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030902360 R ZF ITa ' UC �E 0 H � U, t CITY OF CUPERTINO " BUILDING DIVISION PER �ry7�4H. T AT WINE iV BUILDING ADDRESS: 206,70 T-10MERTEM) ED RANDY A SMITH CONSTRUCTION PERMIT NO0 3 0 9 0 2 3 6 OWNER'S NAME: 5662 LA RIBERA ST. #C PERMIT ISSUE DATE GREAT CLIPS FOR HAIR 11/07/2003 PHONE: (9 2 5) 2 94 - 4 3 4 0 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7 arD,'yJ'�tion 3 of the Bust Code, and my license is in full force a reef. {. `JOS - fr License Clas Lic. q TENANT IMPROVEMENT (14 3 2 SQ . FT . ) Datc, contract CONTRACTOR: RANDY A SMITH CONSTRUCTION (#24837) ITECTSDspu AT I understand my plans shall he used as pu tic records TEMP PERMIT #03100169 (EX.11/23/03) Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following mason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure - prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $46182 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 five hundred dollars ($500). 32610060.00 ' 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 offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law docs 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. IL however, the building or improvement is sold within one year of compledon, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 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 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. ' 0 1 am exempt under Sec. B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: 0 1 have and will maintain a Certificate of Consent to self -insure for Worker'sCompen-. 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 Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the wor for which this permit is issued. My 5� ker's Compensation Insurance carrier and number are: air.. S f `i n ti/ 0;,y Policy No.: 0 Ql i, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars (E 10(1) 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 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. CONSTRUCTION LENDING AGENCY + 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.) Lender's Name r Lender's Address 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 building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. y (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 r in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date S UREG TkL IO ! 7 O % ` Re -roofs !/ Type of Roof S' nature of Applicant/Contractor Date HAZARDOUS MATERIELS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Munic'pa[ Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes o 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 MR. hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safely Code, Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the requiZghich ass et prior w i nuance of a Ccnifica yp�%e Signature of Applicant Date `�/ 7��--i All roof coverings to be Class „Bn or better ,7 - Owner or authorized agent Datc CITY OF CUPERTINO BUILDING DIVISION PERM BUILDING ADDRESS: RANDY A SMITH CONSTRUCTION PERMIT N003100169 20670 HOMESTEAD OWNER'S NAME: 5662 LA RIBERA ST. #C PERMIT ISSUE DATE GREAT CLIPS FOR HAIR 10 23/2003 PHONE` (925) 294-4340 SANITARY NO. CONTROL N0. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECTPLUMB MECH o 0 0 LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I licensed of Chapter 9 (commencing Job Description am under provisions With Section 70(10) of Division 3 of the Business and Professions Code, and my license is in full force a l+Qeffect. u /,SO6v TEMP PERMIT EXPIRES License Clas's Lic, .11/23/03 Date O Contr for RCHITRTS DE .A ATION ' 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law ['or the ' 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 3 2 prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's 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 32610060.00 Section 7031,5 by any applicant for a permit subjects the applicant to a civil'penaliy of APN Number Occupancy P Y Type not more than five hundred dollars ($500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business Inspections and Professions Code: The Contractor's License Law does not apply to an owner of .Required property who builds or improves (hereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale,). [11, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- _ cense law docs not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ 1 am exempt under Sec. , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penally of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued, My Worker' ]nsurance carrier and eoliefnumber arc: _.nomppeennsaauuon �(.f X- D Policy No.: 6 l/ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he completed if the permit is for one hundred dollars ($I(X)) or less.) ' I certify that in the performance of the work for which this permit is issued, 1 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 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. I CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency 1'or the performance of ' the work for which this permit is issued (Sec 3097, Civ. C.) Lender's Name Lenders Address jI certify that I have read this application and stale that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to r building construction, and hereby authorise representatives of this city to enter upon the )above-mentioned property for inspection purposes. I (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 in the this y ,0 consequence of granting of permit. Date 7 3 LL MPLY WITH ALL NON -POINT APPLICANT UNDERSTANDS AND WI6 Issued by: SOURCE G S. �_ - '� Z7 Re -roofs S `azure of Applicant/Contractor Dale HAZARDOUS MATERIALS DISCLOSURE Type 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)? All roofs shall be inspected prior to any roofing material being installed. ❑ Ycs u a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or uture 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? 1] Yes gNu ' I have read the hasardoussmaterials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505,25533 and 25534. I understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the quire cots hi •h must be mit pnorr issuance of a Certificate of Occupancy, Signature of Applicant Date �%�8% All roof coverings to be Class "B" or better Owner or authorized agent Dale