08070077CITY OF CUPERTINO
BUILDING DIVISION P�
E'�
, w z x i y r�
� .� ���IN�i�JFr u�i
a
BURIN
VAI
21410 VAI AVE
07/22/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER-
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
bunchy Chapter 9
Job Description
I affirm that I am licensed under provisions of (commencing
with Section 70D9) of Division 3 of the Business and Professions Code, and my license is
REVISE FOUNDATION DETAIL AT 5 4 , 5 5 , 5 9 ; ADD NEW
and effect.
Licen¢Qass Lie.•
DETAIL IN S9;ORIG# 08070077 NO NEW PERMIT
Date Contractor
ARCHITECTS DECLARATION
1 undersu cal my pWta shall be used as public records
-
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License law forthe
following reason- (Section 70313, Business and Professions Conk: Any city or county
which requires a permit to construct. alter, improve. demolish, or repair my structure
prior to its WILSOCC, also MgUIM the applicant for such permit to file a signed stir ment
that he is licensed to the of the Contractor's License Law (Chapter 9
-
Sq Ft. F1 oor Area Valuation
pursuant provisions
.
$ 2 0 0 0
(commencing with Section 700M of Division 3 of the Business and Professions Codc) or
_
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Number
3 6 2 0 5 0 2 6
Occupancy
P y TYPe
Section 70315 by any applkam for a permit subjcus the applicant to a civil penalty or
not in= than five hu did doll= (s Wo
.'�
❑ I, as owner or the property. or my employees with wages as their sole compensation.
Required Inspections
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Profession Code_ The Contractors License law does not apply to an owner of
property who builds or improve, thereon, and who does such wort 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 cmmpWfon. the owner -
builder will have the burden of proving that he did rot build or improve for purpose of
sale.).
L as owner of the property, am a chutively contracting with licensed contractors to
nstroct the project (Sec 7044. Business and Professions Code) The Contractors Li-
cense Taw does not apply to an owner of property who builds or improves thereon, and
who concocts for such project& with a tontramor(s) licensed pursuant to the Contractors
License Law-
❑ I am exempt and ee , B & P C for this-
Owner -
�mMqhhON DECLARATION
1-hereby affirm penalty 'utry one of the followi dedaradons
❑ I have and will maintilin a cote of Consent to self -insure for workers Compen-
sation, as provided for 3700 of the Labor Code:, for the performance of the
work for which this issued. -
-
❑ I have and will maintain Workers Compensation pr,....x=. 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:
-
Cartier: Policy No-:
'EXEMPTION
CERTTACATE OF FROM WORKERS'
COMPENSATION INSURANCE
O'his section need not be Completed if the permit is for one hmndreul dollars CS I00)
or less)
1 cenfy that in the performance of the wort for which this permit is issued, 1 shall not
employ any person
NOTICE TO APPLI to 6S rifica f lion• you should
become subject to the WorkcYs Compensation p ions of the Idibfir Code, you must
forthwith comply with such provisions or thispelimit shall be declabi5d revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec 3097. Civ. C.)
Lenders Name
!.enders Address
I certify that I have read this application and state that the shove Information is
"
corrat I agree to comply with all city and county ordinances and State laws relating to
building construction• and hereby authorize representatives of this city to enter upon the
above -mentioned Property for ittapection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilitica, jodgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of This
APPWA� A WI COMPLY wlTTi ALL N-Po►NrIssued
l
by: DateSOURS
Re -roofs
Type of Roof
sign., nr HAZ R60US DISCLO
Will rho applieantyr fir !ding oexupmt store sir cm hazardous material
as defined by the Cur�pal Code. Chapter 9.12. and the Health and Safety
Code, Section 25532( +
All roofs shall be inspected prior to any roofing material being installed.
❑ Yu
If a roof is installed without first obtaining an inspection, I agree to remove
Vas the applicant or mom building occupant erne equipment or devices whim
colt hazardous air contaminants as defined by the Bay Asia Air Quality Management
all new materials for inspection.
District?
❑Yeso
1 bave read the hamrdous inatttials m ' under Chapter 6.95 of the Ca)ifor-
nla }Health & Safety Code" Sertiom 25505, 25 3 and 534.1 undm3and tam if the building
does not curtendy
of Applicant Date
>Y
All roof coverings to be Class '%q." or better
Doc -
Ownercoo. clef