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07080059 CITY OF CUPERTINOr BUILDING DIVISION PE'RNIIT ,� y` �r * BUILDING ADDRESS: PERMIT NO. 10123 N WOLFE RD SAN JOSE CONSTRUCTION 07080059 OWNER'S NAME: PERMIT ISSUE DATE 1210 COLEMA4 AVE 11/08/2007 PHONE: SANITARY NO. CONTROL NO. (408) 986-8711 ARCHITECTIENGINEER: BUILDING PERMrr INFO - '- BLDG ELECT*D 0 PLUMB MECH D (� i o p LICENSED CONTRACTOR'S DECLARATION .Lit is I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description Z m with Section 7000)of Division 3 of the Business and Professions Code,and my license is REVISION #TO T 2 4 C OMPL I ANE AT BAR AREA 5% in full force and effect � z License Gass Lie.te ORIGINAL PERMIT #06080090-NO NEW PERMIT. F aDate Contractor a AiEFF crs DECLARATION STRIKE 1 understand my plans shall be used as public:records- .0.t`, BOWLING ALLEY. - - - - - .a LicoesedProCessional- - - o y OWNER-BUILDER DECLARATION < I hereby affirm that I am exempt from the Contractor's License Law for the OO following reason.(Section 7031.5,Business and Professions Code:Any city or county C m V which requires a permit to construct,alter,improve,demolish,or repair any surrcture Z y prior to its issuance,also requires the applicant for such permit to file a signed statement S that he is-licensed pursuant to the provisions of the Contractor's Liccnsc Law(Chapter 9 Sq.Ft.Floor Area Valuation (commencing with Section 7000)of Division 3 of the Business and Professions Codc)or $O 1 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 ofNllrrlber Occupancy Type not more than five hundred dollars($500). 3162 0 0 6 3 U U ❑I,as owner of the property,or my employees with wages as thein sole compensation, will do the work.and the structure is not intended or offeredtorsale(Sec.7044,Business - Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of L] P property who builds orimproves 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 thathe did not build improve for purpose.of sale. I,as owner of the property,am exclusively contracting:with licensed contractors to _ construct the project(Sec.7044,Business and Professions Code:)Tie Contractor's U_ 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 Contractor's License Law. ❑I am exempt de kc. B do P C for o n Owner ate `et7 K MP N DF-CLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insureefor 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. ❑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: Cartier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is formic hundred dollars WOO) or less) - I certify that in the performance of the we*for. hfeh this permit is issued.!:shad not employ any person in an anner so 15o tbje t to the Workers'Compensation Laws of Cal it Applicant- - NOTICE TO APPLICANT:If,after making L*Certificated Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z~ CONSTRUCTION LENDING AGENCY Cn I hereby affirm that there is,a constructionlending agency for the pmformancc of IY..7 the work for which this permit is issued(Sec.3097,Civ.C.) a A Lender's Name Z Lender's Address U 0 1 certify that I have read this application and state that the above information is V.H correct.I agree to comply with all city and county ordinances and state laws minting to 0 V building construction,and hereby authorize mirmsentativcs of this city to enter upon the. W above-mcmioned property for inspection purposes (We)agree to save,indemnify and keep,.harmless the City of Cupertino against rF-u 04 liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit 0'4 APPLICANT UNDERSTANDRIAND WILL COMPLY WITH ALL NON-POINT Issued by: Date S E REGULATION f� Re-roofs natum o Applicanfor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building ottvpantstom or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes (Wm If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or furore 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? ❑Yes �n I have read the hazardous materials requirements undor Chaptcr6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533ant125534.1vnderstandthatifthe building docs not c dy have a tenant that it is my responsibility to notify the t of the mqui is which must der to issuance of a ccniftcate of Occup Signature of Applicant Date lc All roof coverings to be Class"B"or better Owe,-ora agent riate