07030217 CITY OF CUPERTINO ���yT C� �R I `t}RIATI�N
BUILDING DIVISION �Ei11V111
PERMIT NO.
BUILrilr�c��D�EsJOHANSEN DRIVE TARA HOMES 07030217
l U L��J — PERMIT ISSUE DATE
'R'S NAME:
20
�UBRO KOLLAR 200 LUCILLE AVE, APT#41 03/23/2007
SANITARY NO. CONTROL NO.
PHONE: (408) 253-7828
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0
p Q LICENSED CONTRACTOR'S DECLARATION Job Description
to P I hereby affirm that I am licensed under provisions of Chapter 9(commcrte1 9
U U with Section 7000)of Division 3 of the Business and Professions Code,and my license is NEW GARP GE INCLUDING FOUNDATION 168 '
t w in full force and effect
t v�z License Class LM•#
F p Date
Contractor
m
ARCHITECTS DECLARATION
j aa
< t understand my plans shall he used as public records
5wu
u.y Licensed Professional
a OWNER-BUILDER DECLARATION
ja I hereby affirm that I am exempt from the Contractor's License Law for the
a 0 following reason.(Section 7031.5,Business and Professions Code:Any city or county
<m which requires a permit to construct,atter,improve,demolish,or repair any structure Valuation
a"rn prior to its issuance,also requires the applicant for such permit to file a signed statement t' .Ft.Floor Area
- < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 `'q $36014
e.F a (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i ^° that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 375360 0,) Number PanC Y YP
not more than five hundred dollars($500).
0 I,as owner of the property,or my employees with wages as thew sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business ''Required Inspections
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,
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
I,as owner of the property,am exclusively contracting with licensed contractors to
struct 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 Contractor's
License Law B&P C for this n
C lase a mpt u der Sec.
er
Date
»y ! ATION DECLARATIO
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.
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 Worker's Compensation Insurance carrier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work Cor which this permit is issued,)shall not
employ any pwro in any mann as to be otep y t to the Workers'Compensation
Laws of ifomi.Date E/
Applic
NOTICE CANT If,afterJt�aking Ibis i mp ton,you should
become su t-to the W "Cort'tpef ,on provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
[� 1 hereby affirm that there is a construction lending agency for the performance of
fx> the work for which this permit is issued(Sec.3097,Civ.C.)
W QLender's Name
a, Lender's Lender's Address
U C) I certify that I 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
Ubuilding conswction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
✓ a (We)agree to save,indemnify and keep harmless the City of Cupertino against
vj liabilities,judgments,costs and expenses which may in any way accrue against said City
U 2 in consequence of the granting of this permit, ,,; Date
APPLIC UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b
SOU R GULATIONS.
2(2-31 6)> Re-roofs
sigureo.�aat/Ct Date Type of Roof
OUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
+s defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
)dc,Section 25532(a)? All roof: shall be inspected prior to any roofing material being installed.
0 Yes
If a roof is installed without first obtaining an inspection, agree to remove
Will the applicant or future building occupant use equipment o devices which all new I naterials for inspection.
emit hazardous air contaminants as defined by the Bay Area Air QualityManagement
District?
0 Yes o
I have read the hazardou materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building
docs not current) ve a tenant,that it is my responsibility to notify the occupant of Ute Date
rcquirem�dc
is ust be met rior to issuance ofA Certificate of Occu Sig of Applicant
y All roof coverings to be Class"B or better
Owncr Date