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CITY OF CUPERTINO
BUILDING DIVISION PERNHT
BULN
L �'(�TS WAY
BC ELECTRIC AKA LIFETIME
PERMIT NO.
08040021
OWNER'S NAME:
PEramISSUE DATE
ECI TWO RESULTS LLC
308 S ABBOTT AVE
04/03/2008
PHONE:
(408)719-8644
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MI CIi
0 o a a
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
fe '
Job Description
INSTL 4 RPLCMNTS
with Section 7000)ol'Division3oftheBusiness and s ,andmylicenscis
in full fore an effeei3i j�
& PWR FOR COOLING UNIT
t
License Ci v Lic. p
Date Contractor
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's 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, dcmoltsh, or repair any structure
prier 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
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$16 5 0
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
3 592 0042 Number
Occu
QCCll pancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (ssoo).
❑ i, as owner of the property, or my employees with wages as thew sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
Required Inspections
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employers, 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.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li-
.
cense Law does not apply to an owner of property who builds or improves thereon, and.
who contracts for such projects with a contractors) licensed pursuant to the Contractor's
License Law.
❑ 1 am exempt under See. , B & PC for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
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 Worker's 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 avc and will maintain Workcfs Compensation Insurance, as required by Section
37 of the Labor Code, for the performance of the work for which this permit is issued.
'
My Workers Compensation Insurance carrier and Policy �n�urr/�� c/�
"4 e
��
Carrier.eAl ` Polity Ni.: ]Ly v
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S100)
or Icss.)
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
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 revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction )ending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
-
L.endces Name
,
Lender's Address
1 certify that I have mad 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 conawction, and hereby authorize 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,judgmcnts, costs and expenscs which may in any way accrue against said City
in consequence of the ring o is permit.
APPLICA ND N AND W1L COMPLY WITH AL O -POINT
Issued by: Date
SOUR
Re -roofs
Type of Roof
SiWContractor Date
AZARDOUS MATERIALS DISCLOSURE
antor futurebuilding occupant store or handle hazardous materialas
ertino Municipal Code. Chapter 9.12. and the Health and Safety
Code, SecYcs 25532(a)?
All roofs shall be 'inspected prior to any roofing material being installed.
No
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
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection,
District? q �,
❑Yes BfNu
1 have read the hazardous materials requirements under Chapter 6,95 of the Califor•
niaHealth & Safety Code,'Seerions25505,75533and 25534,1understand that ifthc building
does not cueen y ha n that it is my responsibility to notify the c ant of the
requiremen 'c et prior to issuance of a Certificate of Oc
Signature of Applicant Date
All roof coverings to be Class'" or better
Own oo d agent Date