07090063 CITY OF CUPERTINO ` ' `
BUILDING DIVISION PERIVIIT ��l�r� ���� i����T��N :
, . > ,:
PERMIT NO.
avi � n � r �� r � o � es �IDGEVIVIEW CT 1ST FLR SOUTH I3AY CONSTRUCTION CO 07090063 .
t'S NAME: �— PERMIT LSSUE DATE
APPLE 170 KN�)WLES DR � 10/16/2007
PHONE: SANITARY NO. CONTROL NO.
ARCHITECf'/ENGINEER: BUILDWG PERMITINFO
T. I. Nf�W WALLS , BASE- a� E� pL� M�
i p p LICENSED CONTRACCOR'S DECLARATION ^^^^ ry "^ ,_ T ry � T^ ,^
' V �:. I hcreby affirm �hat I am licensed undcr provisions oCChap�cr 9(commencing Job Description
; z� with Scction 700U) of Div' ' n 3 oC thc Budncss and Protcssions Codc. and my liccnsc is
�� y in full force and cffec� ��
� v� z Licensc Ciass Lic. #
; t „ p Datc Contraclor
'?� RCHITECI'S DECLARA ION
7�� 1 undcrstanJ my plans shall be used az public records
)aU
' u. y Licenscd Pmfcuional
� y � OWNER-BUILDER DECLARATION
� s� 1 hcrcby alTirm tha� 1 am excmpt frum the Canuaaors Liccnsc Law [or the
y O O follawing rcason. (Scctian 7031.5, Busincss and Professions Catc: Any ciry ar county
�°, � which rcquires a pertnit to conswct, almr, improve, dcmolish, or repnir any swcture
`? z} prior ui i�s issuance, also requircs �he applicant for such permit ta file a signed statement �,
< that hc is IiccnscJ pursuant to thc pmvisions oC thc Contractur's Liccnsc Law (Chaptcr 9 �� Ft. Floor Area Valuation
r t �(commencing wiih Scction 7000) of Division 3 0( �hc Business and Prokssions Codc) or
i�� that he is exemp� thecctrom and ide buis for the allegcd exempuon. Any violation oC
Section 7031.5 by amr applicant for a permit subjccts Ufe applicant w a civil penalty of APN Number Oceupancy Type
not more than five hundred dollars (5500).
❑ I, as owncr oC tt�e pmperty. or my uaployces with wages az the'v solc compensation,
will do Uu work, and �he suuctwe is not intendcd or ollered for salc (Sec. 7044, Business
and ProFessions Code: The Conuxwrs License Law does not spply to an owner of ReC;U1rCd jIIS�eCUOiIS
propeny who 6uilds or improves thereon, and who daes such work himselCor through his
own employces, providcd that such improvements are not in�endeA or o[kred for sale. If,
however, the building or improvement is sold wilhin one year of completion, �he owna-
builder will have the burden oC proving �ha� he did not build or improvc for purpose of
salcJ.
❑ I, as owner oC �he propeny, am ezGu�ively conuacting with Iicensed rnnuutors a
rnnstruct the projea (Sec. 7044. Business and Professions Code:) The Contnctors Li-
cense Law docs not apply to an owncr of propeny who builds ar impcoves Ihe�eon, and ,
who convacts Cor such projects with a conuactor(s) Iicensed pursusnt to ihe Contracmrs
License Law.
I� I am ezempe under Sec . B& P C for this rcason
.r Datt
WORKER'S COMPENSATfON DECLARATION -� �
1 hercby �rm under penalty o[ perjury onc ot �he following declaruions:
❑ f have and will maintain a Cenificam of Consent to ulf-inswc fw Workefs Compen-
sation, as provided for by Secuon 3700 of the Labor Code, for the performance at the
woric for which this pertnit is issucd.
❑ I havc and will maintain Workcrs Compensaaon [nsunnce, as rcquircd by Section
3700 of thc Labor Codc. (ar thc pcdortnance of the work for which this permit is issued.
My Worku's Compensation Insucance cr and Policy number azc:
Carrier. �� �SPolicy No.: �� 3 � �.z —�
� CERTIFIC TE Of EXEb1P'I'[ON FROM WORKERS'
OMPENSAT[ONINSURANCE
(Chis scc8on necd not bc comple�cd if the pecmit is for onc hundred dollars (S 100)
or Icss.) �
I cenify thxt in the perfortnance af �hc work for which ihis pertnit is issued, t shall na
e�nploy any person in any manncr so az to becomc subjcct ta � Workcrs' Compensation
Laws of Califomia. Datc
Applicant
NOT(CE TO APPLICAM: If, aftcr makingi this CcrtiGcate of Exemption, you should
bccame subjcct to thc Worker's Compcnsadon provisions of �hc La6or Codc, you must
� O foMwith comply with such provisions or U�is permi� shall bc dccmcd mmkcd.
z ""' CONSTRUCTION LENDING AGENCY
[-r �-�. I hc�cby aftirm that thcre is a consuuc�inn lcnding agcm.y Cor thc per(ormancc uf
pi •� ihe work fur which this permit is issued (Sec. 3097, Civ. C.)
W� A L.endcr's Namc -
� � Lcade�s Address
U � I ceni(Y U�at 1 havc read this applieation and siatc �hat U�c abovc info�matiun is
� ►-� cortcct. 1 agrce �o comply with all city and county oreiinances and state laws rclating to
� U building consWttion, and hcicby authoriie reprexntativcs of this city to cntcr upon thc
� W abovc-mcnuoncd property for inspccuon puqwses. �
(Wc) agrce to save, indcmai(y and kecp harmlcss ihc City of Cupcnino against
H� liabilitiu, judgmcnts, costs and expenscs ich may in any way accruc agains� said City
(„) z in co e oC t6c granting o( this .
�'" APP CA UNDERSTANDS�D LL COMPLY ITH ALL NON-POINT Issued by: Date / ��-.�
S RCE ULATTO
TU t o Re-roofs �—�
Sig rc of Applicant/Comcxtor atc
HAZARDOUS MATERIALS DISCLOSURE Type of Rc of
Will thc applicant or futurc building occupant store or handlc ha•rardous matcrial
�lcfincd Ay the Cupenino M pal Code. Chaplcr 9.12, and the Hcalth and Safcty
,�. Scction 25532(a)? All roofs s iall be inspected prior to any roofing material being installed.
� Y � � .
Will the applicant or future building accupant use eyuipment or Jcvices which If a roof is installed without first obtaining an inspection, I agree to remove
cmit harardous air conuminants u dcfincd by the Bay Area Air Quality Managcmcnt all new ma teriais for inspecr.ion.
District?
❑ Ycs o
I havc rcad �he ha�ardcws maicrials requirement� under Chap�cr 6.95 0( �Mc Califor- � /// /
niaHcalih&SafcryCodc,Scctians25505,25533and25534.fundcrstandthatiCthe6uilding i ���� /
docs not ily havc a �cnan4 �hat it is y ns�bility to tify thc axupant nf �hc . � � r ---
rcyui cn�s hich must bc mei prior u of a Certit o�cu ��/ Signature c f Applicant Date
��-�` All roof coverings to be Class "B" or better
Owncr or authorizcd agcnt � Datc '