Loading...
06120010 CIT�I OF CUPERTINO y� ym r 7 BUILDING DIVISION PERMIT �C► ������1�������1©N`� PERMIT NO. �� O BUILDING ADDRESS:La - — Q 1 �►/JT+� �V•J�L PERMIT ISSUE DATE OWNER'S NAME:,vlt r �{ �I - 113110 SANITARY O. CONTROL NO. .—ONE: — BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH J 0 LICENSED CONTRACTOR'S DECLARATION L Job Description t m F 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing '1 ., ...+� &�e 1(/'w(`1'�'1-(l•,�h�Q r Z with Section and of ecof Division 3 of the Business and Professions Code,and my license is Qu 'yn'w��11JI •in full force and effect1�C��/a ,•—` IV.jV / Z License Class Lic.N i C 4p Datc Contractor ^A ARCHITEC'T'S DECLARATION n� ��fi�� d I n„� room cel a 1 understand my plans shall be used as public records v V1 1 '��'rd�V A 1 w H Licensed Professional / �[I//� o a OWNER-BUILDER DECLARATION01 a ` !{� ► 11 J� J v I hereby affirm that 1 am exempt from the Contractors License Law for the ID cc following reason.(Section 7031.5,Business and Professions Code:Any city or county m ff which requires a permit to construct.alter.improve,demolish,or repair any structure prior w its issuance,also requires the applicant for such permit to file a signed statement Sq.Ft.Floor Area Valuation Z a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 yF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of PN Number a Qccupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(3500). I,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's 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 the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- ccnse Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. lam exemp nder Sec. B&P C for this reason ^vner Datet. WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: Q 1 have and will maintain a Certificate of Consent to self-insure for Workces Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this pennit is issued. My Worker's Compensation Insurance carrier 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 permit is issued.I shall not employ any person to y mann r so to become sub t to the Workers'Compensation Laws of Califon �� � Applicant gii� Or NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. z CONSTRUCTION LENDING AGENCY E~.r►�-. I hereby affirm that there is a construction lending agency for the performance of (Z> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name 2 Lender s Address U C I certify that I have read this application and state that the above information is CL " correct.I agree to comply with all city and county ordinances and state laws relating to CDU building construction,and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. f•L (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date 31-0 9 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SORC wULATIO �—J/d7 Re-roofs Signature of Applicant/Contractor Dare Type Of Roof HAZARDOUS MATERIALS DISCLOSURE yP 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 ^ode,Section 25532(a)? All roo's shall be inspected prior to any roofing material being installed. []Yes 0No If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or device deviceswhich all new materials for inspection. emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? 0 Yes ❑Nu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the Date requircm which must be met prior to issuance of a Certificate of Occupancy. SlgnatL re of Applicant �i«�.•f����s ,;, 3---o"7, All roof coverings to be Class"B"or better Ow--,or authorized agent Date