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CITY OF CUPERTINO
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BUILDING DIVISION PER_ MIT
BUILDING ADDRESS:
BAY AREA SUNROOMS
PERMITNO.0 6 01012 4
10453 SCENIC CT
OWNER'S NAME:
PERMIT ISSUE DATE
GAIL
W 41ST AVE
04 05 2006
PHONE:
SANITARY NO. CONTROL NO.
(650)341-6201
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 70t10) of Division 3 of the Business and Professions Code, and my license is
ul full rnrce and err 42
PATIO ENCLOSURE (3 3 6 ' )
License I Lk. N
Date Contractor
ARCHITECTS DECLARATION
I understa d my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I 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 stneture
prior to its issuance. also requires the applicant for such permit to file a signed statement
he is licensed to the of the Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that pursuant provisions
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$ 3 0 0 0 0
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (S500).
❑ I, as owner or the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work and the structure is not intended or offered for sale (Sec. 7044. Business
and Professions Code: The Contractors L.icertse Law does not apply to an owner of
property who builds or improves thereon, and who doessuch work 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 or completion, the owner.
builder will have the burden of proving that he did not build or Improve for purpose of
'
sale.).
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions code:) Tbc Contntcmrs Li-
cense 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.
❑ 1 am exempt under Sec , B & P C 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 Workers Compen-
sation, as provided for by Section 3700 or 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 Labor Code, for the performance of the work for which this permit is issued.
'
My Wor Comp nsati n urance cartiu and Policy number arc:
Cartier Policy No.:
I
CER 1 CATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
I
(This section need not be completed if the permit Is for one hundred dollars ($I00)
or less)
I certify that in the performance of the work for which this permit is issued. I shall not
employ any person in any manner so as to become subject to the Workers Compensation
Laws of California. Date
Applieant
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption, you should
become subject to the Workces Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a consuucdnn lending agency for the performance of
the work for which this permit Is issued (Sec. 3097. Civ. C.)
'
Landers Name
Landers Address
I certify that I have read this application and sate that the above information is
correct I agree to comply with all city and county ordinances and sate laws relating to
building construction, and hereby audtorire 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
j liabilities judgments, costs and expenses which may in any way acauc against said City
in consequence of the granting of this permit.
' APPLICANT UNDERSTAN AND WILL COMPLY WITH ALL NON -POINT
/
Issued by: Date G/�" 6 `—
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SOU
Re -roofs
Type of Roof
Signature of
DOUS MATERIALS DISCLOSURE
the applicant or future building occupant store or handle material
Will hazardous
as Wined by the Cupertino Municipal Code, CEaptcr 9. It and the Health and Safety
Code, Scction25532(a)4
❑Yes
All roofs shall be inspected prior to any roofing material being installed.
L�"b
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 cd by the Bay Amu Air Quality Management
all new materials for inspection.
District?
❑ Yes u
I have mud the hasardous materials mequircmcnts under Chapter 6.95 of the Califor-
nia Health & Safely Code, Sections 25505.25533 and 25534.1 understand that if the building
does not c rrently have a tenon that it is my responsibility to notify the occupant of the
re ch rto. uanccofaCertificate ofOccupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or authorized gent D„c