08030031CY OF CUPERTINO
BUILDING DIVISION PERK UT
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ARCHTIECTIENGLNEER:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am liceokd under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Buavxs and Professions Code, and my license is
in run force sand effect.
License, Class
Date Contractor
AREF ECI-S DECLARATION
I understand my plara shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby afliirm that i am erompt from the Contractors License Law for the
following reason- (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct. alter. imprum demolish, or repair 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 Con uwtors License Law (Chapter 9
(commencing with Section 70D0) of Division 3 of the Business and Professions Co(e) or
that he is exempt therefrom and the buss for the alleged exemption. Any violatian of
Section 7031.5 by arry applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars WOO).
❑ L as owner of the property. or my employces with wages as their sole compensation,
will do the work, and the structure is not intended or offered for Zak (See- 7044. Business
and Professions Code, The Contractors I kense Law does not apply to an owner of
property who builds orimproves thereon, and who does such work himself or thsoegh b4
own employees, provided that stch improvements are not inteded oroffesed forsaki. if.
however. the building or Improvement is sold within one year of completlae. the owner -
builder will have the burden of proving that be did not build or Improve for purpose of
sale.).
C!rL as owner of the property, am =cl Wvely contracting with licraaed contractors to
construct the project (See. 7044. Busirxs and Professions Code:) The Contractors Li -
cease Law does am 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 Contractors
L iceme Law.
❑ I am exempt unA Se;- 8 h P C for this mama
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I hereby aditm under penalty of perjury one of the following declarations
1 have and will maintain a Certificate of Consent to self-Insum for Warimes Canpew
setion, as provided for by Section 3700 of the Labor Cede, for the Performance of the
work for which this permit is Lssu d.
0 1 have and will maintain Workes Compensatim itwuance, as required by Section
3700 of the Labor Coo, for the performance of do weft for which this permit is Issued.
My Work&& Compensation inmmance carrier and Policy number are.:
Policy No.:
CERTIFICATE OF EXEMPITON FROM WORKERS?
COMPENSATION INSURANCE
(ntis section need not be campkwd If the permit is forone hundred dollars ($100)
or lest)
1 certify that in the performance of the work for which this permit is issued. 1 shall not
—ploy any person in any manner so as to the Wormers' Compensation
Laws of Caltfor»L Due
Appli
become subject to the Workers Compensation provisions of the Labor Code, you mum
forthwith comply with such provisions or this permit shall be deemed mroked.
CONSTRUCTION LENDING AGENCY
1 hereby afnim that them Is a contraction lending agency for the performance of
the whet for which this permit is isued (Sec. 3097. Civ. C)
Lenders None
Lenders Address
I verify that I have read dds application and state thnu the show in onnation Is
correct. I agree to comply with all City And County Mdlmrcq and stale laws muting to
building construction, and hereby authorize representatives of this city to enter upon the
,rove -mentioned property for inspection purposes
(We) agree to save, indemnify and keep hannicas the City of Cupertino against
Ilabilltles, judgments, cow tad expenses which may in any way accrue aping said Clty
in consequence of site granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WiTH ALL NON -POINT
SOURCE REGULA ONS
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signature o deam/
DISCLOSURE
Will dw applicant or future budding ocrnpent store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code, Section 25332(a)7
❑ Yes EffNo
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as dcOned by the Bay Area Au Quality Management
DisurictT
❑ Yes fsl'No
1 have read Ure h—rdous maerials requhcn em miler Ompter6.95 of the Califor-
nia Health & SafctyCode, Stcdaus25505.25533 ad 25534. I understand thatif the building
does not currently have a eaam, IhM it is my responsibility to notify the occupant of the
requremcntz hicb NO t be met prior to issuance of a Certificate of Occupancy.
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08030031
PERNirr i5R M DATE
07/10/2008
SANITARY NO. CONTROL NO.
BURRING PERMrr INFO
BLDO ELECT PLUMA
Job Description
NEW 2 STORY DUPLEX W/ATTAHCED GARAGE 3,676 SQ
FOOTAGE. 10638 & 10640 MERRIMAN RD.
Ft. Floor Area
34216075.
$500000
Required Inspections
a1 �r�__ '
Re -roofs
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