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CITY OF CUPERTINOA.
PERNII1Q'l'
BUILDING DIVISION
BUILDING ADDRESS:
GREGG & LILY MAHUR I N
PERMIT NO() 3120050
20725 SUNRISE DR
OWNER'S NAME:
PERMIT ISSUE DATE
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
'
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
Lene full force effect.
ADD 906 SQ.FT./REMODEL 1254 SQ.FT.
Classand
License Class Lic. #
Date Contractor
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section W31.5, Business and Pmfessons Code: Any city or county
which requires a permit to construct, alter, improve, 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 Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(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
3 QZa bex 0.0
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (M).
❑ L as owner of 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 We (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 We. 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.).
0 1, as owner of the property, am exclusively contracting with licensed contraclors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractors Li-
cense Law does not apply to an owner of property who builds or improves thereon, and
who contracts fors projects a contractors) licensed pursuant the Contractor's
Law.
❑ lam . . B & P C for n reason
Ow r Date
ORK CO NSATION DECLARATI
fol declamdonv:
hereby anrm under penalty of perjuryore of the owing
❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compcn-
.
cation, 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 Workers Compensation Insurance carrier and Policy number arc:
,
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Phis section need not be completed if the permit Is for one hundred dollars (S 100)
or Icss.)
1 certify that
Ex prior, you should
been object to the W er's C nation provision of the Labor Code, you must
' i comply with such provision or this permit shall be deemed revoked.
' CONSTRUCTION LENDING AGENCY
"
I hereby affirm that there Is a consuuction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name
Lenders Address
I certify that I have read this application and state that the above information is
' correct. I agree to comply with all city and county ordinances and state laws relating to
building convection, and hereby authorize representatives of this city to enter upon the
above -mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
j liabilities, judgments, costs and ex hi may in any way accrue against said City
' in the
conseq urnccAf granting of permr
APPLICA UNDERSTAN ND L COMPLY WITH ALL N -PO
Issued by: Date
S CE LATION
Re -roofs
Type of Roof
2 G%
S u d
WIII ant or future building occupant store or handle hazardous material
as defined by the Cupertino Muni pal Code, Chapter 9.12. and the Health and Safety
Code, Section 25532(a)T
All roofs shall be inspected prior to any roofing material being installed.
� Yes No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future ilding occupant use equipment or devices which
emit hazardous air contaminants fined by the Bay Area Air Quality Mangcmcnt
all new materials for inspection.
District?
C3 Yes Nu
1 have read the hazardous materials require nos u r Chapter 6.95 of the Califor-
niaHralth&Safety Code,Seciion25505,255 and25 4.IunderstandthazifthebuilJing�ature
I
does no llj' h a tenant. that it is respyn ibility m notify the occ pan(
requi ntsy6jri must be m`�ty. Occup cy.
fApplicant e
All roof coverings to be ass " B" or better
ow nr seed ag a