08070141CITY OF CUPEKI'INU
BUILDING DIVISION PERK M
PERMIT
8070
BUILfft 1 �lERRIMAN RD C&S CONSTRUCTION SERVICES, 08070.
141
MISSION BLVD STE '629 07/29/2008
PHONE (510) 402-8422 SANITARY NO. CONTROL NO.
ARCHrrF=/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
C Zp LICENSED CONTRACTOR'S DECLARATION
m 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
< with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and efrect-
ZLicense Claw Lic. N
F;• c Dater Contractor
ARCHITECTS DECLARATION
i p I understand my plans shall be used as public records
. L)
O
y Licensed Professional
N OWNER -BUILDER DECLARATION
ii f I hereby affirm that 1 am exempt from the Contractor's License Law for the
0 following reason. (Section 70313, Business and Professions Code: Any city or county
which requires a permit to constnici, alter. improve, demolish, or repair any structure
t o rn za prior to is issuance, also requires the applicant for such permit to file a signed statement
that be is licensed parsumt to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 70M of Division 3 of the Business and Professions Code) or
drat he la er¢mpl therefrom and the basis for the alleged exemption. Any violation of
sm-lion 7031 S by arty applicant for a permit subjects the applicant to a civil penalty of
not mom than free hundred dollars (S500).
❑ L m owner of the property. or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for side (Sec. 7044, Business
and Professions Code_ Tire Contactor's License Law does not apply to in owner of
property who builds or improves thereon, and who does such wort himself or through his
owa employees, provided that such improvement& are not intended or offered for We, 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.).
❑ L m owner of the property. am exclusively contracting with licensed contractors to
concoct the project (Sec 7044. Business and Professions Code) The Conractor's Li-
cense Law does not apply to in °wrier of property who holds or Improves thereon, and
who contracts for such projects with a contractnr(s) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under . B & P C for n
Owner _ �L
^WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I its. and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, m 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 Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the wort for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number arc:
Carrier. Policy No-
CERTIFICATE OF EXEMPTION FROM WORKERS -
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less-)
I certify that in the performance of the work for which this permit is issued. 1 shall not
employ any person in my manner so yi�bC�NF s jc tgJhQyorf¢rs Comps sadoo
Laws of California. Date � [/ i7 h !1
Appliantc
N0710E TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you most
O forthwith comply with such provisions or this permit shall be deemed revoked.
V) CONSTRUCTION LENDING AOFNCY
I hereby affirm that Here is ■ construction lending agency for the performance of
> the work for which this permit is issued (Sec. 3097, Civ. C.)
0 Lender's Name
Z Lender's Address
J 0 1 testify that 1-have read this application and stun: that the above information is
'—' correct I agree to comply with all city and county ordinances and state laws relating to
UU building construction. and hereby mthorim representatives of this city to enter upon the
y above -mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
to liabilities, judgments, costs and expenses which may in any way accrue against aid City
,Z in consequence of the granting of this P=IL
�--^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-Po
SOURCE ONS. ID
Signature /D
Signature of Applicant/Contracior C� z /Dates
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant more of handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety
Code. Section 25532(a)7
❑ Yes hutNo
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants is defined by the Bay Area Air Quality Management
District?
❑yes
I have mad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building
does not currendy have a tenant, that it is my responsibility to notify the occupant of the
requhement& whi q usl be.
-TRUSS DETAIL FOR A-11C, STRAP
DETAIL/KETCH-2 ORIG #07030227 NO NEW PERMIT.
Sq. Ft. Floor Area
34216031 AJW Number
$ 0 Valuation
Required Inspections
Issued by:
��� �►����/I
Re -roofs
Type Roof
Type
Date .7`2- Jc
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'Ag ' or better