04070197 CITY OF CUPERTINO
BUILDING DIVISION PCRMIT CONTRACTOR INFORMATION ,i
BUILDINGADDRESS: HALLMARK CONSTRUCTION INC PERMIT"®4070197
0807 STEVENS CREEK 13II111h
OWNER'S NAME: PERMIT ISSUE DATE
J VOLCKMANN & ASSOOCIATES 3360 DE LA 4
NE: SANITARY NO. CONTROL NO.
(408) 727-4422
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u00 LICENSED CONTRACTOR'S DECLARATION
or F I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing _ .lob Description
with Section 7(HApof DiAxion 3 of the Business and Professions Code,and my license is
,y infuRrormandeffect. NEW RETAIL BLDG (7100 SQ. FT. )
License Class Lic.N
st
,F n Date Contractor
n H ARCHITECT'S DECLARATION
? U l understand my plans shall be used as public records
;oN Licensed Professional
S OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
O O following mason.(Section 7031.5,Business and Professions Code:Any city Or county
K$ which requires a permit to construct,alter,improve,demolish,or repair any structure
HZ>• prior to its issuance,also mquiies the applicant for such Permit o rile a signed statement
that he is licensed pursuant o he provisions of the Contractor's Lic rxet Law(Chapter 9 Sq.Ft. Floor Area Valuation
as M (commencing with Seeman 70san of Division 3 of the B usiness and Professions Code)or
i Nat he is exempt therefrom and Ne basis for the alleged exemption.Any viNaaion of
Section than by any applicant for a permit subjects the applicant a civil penalty of GccuanC T e
not mom than five hundrcdicant for a per :a■fig' P Y YP
❑1,m owner of the property,at my employees with wages as their sole compensation.
will do the work,and the swemre is not intended or offered for Sale(Scc.71M4.Bushman "� R"e aired Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of q p
property who builds or improves thereon,and who does such work himself or through his '
own employch,provided that such improvements are not intended or offered for sale.If. R A�1�
however.the building or improvement is sold within one year of completion,the owner. !9 tly
builder will have the burden of proving that he did net build or improve fur purpose of p �}
si las owner of the property am exclusively contracting with licensed convectors i BUILDING Y p
cent,La the project(Sec.to an
Business and property
who
Code:)The Convector's n lL W■
come Law docs not apply je an owner of property who builds or improves thereon,and
whocontractsLacts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑ 1 an,exempt an .B&PC for this reason
Owner I Dam 1p1� -
ORKER'S/CpI�IPENSA ON DECLARATION
1 here ySffum under bcaalCy of perjury one of the4gleallIng declarations:
1 he ve and will maintain a Ci nificate of Consent to self-insum for Worker'sCompen-
saaion,as provided far by Section 3700 of the Labor Code,for the performance 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 pesfmoran n of the work for which this permit is issued.
My Workers Compensation Insurance camier and Policy number am:
Cartier: Policy No.: _
CERTIFICATE OF EKEM"ION FROM WORKERS'
COMPENSATION INSURANCE
(This Section need not becomplc¢d if the permit is forum,hundred dollars($100)
in,less.)
I ccnify that in the perlirmance,of the work for which this Permit is issued,1 shall not
employ any person in any manner so as m become Subject o the Workers'Compensation
Laws of California.Date .
Applicant
NOTICE TO APPLICANT:IL alter making this Ceni licate of Exemption,you should
become subject to the Worker's Comp,asetion provisions of the Labor Code,you must
.JO forthwith comply with such provisions or this Firm i t shall he deemed revoked.
z'""t CONSTRUCTION LENDING AGENCY
'F 4 I thereby affirm that there is a consuucurn lending agency for the performance of
Did;a: work fm which this permit is issued(Sec.3197,Civ.C.)
1 Q Lender's Name C/
z Lchdcr's Address
U Q 1 cenify Nat 1 have read this application and state that the above info rnatiun is
ry F Cortcct,l agree to comply with all city and county uNinunces and state laws relating to
0 building construction.and hereby autharim representiones of this city to enter upon the
W
above mentioned property for inspection purposes. .I\',/Lfyf—(/1 //
(We)agree to cost,indemnify and keep harmless the Clay of quorsno against
tF'—t p) liabilities,judgments,costs and expenses andwhichkeep may Lnany ss the accrue of Cuprtinoa against
t) ,'� A APPLICANT
of the gromin a permit.
^' APPLICANT UN RS DS D W LL CO PLY WITH ALL NON-POINT Issued by: Date
SOURCER
Re-roofs
gee ser fApFIrtaHAZAR cm ATERIALS DISCLOSUR ale Type of Roof
Will th,applicant or building occupuntstmc or handle haearduus material `] ,
as defined by the Cupertino Municipal Code,Charier 9.12,and the Health and Safety
Code,Salina 25532(a)? All roofs shall be inspected prior to an roofing material beim
p Yes `f�N, P P Y g g installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it,hozadnue air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
istrin? .
❑Yes n �
I hos read the huvard,1smatedsisrequimmtnts under Chopmr 6.95 of the Califon
niaHwlahl4 Safety Code.Sc 25505.25533 and 25534.1 uWcrsmndthatifahe building
does not current) at brat, at onnyr sibilitymnndly ane cecupwt nl the
mquarron, In ,is of a Certificate of Occuancy, Signature of Applicant Date
Own apmnri,edage DmeO All roof coverings to be Class "B" or better