07030021 CITY OF CUPERTINO
BUILDING DIVISION PERMIT STT®RI � Id �'
PERMIT NO.
BUILDING ADDRESS:
22654 OAKCREST CT TBD — TO BE DETERMINED 07030021
PERMIT ISSUE DATE
(1111*1ER'S NAME:
"ENOLD STANLEY E AND MARGO L 03/22/2007
'NE: SANITARY NO. CONTROL NO.
1
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 Z LICENSED CONTRACTOR'S DECLARATION
SV P I hereby affirm that I am licensed under provisions of Chapter (commencing Job Description
:z UW with Section 70(10)of Division 3 of the Business and Professions Cmde, n my license is SOLAR PANEL—SOLAR CITY PD FOR BUS LIC 3/5/7 .
=y in full force and tom-.
1 ? License Class •
• p Date Contractor
ARCHITECTS DECLARATION
i a< I understand my plans shall be used as public records
)yV
a
l'- Licensed Professional
:O a OWNER-BUILDER DECLARATION
j< 1 hereby affirm that 1 am exempt from the Contractors License Law for the
p O 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
a "N prior m its issuance,also requires the applicant for such rmit to rile a signed statement Valuation
?<
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Ft.Floor Area $15000
t t-- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
11 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 61 Number Occupancy Type
not more than five hundred dollars(5500). 3 4 2 4 8 0 0 5)
❑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 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.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's U-
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 exempt under Sec. B&P C for this reason
•er Date
WORKER'S COMPENSATION DECLARATION
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 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.
M Workgr opensation Insurance cam1"d Policy number are: ^�
CarrierZl1D `polity No�_ � I
CERT F 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 manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J z forthwith comply with such provisions or this permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
a the work for which this permit is issued(Sec.3097,Civ.C.)
W QLender's Name
Lender's Address
U C) 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
J building conswction,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
Hto liabilities,judgments,costs and expenses which may in any way accrue against said City
U z in const cc of the granting of this permit. Date
►� APPL A UNDERSTANDS AID WILL COMPLY WITH ALL NON-POINT Issued by;
SO C ATIONS.
�� /r:;2
Re-roofs
Sign um of Applicant/Contractor °re T of F.00f
HAZARDOUS MATERIALS DISCLOSU E Type
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 Safety
ic,Section 25532(x)? 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 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 Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
does.not currently have a tenant,that it is y responsibility to notify the occupant of the
require which must be met prior • uance of a Certificate of Occupancy. Signature of Applicant
Date
`.--' All roof coverings to be Class r'B"or better
Owner" uthorized agent :�?�D=c