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CITY OF CUPERTINO
BUILDING DIVISION PERMIT���"'1°101.
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BUILDING
PERMITNO.
TESS:
105y1 WUNDERLICH DR
TBD — TO BE DETERMINED
06080127
OWNER'S NAME:
PERMIT ISSUE DATE
06/25/2007
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
p
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
NEW SFDWL 3063 ' — 1ST FLOOR 1957', 2ND FLOOR 866'
in full force and effect, r/
License Class Lie. s •� �Z
BASEMENT 1527', GARAGE 532'
Datetractor
ARCHITECTS DECLA TION
GARAGE 532' X 56.38 = $29,994.16 PERMIT APPL
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's Uccnse Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or County
which requires a permit to cnnstruct, alter, improve, demolish, nr repair any structure
prior to its issuance, also requires the applicant for such permit to rile a signed statement
he is licensed to the of the Contractor's License Law (Chapter 9
Sq. Ft. Floor AreaValuation
that pursuant provisions
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$686610 686610
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (s500).
3 7 5 3 3 0 5 3ff
❑ 1, 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 docs 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,
howevrr, 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 Contractor's L) -
cense Law docs not apply to an owner of property who builds or improves thereon, and
who contracts for such pmjects with a contractor(s) licensed pursuant to the Contractors
License Law.
❑ I am exempt under Sec. . B & P C for this reason
Owner Date
WORKER'S COMPENSATION 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 Worker'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.
❑ 1 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 Worker's Compensation Insurance carrier and Policy number are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be complexed if the permit is far one hundred dollars (5100)
or less.)
1 certify that in the performance of the work for which this permit is issued. I shall not
employ any person in any manner so }s.to�ello�c suhiect to orkempensa6on
-
Laws of California. D e• y S
Applicant
NOTICE TO RCPP CAM: 4�Aermaking this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construetinn lending agency for the performance of
the work for which this permit is issued (Sec, 3097, Civ. C.)
`
Lender's Name
Lender's Address
1 certify that I have read 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 authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and ex `es �*h may in any way accrue against said City
in the
consequcncc of g nl ng rs�1tc tL
APPLICANT "N STWD1,AND W] COMPLY WITH ALL NON-POINTIssued
by: Date
SOURCE
Re -roofs
_
Type of Roof
gnaturc of isontractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupantstorc or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
El Yes P�1-o
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 -
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
El Yes No
1 have read the hvardous materials requircmcws under Chapter 6.95 of the Califor-
nia Health & Safcty Codc, Section 25505, 2 33 d 25534. I understand that if the building
dors not currently have a tenant, that i ' responsibility otiry the occupant of the
requirementswhichmu suan of tcateofOccupancy.
Signature of Applicant Date
roof coverings to be Class "B" or better
owne r, orncd ago Date