Loading...
07030313CITY OF CUPERTINO 7� BUILDING DIVISION PERNHT BUIL.DjN�j t"grr, 10 5 9 6 N TANTAU AVE OWNER'S NAME: VERITAS PROPERTY MGMT PHONE ARCH11EC (ENGINEER: z 00 p LICENSED CONTRACTOR'S DECLARATION v F I hereby affirm that i am licensed under provisions of Chapter 9 (commencing cwith Section 7000) of Division 3 ofihc Business and Professions Code, and my license is in full force and affect ' zLicense C a Lie. N v F- ❑ Dale Contractor ARCHITECTS DECLMMTON aa I understand my plans shall be used as public records pU O Licensed Professional "I OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the 0 8 following reason. (Section7031-5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repass any structure z r prior to its issuance, also requires the applicant for such permit to file a signed statement that be is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 F (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 civil penalty of not more than five hundred dollars (S5(10). ❑ 1, as owner of the propercy, or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thercon, and who does such work himself or through his own employers, provided that such improvements 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.). ❑ I, as owner of the property, am exclusively contracting with licensed conuactora to construct the project (Sec. 7044, Business and Professions Code:) The Cootnaor's Li- ccase Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a conuactor(s) licensed pursuant to the Contactors License Law. ❑ I am exempt under Sec , B & P C for this reason Owner Date WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations.. ❑ I have and will maintain a Certificate of Consent to self -insure for Workers 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 Work Co .: Z� C R Fl A F XEMPTION FRO RKERS' COMPENSATION INSURANCE (Ibis section need not be completed if the permit Is forone hundred dollas (5100) or less.) I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workers' Compursadon Laws of California Date Applicant NOTICE TO APPLICANT: It, after. making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCrioN LENDING AGENCY F-+ I hereby affirm that there is a construction lending agency for the performance of (S; the work for which this permit is issued (Sec. 3097, Civ. Q Lrj Q Lenders Name az Lenders Address U 0 1 certify that 1 have read this application and stale that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to U building construction, and hereby authorize representatives of this city to enter upon the W above -mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against rF--i liabilities, judgments, costs and expenses which may In any way accrue against said City U z in consequence of the granting of this permiL .--r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SRAn ��� Signata°re of Applicant%Conuactor r 1,Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupantstore or handle hazrardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? C:] Yes CEO Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as dcfncd by the Bay Area Air Quality Management Disvict? ❑ Yes ❑Z9— I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Coda Sections 25505.25533 and 25534. I understand that if she building does not Lly have a tenant, that it is myresponsibility tonotify tine occupant of the rcyuirc n t rc mus be mu rior I.,— of a Ccnifica of upa[rcy MV Owner or authorized agent ~ IDaic PERMIT NO. TBD - TO BE DETERMINED 07030313 FI RM17 ISSUE DATE 08/01/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG . ELECT PLUMB Job Description SEISMIC RETROFIT -ROOF SUB DIAPHRAGM & CONTINUOUS CROSSTIES Sq. Ft. Floor Area 31618035 "F Re -roofs Type of Roof $30000 Required Inspections argimerAky 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 "B" or better