07120253CITY OF CUPERTINO
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BUILDING DIVISION PERMIT����+�y'�*
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BUILDINGA DRESS:
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PERMrr NO.
1951 STEVENS CREEK BLVD FRNT
MENLO EQUITIES CPRTNO HSNG
07120253
OWNEWSNAME:
PER IITISSUEDATE
MENLO EQUITIES CPRTNO HSNG
2901 TASMAN DR STE 220
01/24/2008
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SANrfARY NO. CONTROL NO.
ARCHI EC IENGINEER:
BUILDING PERMIT INFO
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LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
vith Section 7000) of Division 3 of the Businraa and Professions Code, and my license is
a full force and ellen.
rcense Class Lie. t
)ate Contractor
ARCS nsm DECLARATION
I understand my plans shall be used as public records
.iexnsed Professional
OWNER -BUILDER DSCI ARATION
I hereby affirm that 1 am exempt [rum Ibe Contractor's License Law for the
ollowing mason. (Section 7031.5• Business and Professions Coda Any city or county
which requires a permit to construct, alter, Improve, demolish, or repair soy struemm
)rior to its issuance. also requires the applicant for such permit to file a signed staicmcm
hat he is licensed pursuant to the pmvisions-of the conuactor s License Law (Chapter 9
commencing wide Sesuon 700tH of Division 3 of the Business and Professions Code) or
hat he is
exempt therefrom and the bests for the alleged exemption Any violation of
Section 7031.5 by any applicant for a permit subjects the appfimm to s civil penalty of
iot more than five hundred dollars (S500).
1, as owner of tike property, or my employers with wages as their sole enmpeas idon,
win do the work, and the structure is not intended or offered for sale (Sec 7044. Business
and Professions Code: The Contractor's license Law dors not apply to an owner of
property who builds or improves themon, and who dors such work himself or through his
own employees, provided that such improvements are not intended at 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.).
❑T r as owner of the property. am exclusively contracting with licensed contractors to
construct, the project (See 7044, Business and Professions Code:) Me coenbacmes G-
rease Law does not apply to an owner of property who builds or improves thereon. and
who contracts for such projects with a contrannr(s) licensed ptuauant to the Cormactoes
Gccnse Law.
❑ 1 am exempt _ B & P C for this reason
Owner
Date
I hereby eII'um under penalty of perjury oro of the following declarations:
❑ I have and will maintain a Certificate of Consent to self-iwtm for Wodox'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 Workers Compensation Insurance carrier and Policy number ace
Carrier. Policy No.:
CERTIFICATE OP EKEMPITON FROM WORKERS'
COMPENSATION INSURANCE
(ibis section need not be completed tribe permit is for enc hundred dollars ($100)
or Ices)
1 cenify that in the performance of the work for which this permit is issued. l shall not
employ any person in any m r so b c sub' the Worlars' Compensation
Laws of Calir0ndL Date
Appilij
NOTICE TO APP Ll o Fxempuon you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this posmit shall be deemed revoked
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is p construction lending agency for the performance of
the wort for which this permit is issued (Sex. 3097, Civ. C)
L.endet's Name
Lenders Address
1 certify that 1 have mad this application and state that the above information is
correct 1 agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby amhoria representatives of this city to enter upon the
above-mendoned property for inspection proposes
(Wer) agree to save, indemnify and keep harmless the City of Cupcnino against
liabilities, jodgments, costs and exprascs which may in any way accrue against said City
in consequence of the granting of this permit
APPLICANT UNDERSTAND AND WILL COMPLY WITH ALL NON -POINT
SOUTHA ELATION&^ t
&ignath�i oetP6ctdF - — Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupanlst)re orhandle haurdous material
as defined by the Cupenino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑Yrs 2.90—
V611 the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District? �,�
❑ Yes 279,.
1 have mad the hazardous materials requucmems under Chapter 6.95 of the Califon
nia Heal th & Safety Code, Semions 25505, 25533 and 25534.1 understand thatif the building
docsnot c ly have a tenant that it is my responsibility m notify the occupant of the
tcquilrmc a ccrtifrcam of occupancy.
Job Description
ADD SHAFT TO VNT THE TRASH CHUTE
Sq. Ft. Floor Area Valuation
$15000
316 2 0 0 8 7 JPA]Fumber
Required Inspections
Issued by
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Re -roofs
1pe of Roof
Occupancy
Date
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
all new materials for inspection.
Signature of Applicant
A
Date
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