08040172BUILDING DIVISION PERMIT
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BUILDING ADDRESS: PERMIT NO.
7984 WOODLARK WAY TBD — TO BE DETERMINED 08040172
OWNER'S NAME: PERMIT ISSUE DATE
04/24/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHrrECrfENGINEER BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 70DIn of Division 3 of the Business and Professionss �Code, and my licuoc is
a full force and effect �2r
acenae�l — Lie. N
)ate CAnaaaor
ARCHr1ECrS DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby alfrrm that 1 am exempt from the Contractor's License Law for the
'ollowing reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires it permit to construct, alter, improve, demolish, or repair any mature:
prior to its issuance, also requites the applicant for such permit to rile a signod Statement
drat he Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 70D0) of Division 3 of the Business and Professions Code) or
Chas he Is exempt Ihorefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mote than five hundred dollars (S500),
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 Contractor's License Law does Dot apply to an owner of
property who builds orimproves heroon, and who does such work himadf or through his
awn employes, 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 cite burden of proving that he did not build or improve for purpose of
sale-)_
L as owner of the property. am exelusively,eontnrxing with lioansed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li-
ccnse Law dots 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 Contractor's
Urense Law.
❑ I am exempt under Sec , B & P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 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 Compcn-
sadon, as provided for by Section 3700 of the Labor Code, for the performancc of the
work for which this permit is issued.
M I have and will maintain Worker's ComprnsaUon Insurance, as required by Section
3700 of the Labor Code. for the performance of the work for which this permit is Issued.
My Workeerr�'s Compensation carrier and Policy number are: )�
Policy No.:�-(527'KJ ,
CERTIFICATE OF EXEMPTION FROM WORKVS
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S 100)
or Ices)
1 certify that in the performance of the work for which this permit is issued, I shall not
employ arry person in any manner so as to become subject to the Workers' Compensation
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 revoked.
CONSTRUCTION LENDING AGENCY
I hereby arum thu there is a constrtretinn lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
i certify that 1 have read this application and state that the above information is
comet I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby author m 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, judgments, toss and expenses which may In any way accrue against said City
In consequence of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WiTH ALL NON -POINT
SOUR�
store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Cork, Section 25532(a)? [3Yes /,,go
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Managemcm
District?
[3 Yes
1 have read the harardous materials requirern nu under Chapter 6.95 of the Califor-
nia Health & SafetyCodc- Sections 25505.25533 and 2.5534.1 understand that if die building
does not currently have a tenant that it is my responsibility to notify the occupant of the
requircm�nts which must be met prior to issuance of a Certificate of Occupancy.
SFDWL DEMO
Sq. Ft. Floor Area
36204036.TNumber
Issued by:
Re -roofs
Type of Roof
Job Description
$ 2 0 0 0 0 Valuation
Occupancy Type
Required Inspections
Date 30 , 6 �
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.
Signature of Applicant Date
All roof coverings to be Class '%" or better