06100055 77.
CITY OF CUPERTINO ZQTQ �
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:
10668 CARVER DR TBD — TC BE DETERMINED 06100055
PERMIT ISSUE DATE
OWNER'S NAME:
05Z22/2007 --
KARAM GERGES & SAMIA GERGES SANITARY NO. CONTROL NO.
IE:
BUILDING PERMIT INFO
ARC HITECT/ENGiNEER: BLDG ELECT PLUMB MECH
w 0 LICENSED CONTRACTOR'S DECLARATION Job Description
U4
P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z with Section 7otw)at Division 3 of the Business and Professions Code,and my license is ADD: 1499 ' LIVING, 3 BEDRMS, 3 BATH, FMLY RM,
I a a in full force and effect.
>yz License Class uc.n DINING IM & KITCHEN. REMODEL: 1036 ' KITCHEN,
p Date Contractor
w
_5 ARCHITECTS DECLARATION NEEDS
J;,< I understand my plans shall be used as public records DEMO PERMIT
:,"r,u
U.y Licensed Professional
y< OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
'00 following reason.(Section 703 1.5,Business and Professions Code:Any city or county
01 which requires a permit to construct,alter,improve,demolish,or repair any structure
— prior tri its issuance,also requires the applicant for such permit to file a signed statementq,Ft.Floor Area Valuation
?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $463348
4 H$ (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 Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of _/1 PN NUInber
not more than five hundred dollars(5500). 37532011) . v
0 1,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.).
20/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-
cerise 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.
am exempt B&P C for this reason
I f !c. `
O
Owner Date
A.42:2
COMPENSATION DECLARATION
I he
Jon
under penalty of perjury one of the following declarations:
tJ I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 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 permit 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 Icss.)
1 certify that in the performance of the work for which this permit is issued,I shall not
employ anyperson in any m is.to bccoEre�ttbjcct to the Workers'Compensation
Laws of Cafifomia D
Applicant
NOTICE TO APPLICANT:If,JJiLpIking this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Fr to 1 hereby affirm that there is a construction lending agency for the performance of
a 7 the work for which this permit is issued(Sec.3097,Civ.C.)
[>I A Lender's Name
a z Lender's Address
U 0 I certify that 1 have read this application and state that the above information is
L4 n the
► ordinances and state laws relating to
building construction,and hereby authorize representatives of this city to enter upo
correct.I agree to comply with all city and county or
above-mentioned property for inspection purposes.
✓ a (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 L 7
►" APPLICANT UNDERSTAND DWI MPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATION 6 /
Re-roofs
SignatureofAppIi on r Dare Type of F.00f
HAZAR S 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
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
0Yes ;XNe If a roof:s installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0 Yes ANo
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
requirements which must be met ' r to' uanceof a Certificate of Occupancy. Slgnatur( of Applicant
�2 C All roof coverings to be Class"B"or better
Owner or authorized agcn `- Date