner __ --', Due (Ili -
WORKERS CAMPENSAno ECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Consent to self -insure for Workers 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 Workers Compensation Insurance, as required by Section
3700 of the (tabor Cod:, for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(this section need not be completed if the permit is far one hundred dollars ($100)
or less.)
I anify that in the performance of the work for which this permit is issued. I shall not
employ any person in
Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
.J z forthwith comply with such provisions or this permit shall be deemed revoked.
z O
fiCONSTRUCnON LENDING AOENCY
.� .r
F-n 1 hereby affirm that them a><eonswction lending agcrury for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C-)
Lenders Name
= z Lender's Address
(,) 0 1 certify that 1 have read this application and state that the above information is
LT. E agree to 1 agto damply with all city and county ordinances and sate laws relating to
0 LE
construction, and hereby authome representatives of this city to onto upon the
a above -mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
►F-e liabilities, judgments. costs and expenses which may in any way accrue agaloat said City
U 7 in consequence of the starting of this Permit.
s APPLICANT UNDERSTANDS AND
MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hrzardous material
as dellned by the Cupertino Murricipal Code, Chapter 9.12, and the Health and Safety
Cod:, Section 25532(a)?
❑ Yes fS7 No
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
District?
❑ Yes NNo
TBD — TO BE DETERMINED
PERMIT NO.
07060110
PERMIT ISSUE DATE
06/11/2008
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Job Description
SFDWL-2 STORY 1,753' PATIO 287', GARAGE 432'.
TOTAL 2,472,
PERMIT APPLICATION EXPIRED 12/14/07—EXTENSION
Sq, Ft. Floor Area $18 0 0 0 0 Valuation
316 4 7 017 .W Number
Required Inspections
Issued by:
Re -roofs
Type of Roof
Occupancy Type
Date v ��
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.
1 have mad the hazardous materials requirements under Ciapter 6.95 of the Califor-
nia Health & Safely Code, Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a rename. that it is my responsibility to notify the occupant of the
requirements which must be met prior .
�_ „ . , _ Signature of Applicant
Owner or authorized agent ( ) Date
Date
All roof coverings to be Class's" or better