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CITY OF CUPERTINO;
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PERMIT NO.
10890 SANTA TERESA DR
CRAFTSMENS GUILD INC
08020104
:
SANITARY NO. CONTROL NO.
(408)366-1000
ARCHTTECr/ENGLNEFR:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions or Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
ADD 6 3 0 S Q TO " E " KTCHN& FAM RM
in full force and err
License Class Lic. N > 1
Date Contractor
ARCHITECTS DECL.ARATI N
61� 1.L
I understand my plans shall be used" public records b '
�M G
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the 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
.
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 Contractors License Law (Chapter 9
Sq. Ft. Floor Area
- Valuation
(commencing$ with Section 7000) of Division 3 or the Business and Professions Code) or
12 0 0 0 0
am he is exermpl therefrom and the basis for the alleged emmptioa Any violation or
Number
Occupancy e
p y'p
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (S500).
35613007 .``(
❑ L as owner of the property, or my employers with wages as their sole compensation,
Required Inspections
will do the work. and the structure is not intended at offered for sale (Sec. 7044, Business
and Professions Code The Contractors License Law does not apply to an owner of
property who builds or improves theroon, and who does sucb work himself or through his
own employers, provided tbat such improvements are not Intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, theowner.
huilder will have the burden or proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li.
cease Law does not apply to an owner or property who builds or improves thereon, and.
who contracts for such projects with a conuactor(s) licensed pursuant to the Contractors
Z- -
Licease Law
❑m I aexempt under See, , B k P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby ,from under penally of perjury one of the following declarations:
❑ I hive and will maintain a Certificate of Consent to self -Insure forwort¢raCompen.
salon. as provided for by Section 3700 of the labor Code. for the performance of the
work for which this permit is issued.
O I have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code• for the performance or the work for which this permit is Issued.
My Worker'
section need not be completed if the permit Is for one hundred dorlars ($100)
or lest)
I certify that in the performance of the work for which this permit is issued, I shall not
employ airy person in any manner so as to become subject to the Workers' Compensalon
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption• you should
become subject to the Worker's Compensation provisions of the labor Code, you must
forthwith comply with such provisions or this permit shall- be deemed rcvokrd.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is p construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097. Civ. C.)
Lenders Nana
.
L.cnder's Address
I certify that I have read this appiieuion 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 authorine 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 Cupcnino against
liahllides,judgments• toss and expenses which may In any way accrue against said City
,
in consequence of the granting or Ills permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH All. NON -POINT
Issued by: Date
SOURCE
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(U7
Yes
All roofs shall be inspected prior to any roofing material being installed.
El hytvo
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
colt hazardous air contaminants is defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
El Yes UQryc
i have read the hazardous materials requirements under Chapter6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 arul 25534.1 understand than if the building
does not currently
cr7w cox or
/./ ��sncy.
Signature of Applicant
Date
All roof coverings to be Class'P' or better
Date
Owner or authorized agent