08070013CITY OF CUPERTINO�'
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PERMIT NO.
20807 STEVENS CREEK BLVD
TBD — TO BE DETERMINED
08070013
OWNER'S NAME
PEIU,117 L%UE DATE
JOHN VOLCKMANN
07/31/2008
PHONE
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEE L
BUILDING PERMIT INFO _
BI.DG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Chapter 9
Job Description
I hereby ai that I am licensed under provisions of (commencing
with Section 700D)ofDivi'on3oCtMBuaineuaad onaCn e, myliceriseis
A—REFC EXTNG COL SGNS@ ENTRY (1) r B/C SML MNMNTS
Lkeneec `
Lieenae Cla IJe. r
—
RPLC EXTNG(5)& D RPLC DIRCTRIES (2) & F RPLC WL -
Date Contractor
ARCHITEC' S—" LARA710N
DIRCTRS (6) —ALL NON—ILLUM &M RSTRM PLAQUES
1 undcstand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
following reason. (Section 70313, Business and Professions Code: Any city or county
which requires a permit to construct, alter. improve, dernolish. or repair say structure
prior to its issuance, also requites 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 or the Business and Professions Code) or
$ 4 5 0 0 0
that he is exempt therefrom and the basis for the alleged exemption Any violation of
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a cavil penalty orA:PT4Number
not mote than five hundred dollars (S500).
32632051
❑ 1, as owner of the property, or my employees with wages u their sole compensation.
Required Inspections
will do the work, and the structure is not intended or offered for sale (Sec. 7D44. Business
and Professions code: The Contractors License Law does net apply to an owner of
property who builds or imprmes thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale_ If.
.
however. the building or improvernent is sold within one year of completion, rho owner -
builder will have the btuden of proving that he did not build or improve for purpose of
sale.).
❑ L as owner or the property, am =ciusivdy contracting with licensed emttmctors m
construct the project (Sec. 7044, Business and Professions Cede:) The Contracmrs I-
rone Law does not apply to an owner of property who builds or improves thereon. sad.
who contracts for such projects with a contractors) licensed pursuant in the Contracmrs
License Lew.
❑ I am exempt under Sec B & P C for this reason
Owner Due
WORKER'S COMPENSATION DECLARATION
1 herby affirm on under penalty of perjury e of the following declarations
I Gave and will maintain a Certificate of Consent to self -insure for Workers Compnr
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 Worker's Compensation Insurz=, as required by Section
370D or the Labor Code, for the performance of the work for which this permit Is issued.
My Workers Compensation Insurance airier and Policy number are:
-
Carrier. Policy No.:
CERTIFICATE OF EXEh4FnON FROM WORKERS
COMPENSATION INSURANCE
(This section need not be completed lithe permit is for one hundred dollars ($100)
or less)
1 certify that in the performance of.dne wo t for which this permit is issued. I shall not
employ an person in y magp subject to Worker' Compensation
Laws of Califotstia. e
Applicant
NOTICE TO APP . 1 making this Certificate of Exemption, you should
become subject to the We s pensadon provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked
CONSTRUCTION LENDING AGENCY
1 herby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097. Civ. C.)
Lenders None
,
Lenders Address
1 cerdry that 1 have read this application and suit Nat the above informadmi is
correct 1 agree to comply with all city and county ordinances Lod state laws relating to
building construction, and hereby a thorim representatives of this city w enter upon Lite
above -mentioned property for inspection purposes.
(We) apee to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs an peso which may its any way accrue against said City
ence of of This
grand permit
NT S AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
A71C
G S. -
7 l k
-
'P
Re -roofs
Type of Roof
Sign of ppl' ntractor Due
US MATERIALS DISCLOSURE
Vn
the ant or future building occupant store or handle ha ardos material
as defined by the Cupertino Municipal Code. Chapter 9,12. and the Health and Safety
5s3zta)?
Code, Section0Yes
All roofs shall be inspected to any roofing material being installed.
❑Yes �o
prior
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 defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes VNo
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor.
cry 505.25533 and 25534. I ontkrsmnd Thu u the buildinga
Uy arc a tern that its my maponsibility m notify the ex:eupant of the
��Ih
h e prior to issosece ors Crutificate or duty.
Signature of Applicant Date
/
All roof coverings to be Class in" or better
Owner d
or au gem re