Loading...
0710020200 W; tz UO w F, OU >a uF.t CI) U7� CITY OF CUPERTINO BUILDING DIVISION PERT CO "i'JI AC,TOR ZN . ORMATIOPERMIT, BUILDING ADDRESS: PERMIT NO, 7574 DEFOE DR TBD — TO BE DETERMINED 07100202 •^ SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTORS DECLARATION Job Description 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 70(Mn of Division 3 of the Business and Professions Code, and my license is RENOVATION TO EXISTING BUILDING, REPLACING NEW in full forte and effect LicensoClass Lic.I WINDOWS. Date Contractor ARCHITECT'S DECLARATION I undcrsund my plans shall be used as public record& Licensed Professional OWNER -BUILDER DECLARATION i hereby affirm that 1 am exempt from the Contnetor's License Law, for the following reason. (Section 7031.5, Business and Professions Code; Any city or county which requires a permit to construct, alter. improve, demolish, or repair my structure prior to its issuance- also requires the applicant for such permit to bile a signed statement that he is licensed to the oT& Conuarwirs lactose Law (Chapter9 rJq;-ft— Floor- Area - Valuation pursuant provisions $ 1 0 0 0 0 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or -that-he-is-exempt therefrom -and -the basis Xor_the-allcgcdssemptioa any-violatlon of - --- Number 3592503 M� Occupancy Type Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500), 9 ❑ L as owner of the property, or my employees with wars as their sole compensation, Required Inspections will do the work and the structure is not intended or offered for sak (Sec. 7044, Business and Professions Code: The Contractor's 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 IL . 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-). ❑ 1, as owner of the property, am exclusively contacting with licensed contractors 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 theeon, and . who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. ❑ 1 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of tfte Tabun Code, for the performance of the work for which tds permit is issued- ❑ 1 have and will maintain Worker's Compensation Insurance, 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 are: Cartier. Policy No.: CE=CATE OF -EXEMPTION FROM WORKERS - COMPENSATION INSURANCE (This section need not be completed if the permh Is for one hundred dollars (S 100) or less. ) I certify that In the performance of the work for which this permit is issued, 1 shall not employ any person in any man rp;sp,as W become subject to the Workers' Compensation Laws of Califomi 1 1 1 `Sl s ApplcanI 11V NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workerr s Compensation provisions of the labor Code, you must forthwith comply with such provisions or this permit sha11 be dccrrued revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that in= is a consuuctinn lending agency for the performance of the work for which this permit is issued (See, 3097, Civ. C.) ' Lenders Name Lenders Address I ratify that I have read this application and state that the above information is comem I agree to comply with all city and county ordinances and state laws relating to building concoction, and hereby authorize rcpmsenutives 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 liabilities, judgments, costs and expenses which may In arty way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date REGUL�TI�y Re -roofs Type of Roof Signature of Applieant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant oriutum building occupant sore or handle harardouu material as damned by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety Code. section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑ Yes [3 No If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes No I have read the hazardous materials requirements under Chaprcr6.95 of the Califor- nia Health & Safety Cade, Suctions 25505, 25533 and 25534.1 understand that if the building does not currently hake a tenant that it is my responsibility to rwtify the occupant of the requirements t prior which be metoisstnan of a Crrtifreaic of Occupancy. Signature of Applicant Date i t ��� All roof coverings to be Class "B" or better Owner or authorized agent Date'