03090015 Cl OF CUPF.RTINO
BUILDING DIVISION PERMIT CONTRACTnR�INFORMATION
BUIL
DING ADDRESS: GREG FAROTTE CONSTRUCTION Nf ff "'03090015
ER's"AME: 8545 MONTEREY STREET , PERMIT ISSUE DATE
IA!I�C
E' (408) 848-9993 SANITARY NO. CONTROL NO.
ITECT/ENGINEER: BUILDING PERMIT INFO
PLUMB MECH
i0LICENSED CONTRACTORS DECLARATIONtI hereby affirm that I am licensed under provisions of Chapter 9(commencinglob Description
ection 7g )of Division 3ofNe Busine&sand Pmfessinm Code,end my license is
foreandcfrea REVI.SIONB
iLIqe Class Lic.N
2C7Dem Cuntmew,
££ ARCHfBC*S DECLARATION
f C< I understand my plans shall he used as public records \�
)dD s
�LL�- Licensed Pmfeanonal JS
o g OWNER-BUILDER DECLARATION \ ``
<f I hereby affirm that I am exempt from the Contescror's License Law for the y
00 following reason.(Section 7101.5,Business and Professions Cade:Any city n,county
3 m which requires a petrels to construct,slier,improve,demolish,or repair any structure
-iy
prior o its issuance.also requinesthe applicant far such permit to file a signed statement
that he is licensed pursuant to the provisions Ofthe Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
Lt- (commencing with Section 7")of Division 5.f the Business and Professions Cork)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of 31626093 . 00
Section 7031.5 by any applicantfor a permit subjects the applicant to a Civil penalty of APN Number_ Occupancy Type
oat mart Nan five hundred dollars(8500). - '- -— - -- --
❑1.as Owner of the property,or my employees with wages as their sale compensation, (�7�T
will do Nstructurew
e wont.and the structure is not intended a 1
wagered f....(Sec.7044,Business - 111d Inspections
and Profession&Coda:The Commerce,License Law don not apply m an owner of 10 2 - PIERS IERS P
prophesy who builds.,improves Hereon,end whodoessuch work himself.,through his
own employees,provided that such improvements are not intended oroffered(or sale.It. 103 - UFER
however,the building or improvement is sold within one yes oreompleeon,the owner-
builder will base the burden of proving that he did not Wild or improve fur purpose of 104 - REBAR
"I`') 105 - ANCHOR BOLTS
❑I,as owner of ct progeny,,B exclusively confessing with:)The
conu¢ton i.
Construct me project(Seco 7lx4,Business and n.roatcna code:)The c.ntracmr,u. 106 - SEWER & WATER
cense law Coca not apply as in owner or properly who Wilds or improve&Renton.and 202 - UNDERFLOOR PLUMBING
who contracts for such projects with a contnctor(s)licensed pursuant to the Contractor'.
Lkenx Law. 203 - UNDERFLOOR MECHANICAL
❑lam exam under Sec ,B A,P C for this rcsson
204 - UNDERFLOOR FRAME
WORKER'SCOMPENSATIO DEC AWN 205 - UNDERFLOOR INSULATION
the yaffirm under penalty ofPerjury oneofthefollowing dmlantions: 301 - ROUGH PLUMBING
I have and will maintain a Ccnifcautof Consent to self-insum for Worker's Compcn- 302 - TUB & OR SHOWER
match,at pmmdcd for by section 37W of the IaWr Code,for the performance of that 303 - ROUGH MECHANICAL
work a which this aimainWorer' 304 - ROUGH ELECTRICAL
s issued,
❑1have and will maintain Worker's ante of den w In&umnee,hrequired,i Sssuon d,
5700 of Nc La Wr Calc,for Nc Performance of Ne wont for which this pc,mit is issued. 305 - FRAME
My Worker',Compensation Insurance carrier and Policy num her ate: 306 - HOLDOWNS
Cartier. PolicCERTIFICATE OFEXEMPIONYFROM WORKERS' 307 - INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
or This section need not W completed if the Permit is for one hundred dollar,(SLOB) 309 - EXTERIOR LATH
I cenif) 310 - INTERIOR LATH
employ eenify Na er on m any once of as wok for which Nis permit l issued,I andl nut
LawoanypconninanymsnnersnssmWeomesubjauotheWarkeriCnmpensstion 311 - SCRATCH COAT
Lawecart mi..Date 313 - ROOF NAIL
Applicem
NOTICE TO APPLICANT.If.after making this CenifieW of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisions of she Labor Code,you must
� ,Z forthwith Comply wish such provisions or this Permit mall Ideemed mvoked. 502 - FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hereby scion that Nem it a construction lending agency for the performance of 504 - FINAL BUILDING ENERGY
3.
the der'sNamc for which mts
itPernitis ,.ed(see.3I»7,ci..ca
Lender's" 505 - FINAL ELECTRICAL
3) Q
DZ <hecesAaarea 506 - GAS TEST
:) 0 I certify that I have read this application and soon that the awn information it S O 7 - FINAL PLUMBING
Fcarted.I agree to comply with all city and county ordinances and tote laws relating t.
jYJ, building contusion,and hereby outhories representatives of this city to enter upon the FIN MEC CAL
U above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep u1no a the City of Cupsnino against O 9 F I
cn Ilabilitiu,judgments,costs and expenses which may in any wayaccmcagainstsaidCity 5 NG
JZ in consequence of the granting of this perm it.
r-t APPL ANT UNDERSTANDS AND WILL COMPLY WI_ AL ^ON-POINT Issued by:55% C WORKS Date
S E REG L
3`D Re-roofs
of re of Applicau Contractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will thcapplicant or lot— Idinguccupant nom or handle hanaol material
as defined by the Cupertino Muni a Code.Gapmt 9.13,and Ne Health and Safety
c.Section 33533(x)? All roofs shall be inspected prior to an roofing material being installed.
❑Yet N. P P Y g 8
Will the applicant or mare building ce.oPanL use equipment atdeviow which If a roof is installed without first obtaining an inspection,I agree to remove
it ha'ramou.air consminnts defined by the Bay Am.Air Quality Management all new materials for inspection.
isuict?
❑Inc. Nu
I have read the hwallous materials mquimments under Chapter 6.95 of Ne Califon
out Health A otyCeds,Sections 25505,25573 and 25534.1 corkaland Net ifthe building
does not currently haves wont.Not o i,my re,positudily to no fy ocupanl of he
on mawhichm map' tuimuanccofa Cc ' camof 7cy3 Signature of Applicant Date
r raumori'redepcm Dmc All roof coverings to be Class oB. or better