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04070122• BUILDING DIVISION ,v PERMIT I. "�"' " I �'rO��_, , r 3'Y'g'.' L�-t.I BUILDING ADDRESS: NOVO CONSTRUCTION "''4070122 .06 LICENSED CONTRACTOR'S DECLARATION - 1 hereby affirm Thal I am licensed under previsions of Chapter 9 (commencing with Section 7&5) of Division Sof the Business and Profession, Code. and my license is L n n Z icenfull se �sand effect. Li. # r-sC.l \ ©a'�3 n�p DaLL' cmannebrl 7WARCHITECTS DECLARATION �i 1 understand my plans shall k used as public records �a.0 is t; Licensed Professional 3 OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Convector's License Law far tic 00 following mason.(Section FD 1.5, Business and Prefeetiuns Code: Any city nr county $ which requires a permit to construct. alter, improve, demolish, or repair any structure t- prior In 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 1- (commencing (commencing with Section 7000)of Division 3 of the Businces and Prefeasions Code) or i that he is exampl therefrom and tin basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil Penalty of not mart than five hundred dollen ($500). ❑ 1, as owner of the property, or my employees with wages as their Cole compensation, willdo the work and the structure is sol intended oroffercd fossale (Sec. 7044, Business and Professions Code: The Convactori License Use does not apply he an owner of pmpeny w ho bui Ida or ineprows; thence, end who does s uch wark himself or through his awn employees, powshad Nat such improvements arc not intended oroffercd formic, IL however, the building or improvement is sold within one year of completion, the ownea builder will have the burden of proving that he did not Wild or improve for purpose of sam.). ❑ 1, as owner of the property, am exclusively contracting with licensed convacton to construct the project (Sec. 7044, Business and Professions Cade:) The Committees LI - cense Law dose not apply to an owner of property who Wilds or impmvas thereon, and who contracts for such Projects with a contrector(s) licensed pursuant to Ik Co rracmr's 0Li se Law. am exempt under Sec. , B & P C for this reason Owner Dau WORKERS COMPENSATION DECLARATION 1 hereby alfitm under penalty of perjury one of die fallowing declarations: have and will minimum a Cenifieate of Consentto self-insum for WorkeYa Cornice.Iodine, as provided for by Smile. 37110 of die labor Com. far the perim rm. 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 die work for which this Permit is issued. My Worker's Compensation Insurance carrier and Polity number are: Cartier. Policy Na.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thisace ion need no tecompleud if the permit isforonc hundred duller (SIM) or less.) I cenify that in the pufnrmaneo of the work for which this permit Is issued, l shell not employ anypenon in any mann�c�r�m az to Mc`me sub, j5ct la IM Workers' Compensation Laws of rnia. Dau �V Asad' \a 1✓a rte..] N TO APPLICANT: If, after mulking this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of Ne Labor Code, you must .JO forthwith comply with such provisions ar this permit shall be deemed revoked. d. LENDING AGENCY �., I hereby affirm that there is a construction lending agcmy for the performance of r1, > the work for which this permit is issued (Sec. 3097, Civ. C.) 6Wi Q Lender's Nam. r7 Lender's Add., J Q I cenify that I have read this application and sum that the above information is LL F cmrem. l agree to comply with all city and county ordinances and sum law$ relating to C) building construction. and hereby audition mpresenudvea of this city in enter upon the W above-momianed property for inspection purposes. y (We) agree to save, indemnify and keep hnmlcss du City of Cupertino against ra VI liabilities. judgments, casts and expenses which may in any way accrue against said City („) Z in consequence of One granting of this permit. ^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Will the applicant or future building occupant store or handle h mandous material az defined by the Cupertino Municipal Cade, Gaper 9.12, and the Health and Safety Code, Section 25532(.)? ❑Yes �u All roofs shall be inspected prior to any roofing material being installed. occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove by the Bay Area Air Quality Management all new materials for inspection. Job TI --INTERIOR REMODEL Area 3MF1IDNef00 Issued Re -roofs Type of Roof PERMIT ISSUE DATE OCT Ob 2004 BUILDING Required Inspections Date M Will the I vardous materials requirements under Chapter 6.95 of the Califon :, Sections 25505.25533 and 25534.1 undersand dist if the Wiiding a moan, that it is my mainnobility m notify the occupied of die Signature of Applicant Date All roof coverings to be Class "B" or better