03100216 E
TY OF CUPERTINOBUILDING DIVISION PERMIT CONTRACTOR-INFORMATION.DING ADDRESS: PERFECT TOUCH CONSTRUCTION\ PERMIT NO.03100216
811 RARQAN(-7� DR
ER'S NAME: PERMTf ISSUE DATE
TENNY N v
ONE: SANITARY NO, 040L NO.
4
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
v00 LICENSED CONTRACTOR'S DECLARATION Job Description
<�F 1 hereby of an Nn I am licensed under provisions or Chapter 9(commencing p
with Section 7")of Division 3 of NC Busiass and Profcuians Cade.and my license is
� N InmOcClaamdeHc
License Class Lin.N NEW 1-STORY SINGLE FAMILY DWELLING
DDam T'SDCL LIVING SPACE 3613 SQ. �mGARAGE 731 SQ. FT
ARCHITECTS DECLARATION ar /nor
I undersand my plans shall bs used u public recards
JtoU
G Licensed Professional f®
g OWNER-BUILDER DECLARATION
d< I hereby affirm Nu 1 am ucmpt from da Contractor's License Law for the JUL/
a0 following reason.(Section 7031.5,Business and Pmfessiotu CasJU:Any city at county
I
m which myuirn a permit in coutrucL alar,improve,demolish.or repair any structure
prior toils issuance,ala requires the applicant for such permit to file a signed statement
That he is licensed pursuant o the provision of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Val{g )n OOO
U,F3 (commencing with Section 7")of Division 3 of the Business and Professions Code)or
i —
that he is exempt thcaftem and the basis for the,alleged eumption.Any violation of
Section 7031.5 by Ory,applicant for a permit subjccu the applicant to a civil Penalty Of APN Number •Oce ancy Type
not mon thin raw hundred dollars(5500).
❑I.as Owner of the pmpeny,or my employees with wages as their sole cumpenntion, 3260
will do the work and Ne swctute is not intended ofo@rd for sale(See706/.Business
Md Professions Cade:The Contractors License law does not apply to an owner of Required Inspections
property who builds or harrower thereon,and who docs such work himself or through his
Own employees,provided that such improvements an,not intended ser offered for We.IL
howeveA the building ar improvement is old within mm year of completion,the owner
builder will haw the burden of proving that he did nm Wild or improve for purpose of
va.j.
❑I.as comer of the property,am¢elusively contracting with lid contrutors to .
construct the pmjen(Sec.7064,Business and professions Code:)The Conuachori U.
ceue Law docs not apply m an owner of property who Wilds or improves themon,and.
who comment for such pmjecu with a conuacmr(s)licensed pursuanuo the Contractors
License Law.
1 am exempt under Sec .B&P C for this moon
eL_ Dam
W RKER'S COMPENSATION DECIARA
1 hereby dfrm under penalty of perjury ane of Ne Tolle ng declarations:
I haw and will maintain a Cevifwm of Consent to rel6esun ifor Workari en
Comp -
mean,u provided for by Mon.3700 of the Labor Cade,far the Performance of Be
work for which this Permit is issued.
El I have and will maintain Worker's Compensation Inaboarm,as raquired by Section
37M of the Labor Cod.,for Ne performance of the work far which this permit is issued.
My Walkers Compensation I....cmricr and Polity number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Mosectioo need not hecomplcad if Use Permit Is forane hundred dollars(SIM)
less)
I cavity this in the p ofm r ante of the.,it for which Nis permit is issued,I shall nm
employ any Noun in My manner u as to become subject o the Workers'Compensation
Laws of Cahramia.Date
Applicant
NOTICE TO APPLICANT:If.after making this Ccnirrcaa of Eacmptiod.you should
Wcome subject to the Walter's Compensation Provisions of the Labor Code,you muse
.JZ forthwith comply with such....teou or this pcoutimall W denied mwked.
z O CONSTRUCTION LENDING AGENCY
F" Thereby afOfm that there is a eautructina lending agency for the performance of
[L the work for which Nu permit is issued(Sec.3107,Civ,C.)
Irl 0 lander':Name
�• Lcndar's Address
Z
U O T certify that I ban mad Nis application and sus Nat the above information is
F coned I agree to comply with all city and county ordinances and sate laws reading to
V building convection,and hereby mumaim representative of this city to enter upon dm
r W above-mentioned prepeny for inspection purlwus
(We)agree to on,indemnify and keep harmless the City of Cupertino aga)mt
F'y liabilitiu.judgments,costs and expenses which may in any way aceruc against said City
of the gritraing of
U z APPLICANTeUNDERSTANDS AND rWILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR REGULATIONS.
_ f Re-roofs
ignuum of P c HAZARDOUS MATERIALS DISCLOSU lco Daa Type of Roof
Will the applicant or future building Occupant store or handle hicom us material
as dcfned by 1W Cupertino Municipal Coda,Clore,9.11,and the Health and Safety
^otic, 0Y.25532(¢)? No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or m building ottupam esu cyuipmcm or Devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit horardous air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
District? JJJ
❑Yes 9k.
I have mad the hasardaosmaterials requirements under Chapter6.95 orda Califor
nice Health&Safmy Code,Sections 15505.35533 and 15534.1 understand thmifthe Wilding
dos not currently ham a moan.that it is my responsibility to notify the occupant of the
myuiremcnls which an M met poor wuse car a Ccourcaaof Ocuanc. Signature of Applicant Date
neroraathod engem DamC All roof coverings to be Class"B"or better