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BUILDING DIVISION PERNM
BUILDING ADDRESS:
10361 MENHART LN
LICENsEDD CON'IRAMWS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (eammencmg
with Section 7000) of Division 3 of the Business and Professions Code. and my license is
in full force and effect.
License Clan Lie. r
Date Contractor
ARCHnECPS DECLARATION
I urAcrstand my plan shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's Ucense Law for the
following reason (Section 70313, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or mpair my wunure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is ueemsCd pursuant to the pmYWOnS of the eonu ewes Llcante Law (Chapter 9
(commencing with Section 7000 of Division 3 of the Business and Profession, Cade) or
taw he is exempt merer om and the basis for the alleged exemption Any vlolation of
Section 7031-5 by any applicant for a permit subjects ibe applicant to a civil penalty of
not moo: than five hundred dollars (2500).
❑ L as owner of the property, or my employers with wages as their sole compensatim
will do the wale and the structure is not intended or offered forsale (Sec. 7044, Business
and Professions Code: The Contractor, License Law does not apply to an owner of
property who builds «improves dinmon, and who dos sorb wort himselror through his
own employees, provided that such improvements we not inumded or offered forale. ff.
however. the building or improvement Is sold within one year of completes, the owner -
builder will haw: the burden of proving that he did not build or improvp for purpose of
KL as owner of the property, ern exclusively contracting with licensed contractors to
eruct the project (Sec 7044. Business and Professions Coda) The Contractors Li-
cense LAw does not apply to an owner of property who builds or improves thereon. And.
who contacts for such pmk= with a contractmt(s) licensed pursuant to the Contnntoes
I.►cenae yr
❑ 1 am ex PI err S B h P C forobis mason
Owns l/�--`
hereby atone under penalty of perjury one of the following declarations:
M I have and win maintain a CeniGcateof Consent to self -insure forWalters Compcn-
adon. as pov dcd for by Section 3700 of the Labor Cock, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation 1nsurAnce, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers Compeasadon Insarrance carrier and Policy number ere:
Policy No:
CERTIFICATE OF OE N—FrnON FROM WORIC ERS'
COMPENSATION INSURANCE
(This section need not be completed if the permh Is forone hundred dollars ($IO(l)
or less.)
f certify that in the performance of the work
became subject to the Workers Compensation provisions of the Labor Code. you must
forthwith comply with such provisions or this pecadi shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hemby affirm that there is a construction larding agency for the performance of
LLte work for which this permit is issued (see. 3097, Civ. C.)
Lzndds me Na
Lenders Address
I certify that I have read this application and stale that the shove Wormalioe is
coned I agree to comply with all city add county orcanances and sane laws mhning to
building coruuvction, and hereby authorize mp2,ematives of this city to ens upon the
above -mentioned property for Inspection ptttpomi
(We) agree to save, indemnify add keep harmless the Cry of Cnpenino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
In consequence of the granting of this permiL
APPLI ANT ERSTANDS AND
Will the applicant or future building occupant store or handle bma ndous material
as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code. Section 25532(a)7
❑ Yes �No
WIII the applicant or future building occupant use equipment or device which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
Diurtct7
❑ Yes No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505.25533 and 25534.1 utderau d that if to building
doe+ t haves a terurn. that It Is my msportdbility to notify thcoecupmt of the
requ nos m �'or to �
LN
08050161
FMAIf ISSUE DATE
07/08/2008
SANrrARY NO. CONTROL NO.
BUILDING PERMrr1NF0
Job Description
ONE STORY SFDWL—LIVING 1818',PORCH 121,ATTACHED
GARAGE 421'. SANITARY 'IS SUNNYVALE'S
JURISDICTION.
Ft. Floor Area
37515043
Re -roofs
Type of Roof
$250000
Required Inspections
Date
Type
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