07020067 CITE'OF CUPERTINO
BUILDING DIVISION PERMIT � RE� ��Z �IIZM�4TI�N
PERMIT NO.
BUILDING ADDRESS:
22350 HOMESTEAD RD THOMAS HARRINGTON 07020067
PERMIT ISSUE DATE
"ER'S NAME:
THOMAS HARRINGTON
SANITARY NO. CONTROL NO.
PHONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
i p p LICENSED CONTRACTOR'S DECLARATION Job Description
V)= I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is "HOMESTEAD CROSSING" SIGN NEW ILLUMINATED; BRANC H
y in full force and effect
v�z License Class Lic•8 CIRCUITS.
t w Date Contractor
ARCHITECTS DECLARATION
7 a< I understand my plans shall be used as public records
)yU
U.i- Licensed Professional
a OWNER-BUILDER DECLARATION
N
I hereby affirm that 1 am exempt from the Contractor's License Law for the
p O following reason.(Section 703 1.5,Business and Professions Code:Any city or county
which requires a permit to construct alter,improve,demolLch,or repair any structure
Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
that he is licensed pursuant to the provisions o!the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area
r H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $22000
Q that he is exempt therefrom and the basis for the alleged exemption.Any violation of qpN
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 2 6 010 L 8 Number Occupancy Type
not more than five hundred dollars(5500).
❑1,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 for sale(Sec.7044,Business Required Inspections
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.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.).
00(as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li.
cense Law docs not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law
❑I am��_
er S ,B&P C f r thi reason
Date Z ��
- er ., .
RKER' MPENSATION DECLARATION
I hereby rm 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 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 carrier and Policy number arc:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one 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 person in any mannerbecome subject to the Workers'Compensation
Laws 0f Califomia.
Applicant
NOTICE ngthis Certificate of Exemption,you should
become subject to c Tr
mpensation provisions of the Labor Code,you must
Oforthwith comply with ons or this permit shall be deemed revoked.
Z' CONSTRUCTION LENDING AGENCY
E.r tom. I hereby affirm that there is a construction lending agency for the performance of
�i> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
Lender's Address
U 0 1 certify that I have read this application and state that the above information is
[>,► correct.1 agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
a (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 1
U Z in consequence of the granting of this permit. Date /
APPR��GU
N ER DS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOU — _
IZ Re-roof
tgnatli ontractor Date Type of Roof
HAZARDOUS MATERIALS DISCLOSURE yp
Wil 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
•ie,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes [ ^
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes C5N.
I 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
docs not c 41y have pant.that it is my responsibility to notify the occupant of the
rcyuircmc which m et a issuance or a certificate er a,pan� Signatu•e of Applicant Date
All roof coverings to be Class"B"or better
Date
n gent "