050300193�
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CITY OF CUPERTINO
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BUILDING DIVISION PERM
ALVAND CONSTRUCTION
BUILDING ADDRESS:
PERMIT NO. 05030019
OWNER'S NAME:lic-ARE)e RD.
PERMIT L5UEDATE
PHONE:
4/25/2 OL NO.
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 Sclion 7000) of Division 3 of the Business and Professions Code, and my license is
In full force and effect
Licrauso LIC.0
REVISION -GARAGE RETAINING WALL
0 NEW PERMIT ISSUED/ORIG. #04060137
Dato �-1 __Al
HITE-rSDECL.AR TIN
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for 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
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 Conuanor's Ucense Law (Chapter 9
Sq. Ft. Floor Area
Valuati o,U 1 15
(commencing with Section 7000) of Division 3 of the Business and Professioes Code) or
y�
duet he is exempt therefrom and the basis for the alleged exemption. Any vlolatlon of
APN Number
Occupancy e
p y �p
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penally of
not more than five hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
35601053.00
Required fired 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 does not apply to an owner of
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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 Contractors U.
celiac I.aw does not apply to an owner of property who builds or improves thereon, and ,
who contracts for such projees with a contnetor(s) licensed pursuant to the contractor's
License Law.
❑ 1 am exempt under Sec. . B & P C for this reason
Owner Date
WORKER'S COMPENSA7ION DECLARATION
1 hereby afro under penalty of perjury one of the following declarations:
❑ f 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 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 Worker'
section need not be completed If the permit Is for one hundred dollars (S100)
or IcsL)
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.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name
Lender's Address
I certify that 1 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 re1Wng to
building construction, and hereby authorize representatives of this city to enter upon the
above -mentioned property for inspwdon purpeses
fill
( ) 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 consegtene of the granting of this permit
APPLI NT UNDERSTANDS AND W COMPLY W: ALL ON -POINT
Issued by: Date
SOU
to
HAZARDOUS MATERIALS DISCLOSURE
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)? �
Yes
All roofs shall be inspected prior to any roofing material being installed.
[I 21No
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
Cmlt hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District? /
❑ Yes
I have read the hazardous materials requirements under Chapter6.95 of the Califor-
nia Health & Safety Code, Sections 2 5505,25533 and 25534.1 understand this if the building
does