07090191CITY OF CUPERTINO
BUILDING DIVISION PERM�CCQRY1
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"'LONIT WUNDERLICH DR
TBD — TO BE DETERMINED
P07090191
:
SANITARY NO. CONTROL NO.
ARCHITECTIENCINEER:
BUILDING PEP MIT TWO
BLDG ELECT PLUMB MECH
ucENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 70D0) of Division 3 of the Business and Professions Code. and my license is
SFDWL — 2 STORY 18 8 3 ' PORCH 4 8 ' GARAGE 400,
in full force and effect { y�' L,_^7
License Clan Lie.N I(6
SANITARY IS. SUNNYVALE' S JURISDICTION.
Date '2 - :1� '• t % k - Conlracwr
ARCHITECT'S DECLAIMION
"
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 70315, Business and Professions Code: Any city or county
which requires a permit to construct, alter. improve, demolish, or repair any swclum
prior to its issuance, also requires the applicant for such permit to file a signed stalcmenl
the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of
$ 4 3 015 0
(commencing with section 70M of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged esanption Any violation of
3 7 516 0 31'�� Number
Occupancy Type
Section 70315 by any applicant for a permit subjects the, applicant to a civil penalty of
not more than five hundred dollars (5S00).
.
❑ L as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
(l
will do the work and the structure isnot intended oroffered for sale (See.70".Business
and Professions Code: The ConuactOes License Law does not apply to an owner of
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property who builds or improves thereon, and who does such wort himself or through his
own employees, provided that such improvemerds 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 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 Cootrror's U.
tense Law does not apply to an owner of property who builds or improves thereon, and ,
who contracts for such projects with a contrwor(s) licensed pursuant to the Comtacnor's
License Law.
❑ I am exempt under Sec , B & P C for this Mason
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations
❑ i have and win 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.
❑ I 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 carries and Policy number am: _
Cartier. 13TACfr
'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (SI00)
or less.)
1 cerify that in the performance of the wort for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after. making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you mum
' forthwith comply with such provisions or this permit shall be deemed rewked
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction leading agency for the performance of
' the work for which this permit is issued (Sec. 3097, Civ. C-)
'
Lendcr'sNamc
Lender's Address
1 certify that I have mad this application and state that the above information is
' correct I agree to comply with all city and county ordinance and state laws relating to
building construction, and hereby authorize represenutives of this city to enter upnn the
above -mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
j liabilities, judgments, Boss 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
Issued by: Date _.j"�7,
SOURCE REGULATIONS.
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 Safely
Code, Section25532(a)7
&N.
All roofs shall be inspected prior to any roofing material being installed.
C]Yes
If a roof is installed without first obtaining an inspection, I agree to remove -
Will the applicant or forum building occupant use equipment or devices which
emit hazardous air contaminants as dcfrncd by the Bay Area Air Quality Management
all new materials for inspection.
District?
-
❑ Yes
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 thatif the building
does not
"