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09020016Zee wp MU _Z i n7y c t.. eaµ Lu Y �aL Z u. �L< �n�77 y - YpC Km(i 4;V _Z) Y. Y .7 C z� .r F W� f3. r� d UC OE FrJ v U ;e CITY OF CUPERTINO DIVISION PERMIT C�TRTURi�MriN: BUILDING . BUILDING ADDRESS: PERMIT NO. 18880 HOMESTEAD RD DEVCON CONSTRUCTION INC 09020016 OWNER'S NAME: PERMIT ISSUE DATE 9 9 PHONE: S A CONTROL NO. (408)942-8200 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT 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 force and effect. e ) b 3 COM' L TI (E) OFC BLDG : INTR MODFCTS INCLD NEW License CI s L1e• � ! � Datat l Q contractor PRTNS r CEILNG &ADDTN ELCTRCL/DATA OUTLTS & NEW ARCHITECTS DECLARATION I understand my plans shall be used as public records F INSH S ; NO RE -RF OR STRUCTURL Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the following reason. (Section 70315, Business and Professions Code: Any city or county which requires a permit to cnnsuuct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade) or $4000000 that he is exempt therefrom and the basis for the alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than rive hundred dollars (5500). 31609037 , APL ❑ 1, 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 onsfferedforsale(See.7044,Business and Professions Code: The Contractors License Law does not apply to an owner of q P property who builds or improves thereon, and who does such work himself or through his own employers, 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 Contractors 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 Contractors License Law. ❑ I am exempt under Sec , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ l have and will maintain a Certificate of Consent to self -insure for Workcrs 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 Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worls Com carrier and Policy n`uAm/ber am: e.� i/ �) L�, V V L' 1:4 l 49 /n p v 0 Carrier. fly `I Y Wim' Policy No.: `U� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if tree permit is far one hundred dollars ($100) , or less.) 1 certify that in the performance of the work for which this permit is issued, l shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of Califomia. 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 must ' forthwith comply with such provisions or this permit shall be deemed revoked. ) t CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work fur which this permit is issued (Sec. 3097, Civ. C.) ' Lenders Name , Lenders Address j l certify that 1 have read this application and state that the above infonnadun is ' correct. 1 agree to comply with all city and county ordinances and state laws relating to ' building construction, and hereby authorize representatives of this city to enter upon the i ahovc-mentioned property for inspection purposes (We) a e to sa indemnify and keep harmless the City of Cupertino against liabilities dm ns, cos and expenses which may in anyway accrue against said City ' in con u rrca o the gian n f 's permit. / ��" APP CA U DERS N S L Y9� Y� rKL�l�llrzp0 SOU CE EGU ATION .I / `}}✓J�s ((//�I Issued by: Date O� Re roofs f/ Signa tare of Applicant/Cantractor DataType HAZARDOUS MATERIALS DI LOSURE of Roof 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 Code, Section 25532(a)? /11, All roofs shall be inspected prior to any roofing material being installed. ❑ Yes [h 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 hazardnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑ Yes//��/nnn( ❑� Ihavo•reprr e�rdo ma nalsrequireme sunder Chapter 6.95ofthe Califor- Hcalth Sof 2 U5, 534.Iundcrstan nia tji oo cd and atdithc building does rat uiren�''y11jj'' a thd it i ility to no ' the occupantf; reyuirem ?qts wchrtjust tit p{•n c c a of OccupaytcY.� n , vV Signature of Applicant Date /h 6 II All roof coverings to be Classor better Owner or authorized agent Date