06090046 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � T� �� '
,.._; _....... .:
BUILDING ADDRESS: PERMIT NO.
06090046
10943 CANYON VISTA DR
PERMIT ISSUE DATE
r•ur jER'S NAME:
JERRY ARDEN 10/05/2006
SANITARY NO. CONTROL NO.
rIONE:
BUILDING PERMIT INFO
ARCHITECr/ENG(NEER: BLDG ELECT PLUMB MECH
IW
o 0p LICENSED CONTRACTOR'S DECLARATION Job Description
?
m 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing z in full orcean CffeCLDivision 3ofthe Business and Professions Code,and mylicense is INTERIOR REMODEL REPLACE ALL WINDOWS, SLIDERS
r=y in full force and effect r
License Class Lie.# NEW BAY WINDOW. ADDING LAUNDRY ROOM IN EXISTING
3t,,a Date Contractor
ARCHITECTS DECLARATION ATRIUM. INCLUDES ELECTRICAL, PLUMBING
2 a< 1 understand my plans shall be used as public records
�yU
H Licensed Professional
y 5 OWNER-BUILDER DECLARATION
2 a M 1 hereby affirm that It exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
<m which requires a permit to construct,alter,improve,demolish,or repair any structure
Z; prior tit its issuance,also requires the applicant for such permit to rile a signed statement Area
Valuation
Ft.Floor
_< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq, $250000
t—$ (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 of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(SSW).
❑1,as owner of the property,or my employees with wages as their 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 Contractors 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.).
M'f-as owner of the property,am exclusively contracting with licensed contractors to
constrAro (Sec.7(b4,Business and Professions Cade:)The Contractor's Li-
censeapply to an ow er of p rty who builds or improves thereon,and
who ch projects a c tors)licensed pursuant to the Convac[afs
Licen❑1 ar Sec. P Cfor this reason
HeDate L ti KER'S COMPENSATION DECLARATION rm under penalty of perjury one of the following declarations:
❑1 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.
❑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 are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is far one hundred dollars(S I00)
or less.) 1
I certify that n th performance ork f which this permit is issued,I shall not
employ any rs n in any m s to bC c subject the$nrkc compensation
Laws of Ca f at
Applicant
NOTICE APPLI NT:If,after making this Certificate of Exemption,you should
become ject to the Worker's Compensation provisions of the Labor Code,you must
,J 0 forthwith comply with such provisions or this permit shall be deemed revoked.
z 2 CONSTRUCTION LENDING AGENCY
F~t►C4. I hereby affirm that there is a construction lending agency for the performance of
a > the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
2 Lender's Address
U C) I 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
0 U building construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(Wc) a to save,indemni and keep harmless the City of Cupertino against
liabilities,' dgrdcnts,costs a ex scs)rhich may in any way accrue against said City //// _
V Z inconse enc oCthegran' g is it. Date C/l�=
►^� APPLI A UNDER S A WILL COMPLY WITH ALL NON-POINT Issued by:
SOUR E cu Re-roofs
Sign re of A icant/Comractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
�,de,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes lidTtu
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes (Wvu
ave ad the hazardtws materials requirements under Chapter 6.95 of the Califor-
nia th& afcty Codc, do 505, 533 and 25534.1 understand that if the building
docs of c ntly ha n at it my responsibility to notify the occupant of the
regal nlswnic us me prior 'ssuancco(aCertificatcofOccupancy. Signature of Applicant Date
iv -rte- vb
All roof coverings to be Class"B"or better
Her or a6thorized agent Date