06090133CY OF CUPERTI
BUILDING DIVISION
ILDINGADDRESS: T TURNER CONSTRUCTION CO PEAMITNO.
06090133
142 W SANTA CT,ARA RT I -I i /?A /?nnti
ARCHITECT/ENGINEER:
O p LICENSED CONTRACTOR'S DECLARATION
cmi C I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
u with Section 7000) of Division 3 of the Busiress and Professions Code, and my license is
u
� H in full force and effect
License Class Lie. p
F;, p Date Contractor
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
>yU
' O Licensed Professional
e y OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
- G O following reason. (Section 7(Y31.5, Business and Professions Code: Any city or county
<m fi which requires a permit to construct, alter, improve, demolish, or repair any structure
Z prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's Ucense Law (Chapter 9
t � (commencing with Section 7000) of Division 3 of the Businessand Professions Code) or
I that he is exempt therefrom and the basis for the alleged exemption Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (S500).
❑ 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
and Professions Code: The Contractors License Law does not apply to an owner of
property who builds or improves thereon, and who doessuch 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.).
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractors U-
ccnse 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 exempt under Sec l . B & P C for this n
Owner I Date 11
WOR,XER'S(COMPFNS T�iO� N DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have 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
❑ 1 have and will maintain Workers 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 are:
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rho section need not be completed if the permit is for one hundred dollars (SI00)
or Icss.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner as to become ls ubjcol tothc piUkers' Compensation
Laws of California. Date f(�' 1 (
Applicant 1
NOTICE TO APPLICANT: JVaf&Kmakidris Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
[-+ I hereby affirm that there is a construction lending agency for the performance of
f1i the work for which this permit is issued (Sec. 3097, Civ. C.)
QLenders Name
= Z Lender's Address
U Q 1 certify that I have read this application and state that the above information is
VS — correct. I agree to comply with all city and county ordinances and state laws relating to
O U building construction, and hereby authorise representatives of this city to.enterupon the
a above -mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
rA liabilities, judgments, costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit.
r—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT.
SOURCE REGULATIONS. I - t I O V`
�JY� 1 l
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.32. and the Health and Safety
Code, Section 25532(a)?
❑Yes ❑No
Will the applicant or future building occupant use equipment or devices which
cmi( hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
❑ Yes aN.
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 tbe building
does not currently have a tenant, that it is my responsibility to notify the occupant of the
requirements which must be met rior (o'ssuance of a Certificate of Occupancy.
Owner or authorized agent Date
408)295-
SANITARY NO. CONTROL NO.
Job Description
BUILDING PERMIT INFO
ELECT PLUMB
REVISION: ARCHITECTURAL, STRUCTURAL & SITE CHAN
ORIGINAL PERMIT 060200.08
Ft. Floor Area
419ap910000
APN Number Occupancy Type
32619020.00
Required Inspections
61
Issued by:
Re -roofs .
Type of Roof .
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
Date
All roof coverings to be Class "B" or better