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CITY OF CUPERTINO
BUILDING DIVISION PERNIIT��R#tal
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"'I' icyAp[�RERERRITT DR
M.�:
HOLT ENTERPRISES
0 MITNO. 4
OWNU'
SPRINGER WAY
01/30/2008
PHONE
(408) 655-6459
SANITARY NO. CONTROL NO.
ARCHITECr/ENGTNEER
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby licensed Chapter 9
Job Description
affirm that I am under provisions or (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my Berme is
RMO DL MSTR & HALL BATHRMS
in full force and effect
-
ueense IJc. !
Date — Contractor
ARCHITECIB DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER-BUTLDER DECLARATION
1 hereby affirm that 1 am extmmpt from t60 Contractors License Lew for the
following mason. (Section 7031-5, Business and Professions Code: Any city or county
which inquires a permit to construct, alter, improve, demolish, or mpalr any svuctme
prior to its issuance. also requires the applicant for such permit to file a signed statement
that he is licensed purstuint to the provisions of the Contractor's Liceiuc Law (Chapter 9
Sq. Ft. Floor Area Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
2 0 0 0 0
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a &A penalty of
316 3 310 2 Number Occupancy
P y T'Pe
not inner man five hundred dell= (ssao).
.
❑ L as owner of the property. or my eroploycea with wages as their sale compensation,
will do the work and the smictum is not intended or offered for sale (Sec. 7044, Business
Required Inspections
and Professions Code The Contractor's L.ivense Law does riot 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 tmprovemems 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 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 licensed contractors to
.
construct the project (See. 7044, Business and Professions Code-*) The Contractor's Lb
terse Law does not apply to an owner of properly who builds or improves thereon, and .
who contracts for such projects with a contractor(s) licensed pursura to the Contractor's
ucenae Law.
[31 am exempt under Sec. , B & P C for this mason
Owner Date
WORKER'S COMPENSA71ON DECLARATION
�t�ereby aQum under penalty of perjury one of the following declarations
C—!,`have and will maintain a Certificate of Consent to xlf-insure 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.
❑ I have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued
'
My Worker's Compensation insurance carrier and Policy number am:
Carrier. Policy No=
CERTIFICATE OF h7CEMPTION FROM WORKERS'
COMPENSATION INSURANCE
,
Onus section need rot be canpkicd if the permit is for anc hundred dollars ($100)
or less)
1 certify
NOTICE uCAM: i<, after making this Ccrtifcatc of Excmp on, you should
become au the Workers Compensation provisions of the Labor Code, you rtnW
forthwith co y with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a co suixdon lending agency for the performance of
the work for which iris permit Is issued (Sec- 3097, Civ. C.)
-
I.ders Name
Lenders Address
I certify that I have read this application and sure that The above information is
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correct. I agree to comply with all city and county ordinances and stale laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
above -mentioned property for inspection purposes
(We) a ice to saw, indemnify and keep harmless the City of Cupertino against
abbliti ju ors, toss and expenses which may in any way accrue against said City
co o the granting of permit
PPLI
Type of Roof
Will the applicant or future building occupant store or handle haardou s malwW
ared by the Cupertino Municipal Code. Chapter 9. T2, and the Health and Safety
Code, Section 532(a)7 ,�
All roofs shall be inspected to any roofing material being installed,
❑ Yea CE,No
El
prior
If a roof is installed without first obtaining an inspection,agree to remove
Will the applicant or future building oavpant use equipment or devices which
emit ha-rudous air contaminants as defined by the Bay Area Air Quality Management
.I
all new materials for inspection. -
Disuict7
❑ Yes No
Ihave to ichaurdousmarcrialsmtpubcm umdcrChapter6.95ofiheCalifor-
nia Heal th & Saf ode, Sections 25505, 25533 and 25 " 1 understand that if the building
ere a IenanL met It is my ility to nodly the occupant of time
Vno,
root coverings to be Class "B" or better