Loading...
09020056Dz C U -~ > �c �z C ?-e f= �9L iz CITY OF CUPERTINO BUILDING DIVISION PERMIT 7rxsN x �q BUILDING ADDRESS PERMIT NO. 21011 GREENLEAF DR TBD - TO BE DETERMINED OWNER'S NAME. A CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with S=Lkm 7000) of Division 3 of the Business and Professions Code, and my Ikense is - infullfouceandefecL REVISE, NEW HOLD DOWNS WITH STRUCTURAL ,CALCS License Class Lk. • Date contractor ORIGINAL #07120178-NO NEW PERMIT. ARCHfIEC1-S DECLARATION 1 understand my plum shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors 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 Contractor's Liecrue Law (Chapter 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions or the (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 0 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 mom than rive hundred dollars (sso 32608056 .00 ❑ L, as owner of the property, or my employes 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 Contractors License Law does not apply to an owner of property who buildsorimproves thereon, and who doessuch work himself ar through his own employcet, provided that such improvements are not intended oreflered far 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 sak ). L as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sea 7044, Business and Professions Coda:) The Contractor's u. tense Law does not apply to an owner of property who builds or improves thema4 and, who contracts for such projects with a contracror(s) licensed pursuant io the Contractor's Lice= Law, der Sea�� , B & P C for this reason ❑ I am Clem' dl Owner '�' ?.s, Due hereby affirm under penalty of perjury one of the following declaration: ❑ I have and will maintain a Certificate of Consent to self-Insum for Workers Compen- radon, as provided for 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 theperformance of the work for which this permit is issued. My Worker's Compensation Iamrance carrier and Policy number tie: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE Crhis section need not be completed if the permit is for one hundred dollars (2100) 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 maser so as e�ff�c sub Worker' Compensation Laws of Calif 'a. Date �(--t AgrpBant NOTICE TO PPLICANT`. If, after eking Certificate of Exemption, you should become subject to the Worker's Compensation pmvisions of the Labor Code you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY i hereby affirm that there is it construction lending agency for the performance of the work for which this permit is Issued (Sec. 3097. Civ. C.) I-endees Name , Lender's Address 1 certify that 1 have read this application and sate that the above information is correct. i agree to comply with all city and county ordinances and sate laws Heisting to building concoction, and hemby authorise representatives of this city to enter upon the above -mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against gm and ex this p which may in any way accrue against said City in cotter, Jud)pncnhecosts inconsequence or the grantag of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date 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)? ❑Ya j�lo 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 or devices which emit hazardous air conandruns as dcrmed by the Bay Ares Air Quality Management all new materials for inspection. District? ❑ Yes 1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health k Safely Code, Sections 25505.25533 and 25534. I wtdm=nd Wuif the building does not currently have a tenant, that his my responsibility to notify the omhpant of the rcga a which retest be met prier to 4=a= of a Cextifieatc Of OCe` Signature of Applicant Date " `�T All roof coverings to be Class'%'' or better 0or aulharv�d agent Da�c"paney.