Loading...
06010127CITY OF CUPERTINO b BUILDING DIVISION PERK` `TT W} try+' BUILDING ADDRESS: ,sw PERMIT NO. THOMAS E HARRIGNTON 06010127 owl&3 &&E: HOMES TEAD RD PERMIT SSUEDATE PHONE: SANITARY NtQ L NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MUCH LICENSED CONTRACTOR'S DECLARATION Job Description 1 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 .� D License C enacClass o Date Contractor PEETS COFFEE SHELL 1 774' /TRASH ENCLOSURE r ARCHITECTS DECLARATION I 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 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 Sq. Ft. Floor Area Val 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 Code) or , that he is exempt therefrom and the basis for the alleged exemption Any violation of f e ''rp -f 7v`i 1s75-1br 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 (f500). .3 G ttt��� UUU 111 v t-0 0 ❑ I, 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 Contractors License Law does 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. If, however, the building or improvement is sold within one year of Completion, the owner - builder will have due burden of proving that he did not build or Improve for purpose of sale.). 9 1, as owner of the propeny, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor' Li- cense Law does not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a eontnetor(s) licensed pursuant to the Contractor' License Law. ❑ of perjury one of the following declarations ❑ I have and will maintain a Certificate of Consent to self -insure for Workers Compen- sation, as provided for by Section 370D of the Labor Code. for the performance of the work for which this permit is issued ❑ 1 have and will maintain Workers Compensation Insurance, as required by Section 370D of the Labor Code, for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPI70N FROM WORKERS COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($I00) or less.) I cenify that in the performance of the work for which this permit is issued, 1 shall not employ any shall be deemed revoked. CONSTRUCTION LENDING AGENCY l hereby affirm that there is a convection lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name , Lender's Address I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building convection, and hereby authorize representatives of this city to enter upon the above -mentioned property for inspection purposes. (Wc) agree to save, indemnify and keep harmless the City of Cupertino against liabilities,judgments, toss and expenses which may in any way accrue against said City in consequence of the granting of this permit APPLIC U RSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date Date HAZARDOUS MATERIALS DISCLOSURE 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. ❑ 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 hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes nigD I have read the hazardous materialsrequiremcnts under Chapter 6.95 of the Califor. nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not c Da