07060039 CITY OF CUPERTINOTtDIt I �? 1TI�1�1
BUILDING DIVISION PERMITpERMITNO.
FBUILDI!IVMSSENHART LN TBD — T J BEDETERMINED 07060039
PERMIT ISSUE DATE
:
& DAO NGUYEN SANITARY N . CONTROL NO.
BUILDING PERMIT INFO
BEPLMECH
ARCHITECTIENGINEER: � � O �
Z LICENSED CONTRACTOR'S DECLARATION Job Description
P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
U with Section 7000)of Division 3 of the Business and Professions Code,and my license is S FDWL—2 STORY 1800 ' W/PORCH 781 /GARAGE
tiin full force and effect. Lica 444 ' -SANITARY I S SUNNYVALE' S JURISDICTION.
Z License Class�— Contractor
p Date
r.4 ARCHiTECI-S DECLARATION
I understand my plans shall be used as public records
U
F' Licensed Professional
a
OWNER-BUILDER DECLARATION
' 1 hereby affirm that 1 am exempt from the Contractors Liccnsc Law for the
Oa following reason.(Section 703 1.5.Business and Professions Code:Any city or county
ti which requires a permit to construct,alter,improve,demolish,or repair any structure Valuation
y prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area
i 0 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $413901
(commencing with Section 7000)of Division 3 of the Business and Professions Code)or Occupancy Type
that he is exempt therefrom and the basis for the alleged exemption.Any violation of A� Number
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 375150 6 . V
not more than five hundred dollars($500).
0 I,as owner of the property,or my employees with wages as their sole compensation, Required Inspections
will do the work and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds of improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.U,
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.).
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves tors
who contracts for such projects with a contractor(s)licensed ptrsuant to the
License Law. ,B&P C f V reason
[7 I am exe pt der Sec
Date
RK ' CO P A DECLARATIO,
1 hereby afrirrn under penalty of pe one of the following declarations:
❑]have and will maintain.7
Ce ca c Consent toself-irtsure 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.
0 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 arc:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This'section need not be completed if the permit is for one hundred dollars($100)
or less.)
I cenify that in the performance of the cork for which this permit is issued.I shall not
cmploy any person in m r� b me bject to the Workers'Compensation
Laws of Califomi a
Applicant
NOTICE TO A :If, aking this ificatc of Exemption,you should
become subject to the Worker's Compensation inions of the Labor Code,you must
Z forthwith comply with such provisions or this unit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
a Q Lenders Name
Lenders Address
�z
I certify that 1 have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating to
U building construction,and hereby authorize representatives of this city to enter upon the
y W ahovc-mentioned property for inspection purposes.
(Wc)'"agree to save,indemnify and keep harmless the City of Cupertino against
y liabilities,judgments,casts and expenses which may in anyway accrue against said City Date
Zin consequence or the granting of this permit.
�— APPLICANT UNDER ST AND W COMPLY WITH ALL ON- OINT Issued 7y:
S REG ULATIO911-0
Re-roo's
ign ureof Appy ontractor. Date T e o.'Roof
HAZARDOUS' ALS DISCLOSURE yP
Will the applicant or future ing occupa L ore or handle hazardous material
'efined by the Cupertino Muni pal Code.Chapter 9.12,and the Health and Safety
e,Section 25532(a)? All roc fs shall be inspected prior to any roofing material being installed.
OYes ° 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 all rev'materials for inspection.
emit hazardous Air contaminants as defined by the Bay Area Air Quality Management
District? . '- 1
0 yes )CJ N°
I have read.the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&SafetyCodc,Sections 25505,25533 and25534.1 understand that if the building
docs not c nU.have a icnant,that i my Monsibility to notify the occupant of the Date
requi is It must be met p' d of Certificate of Occu O Signat ire of Applicant
All roof coverings to be Class"B" or better
DatcJF
_
Owner or ulhorize agent