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08040163.7 C 5 Or C UC wF OL �a UZ CITY OF CUPERTINO BUILDING DIVISION PERMIT��F`Ffi1�77: .; BUILDING ADDRESS: 10056 ORANGE AVE TBD — TO BE DETERMINED PERMIT NO. 08040163 SANrrARY NO. CONTROL NO. ARCFII7EC.T/ENGINEEIL BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby drum that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prorcssiom Code, and my license is DEMO SINGLE FAMILY RES. & GARAGE —NO EXCAVATION in full fora and effect License ClanLk. • UNDER THE OAK TREE PERMITTED PER PLANNING, Dale Contractor - ARCHITECCS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.S, Business and Professions Code: Any city or county which requires a permit to construct, idler, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed stalarn L licensed to the the Contractor's License Law 9 Sq. Ft. Floor Area Valuation that he is pursuant provision of (Chapter g 5 0 0 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basic for the alleged exemption. Any violation of Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil pemlty of not more than five hundred dollars (S5W). 35717058.V(34 ❑ L as owner of the property, or my employees with wages as their sale compensation. Required Inspections win do the work. and the structure is not intended or offered for sale (Sec. 7044, BusinessR and Professions Cede: The Contractor's Licensee Law does not apply to an owner or 9 P Property who builds or improves thereon, and who does such wort himself or through his cow employees. provided that such improvements art not intended or offered for sale. II. 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 or sale.). as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) TTte Contractors Li- cense Law does not apply to an y who builds or improves thereon, andwho contracts for such projects n s) licensed pursuant to the Contractors Tha License Law, ❑ 1 am exempt , B & P C for this reason Owner Da a WORKER COMPENSATION DECLARATION 1 hereby dram under ty of perjury one of the following declaradortt ❑ I have and will maintain a Ceni5cats ofConscm to seif-Inure 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. , ❑ 1 have and will maintain Worker's 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's Compensation Insurance carrier and Polity number am: Carrier. Policy No.: CERI IFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (i2tis section reed rmt be completed if the permit is for one hundred dollars ($100) or lets.) 1 certify that in the revoked. CONSTRUCTION LENDING AGENCY 1 hereby alrum that there is t construction lending agency for the performance of dic work for which this permit is issued (Sec. 3097, Civ. C.) Lenders Name Lender's Address I anify that I have read this application and state dw the above information is correct 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorm representatives of this city to enter upon the above-mendoned property for inspection purposes. (We) agree to save, indemnify and harmless the City of Cupertino against j Iiabilities,Judgmonts, costs and expenses i may in any way acauc against said City in consequence of the granting of APPLICANT UNDER ILL COMPLY WiTH ALL NON -POINT Issued by: Date - SOURCE REGUTA71 Re roofs �e Type of Roof —� Signature of AppliandContrau to HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hamrdous materiel as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code. Section 25532(a)? ❑ Yes 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 WIII the applicant or future building occupant use equipment or devices which emit ha-rardon sir contaminants as damned by the Bay Area Air Quality Management all new materials for inspection. District? ❑ Yes No. 1 have read the ous ma s iremcnts under Chapter 6.95 of he Califor- niaHcalth &Safety Cade. 3 and 25534.1 urtdrswnd thatir the building does not currently my responsibility to notify the occupant of the rtquiremcntswh' tbixoraCrnifieatcnrOccu Signature of Applicant Date All roof coverings to be Classor better Owner or authorr7ed agcn .