08080239CITY OF CUPERTINO
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BUILDING DIVISION PERNIITh
BUILDING ADDRESS:
PERMIT NO.
10295 WUNDERLICH DR
TBD — TO BE DETERMINED
OWNER's NAME:
PERMIT ISSUE DATE
A CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG FJ ECf PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I 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 fora andtigect. c
NEW SFDWL, 1820SQ LIVNG AREA, 61SQ PORCH 419SF
License C7 Lie. # %24►� 1
Date Contractor M, . C-%CrC_J2.l env a
,&
ATTACHED GARAGE . SANITARY IS SUNNYVALE ' S
ARCHI understand my plans shall lbbe used as puCrS blic DECLARATION
JURISDICTION.
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law for the
Following reason. (Section 7M 1.5. Business and Professions Code: Any city or county
which mquires a permit to construct, alter, improve, demolish, or repair any structure
prior b its issuance, aiw requires the applicant for such permit to file a signed u=mcnt
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(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
19 9 0 0 0
APN Number
Occupancy e
p TYp
Section 7031.5 by z" applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollar (S500).
37516019 .00
❑ L as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractors License Law dons not apply b an owner of
property who builds or improves thereon, and who does such work himself or through his
awn employes, 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 win have the burden of proving that he did not build or Improve for purpose of
sale-).
L u owner of the property, am exclusively contracting with licensed contractors to
co the project (Sec 7044. Business and Professions Code:) The Conuactw's U-
cense Law does not apply to an owner of property who builds or improves thereon, and ,
who contracts for such projecs with a contractor(s) licensed pursuant to the Contractors
License Law.
❑ I am exempt under Sec B & P C for this mason
Owner Dam
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations
❑ T ha.e and wr71 maintain a Certificate of Consent to self-insum for Workers 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 mquired by Section
3700 of the Labor Code, for the performance of the work for which this permit Is issued.
'
My Workers Compensation hisurance carrier and nurtrhu are:
�Policy
� J'�.
Cartier.r siilf CO rat O �>'�`�Pollry—Tla: „C( �Ot T'
CERTIFICATE O EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or lets)
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. Due
Applicant
NOTICE TO APPLICANT. If, after making this Certificate or Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCnON LENDING AGENCY
1 hereby affirm that these is a construction lending agency for the performance of
the work for which this permit is issued (Sc,-- 3097, Civ. C.)
L.endefs Name
Lenders Address
1 certify that I have read this application and sum that the above information is
correct I agree to comply with all city and county ordinances and seam 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
j liabilities, judgments, costs and expenses which may in any way accrue against said City
in of the of this
) c
t&�
consequence S=dng permit
APPLICANT UNDERSTANDS A . WILL COMPLY WITH ALL NON -POINT
/
Issued by: Date `—]
SOUR
WIB the appnant 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 25S32(a)7 �(
❑ Yes Ljf no
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
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Au Quality Management
all new materials for inspection.
District?
❑Yes ANo
1 haw the hvarlws malrequiremerequirementsunder Chapter 6.95 of the Califon.
afety Code. SeNons 2mad
nda Health & S3505, 25533 and 25534.1 understand that if the building
does rot currently have a tenant. that it is my responsibility to notify the occupant of sir
requirements
'
or authori7 gent