Loading...
06120019BUILDING DIVISION PERMIT BUILDING ADDRESS: 22622 MARIANIS OWNER'S NAME: PHONE: 0z O z� h—y Lea ; aQ a UO LL. F OU >a Uz ARCHITECT/ENGINEER LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Uc. N Date Contractor ARCHITECTS 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 Contractors 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 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 (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 (S500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered forsale (Sec. 70", 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 art 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.). ❑ 1. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contraewfs Li- cense 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 Contractor's License Law. ❑ 1 am exemp der Se , B & P ACCC for this reason Owner I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 hsve and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 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 Worke's Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit Is for ane hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any pc n in any manner so as to become subject tq9c Wor fit Come Lion Laws of of Exemption, you should become 'ce to c Workers Compensation provisions of the Labor Code, you must forthwith c ly with such provisions or this permit shall be deemed 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.) Lender's Name Lender's Address 1 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 construction. 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 liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Date HAZARDOUS MATERIALS DISCLOSURE aill 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 AN Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants at defined by the Bay Area Air Quality Management District? ❑ YesJu PERMIT No. 06120019 PERMIT ISSUE DATE SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB Job Description ADDING 11M" & "MARIANIST" SIGN ON NEW GATE, AND A I'M" LOGO Sq. Ft. Floor Area 9051.00 Issued by: Re -roofs Type of Roof Required Inspections Valu4c&0 0 0 0 Type Date / Z -,'-� G 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. 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code. Sections 25505.25533 and 25534.1 understand that if the building does not currently haw a tenant, that it is my responsibility to notify the Occupant of the Certificate of Occupan _ �� - Z44 Ow`d%EJf"&4hcri7zdagcnt Date Signature of Applicant Date All roof coverings to be Class "B" or better