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CITY OF CUPERTINO }�
BUILDING DIVISION PERMIT�4`E���"
BUILD NG ADDRESS:
GEENLEAF LOT 2
TBD'- TO BE DETERMINED
PERMIT NO.
07020039
OWNER'S NAME:
PERhffr MUE DATE
GREENLEAF ASSOCIATES LLC
09/14/2007
PHONE:
SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER:
NEW 2 STORY SFDWL- 1ST:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
2084'r
Ob escription
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
" ^ ^ ^ ^ ^ ^_. ., .
with Section 7000) of Division 3 of the Business and Professions Code and my license'
in full force and eff.10
License Class Lie. p
Date Cantracto
ARCHITECTS DEC ON
1 understand my plans shall be used as is records
Licensed Professional .
OWNER -BUILDER DECLARATION
I hereby affirm that 1 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
Ft. Floor Area Valuation
that he is licensed pursuant to the provisions of the Contracmr's License Law (Chapter 9
Sq,
(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
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
APN Number Occupancy Type
not more than five hundred dollars (550
❑ 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 Coda 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 the burden of proving that he did not build or improve for purpose of
sale.).
5I, as owner of the property, am exclusively contracting with licensed contractors to
nswct the project (Sec. 7044. Business and Professions Code:) The Contractors Li-
cense 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 Contractors
.
License law.
❑ I am exempts under Sec , B & P C for this reason
.L r
(�1z_:CJ
Owner Date
-—WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations
❑ I hsve and will maintain a Certificate of Consent to self -insure for Workers Compen.
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as required by Section
00 of the Labor Code, for the performance of the work for which this permit is issued
My Workers Compensation Insurancecarrier and Policy number are:
�� Cb _�Obs
Carrier. TC r.snl.mjZr4 Policy No.: b00atmo-3�
CF_RTIRCATMF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred doll= ($100)
or less.)
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date —
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this peanil shall be deemed revoked.
I
CONSTRUCTION LENDING AGENCY
_
I hereby affirm that there is a construction lending agency for the performance of
' the work for which this permit is issued (Sec. 3097. Civ. C.)
-
Lenders Name
,
Lender's Address
I certify that I have read this application and state that the above information is
c correct. I agree to comply with all city and county ordinances and state laws relating to
c building construction, and hereby authorize rcprescntativcs of this city to enter upon the
ahovc-mentiuned properly for inspection purposes
? (We) agree to save, indemnify and keep harmless the City of Cupertino against
I liabiliues, judg rats• toss and expenses which may in any way accrue against said City
in consequent o the granting of this permit.
l APP ICA UNDERSTANDS ND WILL COMPLY WITH ALL NON -POINT
Issued by: Date /aa" -jz
SO R E ULATIO _
`p�
b
Re -roofs
pplicaDate
sere HAZARDOUS
S'2�PHAZARDOUS MATERIALS DISCLOSURE
Type of Roof 57
Will the applicant or future building occupantsmre or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety
Code, Section 25532(a)?
Dyes �1's7o
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 of devices which
emit hazardous air cur aminans as defined by the Bay Area Air Quality Management
all new materials for inspection.
Disuict7
1 Nu
❑Yes /`
I have re e hazard ousmaterials requirements under Chapter 6.95 of the Cali for-
niaHealLh S tyCode,Sections25505.25533and25534.1understandthatifthcbuilding
does not curve fly have a tenant. t s my responsibility m notify the occupant of the
N(tircmcn hich must t ' to issuance of a Certificate ofOccupancy.
Signature of Applicant Date
,
roof coverings to be Class "B" or better
erotherizndagent Date