07060064 CITY OF CUPERTINO � TR �.T I } TION:
BUILDING DIVISION PERMIT pERMITNO.
111111-liTIn"kILLER AVE #1 ABLE EXT'.�RMINTATORS INC 07060064
PERMIT LSSUE DATE
OWNER'S NAME: 6$ SUNS.�T AVE 06/08/2007
KRIKMAN FAMILY TRUST SANITARY NO. CONTROL NO.
NE: (408) 251-6500
BUILDING PERMIT INFO
ARCHiTECTIENGINEER: BL ELECT� PLUMB
Q MECH
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ce Z LICENSED CONTRACTOR'S DECLARATION Job Description
:t°o I hereby affirm that I am licensed under provisions of Chapter 9(commencing BATHROOM REMODEL TUB BATH & FLOOR. WOOD REPAIRS
U with Section 7000)of Division 3 of the Business and Professions Codc,and my license is
iaa in full force and effect. .237-263 TO CARPCRT, EAVES & SIDING FOR ALL UNITS.
' z License lass w e,,r
�^p Datc - —O Contractor IrAl ]@+r.a 12
F ARCHITECT'S DECLARATION
C-3 1 understand my plans shall he used as public records
iaU
'
t,H Licensed Professional
•o a OWNER-BUILDER DECLARATION
3< 1 hereby affirm that 1 am exempt from the Contractors License Law for the
p o following cc -(Section 7031.5,Business and Professions Code:Any city or county
r, which requires a permit to construct,alter,improve,dcmOILsh,or repair any structure Valuation
r"y prior to its issuance,also requires the applicant for such permit to file a signed statementF3691403
Ft.Floor Area $719 0
?< that he is licensed pursuant to the previsions of the Contractor's License Law(Chapter 9q'
l-- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation o[ Number Occupancy Type
Section 7031.3 by arty applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars(5500).
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 or improves 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 that he did not build or improve for purpose of
sale.).
0 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 thereon,and
who contracts for such projects with a contractors)licensed pursuant to the ContractOes
License Law. B&P C for this reason
0 1 am exempt under Sec
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury One of the following declarations:
0 1 have and will maintain a Certificate of Consent to self-insure for WorkeesCampen-
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 Woe s CompatuUon insurance carrier and Polity number are:
Card AItFDltnf n
�� _Policy No.: 4-012-0(,0-01-03
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 certify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this 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.
ci
Z CONSTRUCTION LENDING AGENCY
,�. I hereby affirm that there is a construction lending agency for the performance of
R!.7 the work for which this permit is issued(Sec.3097,Civ.C.)
(Sa Q Lender's Name
R, Lender's Address
V z 1 certify drat 1 have read this application and state that the above information is
Ct,►� correct.I agree to comply with all city and county ordinances and state laws relating to
0 building construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
>" W (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
APPLICANT UNDERSTANDS AN W LL COMPLY WITH ALL NON-POINT Issued b:I-
SOURC U TIONS. - `O
rAll
Sign a of Applicant/Coaractor Dare (ZOof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
az defined by the Cupertino Muniipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? i shall be inspected prior to any roofing material being installed.
Yes °C"° If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or tutu wilding to 'upant use equipment ordevices which all new materials for inspection.
emit hazardous air contaminants defined by the Bay Area Air QualityManagement
District?
Yes NO
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 dtc building
does not current have a tenant,drat it is my nsibility m notify the occupant of the Date
reyu.mmen h' t x met pri to i ce of a Certificate of Occupancy. Signature Of Applicant
-9-0 All roof coverings to be Class"B"or better
Owner or authorized agent Date