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07100002 CITSC OF CUPERTINO BU[LDING DIVISION PERMIT `±�fi��A.�Q�Z:��C��N��'�'I��t :: ;: _ .:. > t: ,:. . .::: :::: _ ,:. BUILDING ADDRESS: PERMIT NO. 22622 MARIANIST WAY MARIANCST PROVINCE OF THE 07100002 . OW NER'S NAME: •�. - PERMIT LSSUE DATE MARIANIST PROVINCE OF THE 10 01 2007 � � SANITpRY NO. CONTROL NO. ARCHI'IECT/ENGINEER: BUiLDING PERMIT INFO n BLDG ELECT PLUMB MECH N I 1 , /7S / ' G S �� 0 � 0 � o p LICENSED CONTRACT'OR'S DECLARATION : V� I hcreby a�firm that I am licenscd undcr provisions oC Chaptcr 9(commcncing JOb DOSCTlpil017 : z� wi�h Scction 7000) of Division 3 of U�c Busincss and Profcssions Codc and my liccnsc is �jE(�] STC >RAGE SHED / GARDEN ?� y in full Corce and eftec� � �� ? �Licenx Gass Lic. k � . ; F p Da� Contracar � a ARCHITECI'S DECLARATION �� U ! undcrstanJ my plans shall bc uscd as public rcconis ,a � o � Licensed Profcss�onal � � � OWNER-BUILDER DECLARATION j a � 1 hcrcby alTirm that I am czcmpt trom the Conuactor's Liccnx Law for �hc . p O following rcuon. (Scction 7Q31.5, Busincss and Profcssions Cak: Any city or county e,°, � which rcquires a permit w conswct, alter, improvc, dcmolish, or repuir any stn�cture � Z� prior w iLt issuance, also requircs �he applicanl far such permit to file a signed s�atemem �_ � that hc is liccnscd pursuant to thc provisions af thc Contractur's Liccnse Law (Chaptcr 9 Sq. Ft. Floor Area Valuation � F- �(commcncing wiih Scction 7000) of Divisian 3 nf Ihc Busincss and Profcssinns Codc) or $ 4115 9 ,, �.. that he is exempt the�etrom and the basis Cor the allcged exemption. Any violation oC Section 7031.5 by a�ry applicant (or a permit subjecu the applicam to a civil pcnalty o( Number �o� mo� �n� r,� n��aRa aon� cssoo�. 3 4 2 2 9 0 51 `.°'�� Occupancy Type ❑ I, as owner of tl�e property, or my employces with wages u Weir solc compensatlon, will do the work, and ihe structure is not intendcd or offemd for salc (Sec. 7044, Business and Professions Codc: The Conuacmr's License Law does rrot apply to an owner of ReC1UliCd IiISPeCtIOIIS prapeny who builds or improvu thereon, and who does such wart himself or Uuoagh 6is awn emptoyces, providcd tha� such improvements are not in�ended orollered forsale. I[, however, tAe building or improvement is sold within one year of compleuon. �he ownerv builder will have the burden of proving that he did nat dtitd or improvc for pmpase of sa1eJ. ❑ I, as awner o( [he propeny, am exctusively contracting wi�h licensed rnnvactas W wnstruct the pmject (Sec. 7044, Businas and Ro(essians Cade:)'!Le Contrxwrs Li- ccnse Law docs not appty w an owner of propeny who builds ar impmves thereon, md , who conuacts Cor such projects with a conuactor(s) tiansed pursuant to the Conuactors License Law. ❑ I am ezempt under Sec. , B dc P C for this maton Owner Date WORKER'S COMPENSA'ITON DECLARATION I hercby affirm under pcnalty of perjury onc of the following declarations: �] I hsve and will maintain a CeniGcatc of Consent to scl4insum for Workcr's Compen- satian, u providcd for by Section 3700 of the Iabor Code, for �he pedormance aC �he work for which this pertnit is issucd. I havc and will maimain Workcr's Compensation Insurana, as rcyuired by Scction 37 of ihe Labor Code, Cor the perf'ortnance of �he work for which this permit is iscued. ' My Worke�s Co �ensanon rance car�cr a�d Policy number are: ,/Q �/ Cartier: N� No.:.3� Z_ S7O T CERTIFlCATE OF EXEMPT[ON FROM WORKERS' COMPENSATIONINSURANCE (This section need no[ bc completcd if [he permit is for anc hundred doUars (S 100) or Icss.) I cenify thai in thc performancc af thc work for which this pertnit is issucd. ( sAall not employ any person in any manncr so u w bccomc subject ta the Workcrs' Compensatian Laws of Califomia. Datc Applicant NOTICE TO APPLICANT: If, aftcr making �his CcniCcatc of Ezcmp�ion, yau should become subjcct to thc Workcr's Compcnsation provisions of Wc Lalx�r Codc, yau must , O fonhwith comply wi�h such provisions or this permi� shall bc dccmcd revokcd. z � CONSTRUCfION LENDING ACENCY F+ ►-� I hcichy aflirm that thcro is a consuuction Icnding agcncy 1'or thc per(ortnancc u( CYi � thc wurk [ur which this permit is issucd (Scc. 3097, Civ. C.) � A Lendcr's Narnc - � z Lcnder's Address , (� � f ccrtity that 1 havc rcad this application and statc �hat Ihc abovc informauun is - ��-' corrcct. 1 agree to comply with alI city and county onlinances and sute laws relating w � U building conswction, and hcmby authome representalivcs of this ciiy to cmcr u{mn thc abovc-mcn�ioncd propcny (or inspccuon purposes. ( � a (Wc) agrce to save, indemni(y and kecp harmless the Ci�y o( Cupertino against � �.. � liabilities, judgmcn o and expcnscs which may in any way accruc against said City V,'� ia consequence oC 'n oC this permit. "" APPLICAN'f U DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE R �� Re-roofs Signawre of ' C tor Da�c H RDOUS MA7ERIALS DISCLOSURE Type of Ro��f Will �c applicant or future building occupants[orc or handlc harardous ma�crial as dcfincd by the Cupenino Municipal Codc, Chaptcr 9.12, and �he Hcalth and Safcty co��, Scction 25532(a)? All roofs sF all be inspected prior to any roofing material being installed. ❑ Ycs ❑ No If a roof is i nstalled without first obtainin an ins ection I a ree to remove Will �hc applicant or fuwrc building occupant usc cyuipmrn� or dcvices which g P r g • cmii harardous air comaminan�s az dcfined hy the Bay Area Air Quali�y Managemeni all new mat �rials for inspeczion. Disvict? ❑ Ycs ❑ Nu I havc read e h rGous ma�crials requiremcnls undcr Chap�cr6.95 of �hc Califor- nia Hcal�h & Sa(c , c' ns 25505, 25533 and 25534.1 undcrstv�d that iC ihc 6uilding docs not cu tcn nt, ihat i� is my responsibility to notil'y Uic occupanc ot �hc rcqui cn m bc prior u� issuancc of a Ccnificatc of Occupan r. Signature of Applicant Date Owncrorau ori�cdagcn � �� o „� - ._ All roof coverings to be Class "B" or better