07120273CITY OF CUPERTINO
BUILDING DIVISION PERMIT%1�•
—
BUILDING ADDRESS:
PERMIT NO.
10910 WUNDERLICH DR
RICHARD HARO CONSTRUCTION 07120273
OWNER'S NAME.
PERMIT ISSUE DATE
RON QUAN DESIGNS
843 S MCGLINCY LN
08/11/2008
PHONE.
SANITARY NO. CONTROL NO.
(408) 371-7209
ARCHrrE(.-T/ENGINEER:
BUTLDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATDN
Job Description
I hereby affirm that I sin licensed under provisions or chapter 9 (commencing
with Section 7") of Division 3 of the Business and Professions Code, and my license is
ADD 7 2 7 S Q ONE S TRY IV AREA , 2
in full face and effect
LicenseCJass Lies
BDRMS, 1BTH, LIBRARY, 223SQ GARG W/LANDRY, EXTND
Dam ARCHr1EContractor DECLARATION
GARAGE ROOF / WALLS , 3 0 0 SQ & RELCT WHTR
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contraetot'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 say structure
prior to its, issuance, also requires the applicant for such permit to rile a signed statement
is to the the Contractor's License Law 9
Sq. Ft. Floor Area
valuation
coat he licensed pursuant provisions of (Chapter
Section 7000) Division 3 the Business Professions Code)
r 16 817 5
(commencing with of or and or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
y
�..p Number
3 7 5 2 2 0 0 4: (3q
Occupancy Type
Section 7431.3 by any applicant for a permit subjects the applicant to a civil penalty or
not more than five hundred dollars (S500).
❑ L as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
win do the work. and the structure is not intended or offered for sale (Sec. 7044, Business
s Lie Law do
and Professions Code: The ContractorLicense es 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 arc 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 or proving that he did not build or improve for purpose of
sale.).
V, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Cade:) The Contractor's Li.
tense Law does not apply to an owner or property who builds or Improvers thereon, and.
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
-
❑ 1 am seem under See, , B & P C for this mason
6 (
da
Owner A lkeG — Dam / f 1
WORKER'S CO SATION DECLARATION
I hereby affirm under penalty or perjury one or the following declarations:
❑ I have and will main Lain a Certificate of Consent to self-insum for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, far the performance of the
work for which this permit is Ltsued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
370D of the Labor Code, for the performance or the work for which this permit is issued
My Worker's Compensation Insurance arrier and Policy number are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundred dollars ($100)
or less)
I certify that in the performance of the work for which this pump is issued, 1 &hall not
employ any person in any manner so as to become subject the/ ri�crs,COmpensation
Laws ofCslifomia.pt I
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of 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.
CONSTRUCTION LENDING AGENCY
I hereby alum 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
e Lenders Address
i testify that I have read this application and state that the above information is
" correct- I agree to comply with all city and county ordinances and stale laws relating to
building construction, and hereby authorize representatives of tits city to enter upon the
above -mentioned property for inspection purposes
(We) agree to save:, indemnify and keep harmless the City or Cupertino against
7 liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permiL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Vi\T_✓l /
Issued by: Date
SOURCE REG T1ONS. /
Re -roofs
Type
-A)!, a.tcf ice~— N
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
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.
❑Yes LSNo
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or dcvim which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District? ►
❑ Ycs []i�
1 have read the hazardous materials mquireme ns under Chapter 6.95 of the Califor-
nia Health & SafetyCodc, Sections 25505, 25533 and 25534.1 understand thatif tic building
does not currently have a tenant, that it is my responsibility to notify the occupant of the
roqu enLt wihi h must be met prior to issuance of a Certificate or Occupancy.
Signature of Applicant Date
/'� 1" �'— �1 /r � U0
All roof coverings to be Class'n" or better
Owner or author and agent Date