07050273BUILDING DIVISION PERMIT
BUILDING ADDRESS:
10405 WUNDERLICH DR
:
ARCHITECT/ENGINEER:
30 LICENSED CONTRACTOR'S DECLARATION
J 1 hereby dfrno that f am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Divsion 3 of the Business and Professions Code, and my license is
y in full tone and cff=L
z License Class Lic. 0
F Date Contractor
ARCHTTECPS DECLARATION
1 understand my plans shall be used as public records
aV
U. t7, Licensed Pmfcssional
y g OWNER -BUILDER DECLARATION
I hereby alTtnm that I am exempt from the Contractors License Law for the
C ooG following reason. (Section 7031.5. Business and Professions Code: Any city or county
li which requires a permit to construct. alter, improve, demolish, or repair any structure
Z y prior to is issuance, also requires the applicant for such permit to fnk a signed statement
thal he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
r3 — 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 (S500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
will do the work and the suuchre is not intended or offered for sale (Sec 7044, Business
and Professions Code The Contractors License Law does not 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 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 do 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 (Sec 7044. Business and Professions Code,) The Contractors L i-
canx Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such pmjecs with a contractor(s) licensed pursuant to the Contractors
License Law,
❑ I am excWt under Sec
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.
0 1 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 Workers Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if lbe permit is for one hundred dollars ($100)
nr less)
1 certify that in the performance of the work for which this permit is issued, 1 shall not
employ any
of the Labor Code, you must
�Z forthwith comply with such provisions or this permit shall be deemed revoked.
y 0
C/) CONSTRUCTION LENDING AGENCY
►-� I hereby afrnrm that there is a construction leading agency for the performance of
Y.d > the work for which this permit is issued (See. 3097, ON. C)
QLenders Name
Z Lenders Address
0 I certify that I have read this application and sate that the above information is
sanest I agree to comply with all city and county ordinances and state laws relating to
D U building construction, and hereby authorize representatives of this city to enter upon the
[Ja above -mentioned property for inspccuon purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
y liabilities, judgments, costs and expenses which may in any way acme against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
152te
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety
Code, Section 25532(a)?
❑ Yes ❑ No
Will the applicant or future building occupant use equipment or devices which
welt hazardous air contaminants as dcfncd by the Bay Area Air Quality Management
District?
❑ Yes o
t have read the hazardous aterials requirements under Chapter &95 of the Califor-
nia Health & Safety Code, Sections 2550 .25533 and 25534.1 understand that if cite building
does not currently have a tenam. that it is my responsibility to notify the occupant of the
or author'ved