08060235CY OF CUPERTINO
BUILDING DIVISION
PERMIT
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Hu"MTF6-LENCOE DR REAL ESTATE BUILDERS INC 08060235
OWNER'S NAME: PERMIT ISSUE DATE
P 0 BOX 32568 09/29/2008
PHONE: SANITARY NO, CONTROL NO.
(408)829-2805
ARCHiiECT1FNGiNEER 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 70DO) of Division 3 of tie Business and Professions Code, and my Beane is
a ll ff wee and effG4t,
Date <7 Contract"
ARCHITECTS DECLARATION
I unrers aaun d my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby af<rm that 1 am exempt from the Coniracloes License Law for the
following reason. (Section 7031.5. Business and Professions Code: Any city of county
which requires a permit to construct,,alter, improve, demolish, or mpair 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
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he Is exempt therefrom and the basis for the alleged exemption Any violation of
Section 70315 by any applicant for a permit subjects the applicant to a civil penalty of
not more thaa five hundred dollars (350f1).
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
will do the worts, and the am== is not intended or offered fro sale (Sec. 7044, Business
and Professions Code: The Contractor's L icutse Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. ff,
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 pexrsed conasclors to
construct the project (See:. 7044. Husiness and Professions Code:) ile Coatractoes 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 Convector's
License Law.
iZ I am exempt under Sex , B & P CC for this nrsaon
Date 7 Z-fk
WORKER'S COMPFNSA71ON li>�'ION
i hereby affirm under penalty of perjury one of the following declaAadr
❑ I have and will maintain &Certifiate of Consent to self -insure fun 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 have and will maintain Workers Compensation Innuartce, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is Lssued
My WorWees Compensation h,surance carrier and Policy number are:
Carrier, Policy No.:
CERTihlCAT'E OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('this section need not be completed If the permit is fun one hundred dollars ($100)
or less.)
1 certify that in the performance of the work for which this permit Is Issued, i shall nut
employ any person in any manner so as to become subject to the Worked Compeaudon
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensttion provisions of the Labor Code, you must
forthwith comply with such provisions or this peanit shillbe deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby alarm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec- 3097, Clv. C)
Lenders Name
Lenders Address
i certify that i have read this applieatom and state that the above information is
correct, I agrtt w comply with all city and county ordinances and state laws relating to
building convection, and hereby authorve representatives of this city to enter upon the
abovrmentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, coos 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
SOURCE REGULATIONS.
Signature of ApplianVC.r,Uacior Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store "handle hrmrdous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)7
❑Yes $4No
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
District? �r
❑ Yes gj No
I have read tfe hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safely Code, Sections 25%5, 25533 aril 25534.1 understand that if Ube building
does not currently have it tenant. that it is my responsibility to notify ft occupant or the
sect cots which must M met prior to issuarhce of ■ Crrtificetc of Om ry.
9290
Owner or authorizrA agcm - Date
BUILD FENCE 158
BBQ/KITCHE/PATIO
Sq.
32630138.V° '
Issued by:
Re -roofs
Type of Roof
Job Description
LINEAR FT, SWIMMING POOL (650') &
(576').
$ Valuation
65000
Occupancy Type
Required Inspections
Date
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 'A" or better