07090109 CITY OF CUPERTINO ' � 7 � ' . ' `
BUILDING DIVISION pE�T ������fl� Z�I���Lr1�T���:
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BUfLD ��a�B� ESS TILSON AVE TOM REILY LANDSCAPE P 07090109 •
3R'S NAME: PERLWT LSSUE DATE
6749 E ZAYANTE RD 10 11 2007
PHONE: SANITARY NO. CONTROL NO.
(831)335-2102
ARCHITECf/ENGINEER: BUILDING PERMil'INFO
BLDG ELECT PLUMH MECH
� 0 � �
i O p LICENSED CONTRACTOR'S DECLARATION
%� 1 hcrcby afGrm that I am licenscd undcr provisions oC Chaptcr 9(commcncing 7ob Description
� z � w�th Sccuon 70(�) of Division 3 of ihc Busincss and Profcuiuns Codc aod my Iicensc is INSTALL ING OUTDOOR ABOVE CiR��I� S PA & 7 FT F ENC E &
' e a in full Corce and eCfec4
i,'�? �icenscc�ass ��c.�► INSTALLING AVIARY HEATER� NEW FRENCH DOOR� SLIDER
��� � pRCHITECTS�DE LARATION WINDOW (EXSTING OPENINGS TO REMAIN)
i� a 1 undcrstand my pians shali bc uscd as public rccorJs
)yU
' u. y Licensed Pcofcssional
� y � OWNER-BUILDER DECLARA'CION
� a g 1 hcrcby alTirm that I am excmpt Crom thc Cantractor's Liecnsc Law Cor thc
p O following rcason. (Scction 7031.5, Busincss and Profcssions Ca1c: Any city or couniy
�,°, � which requims a pertnit to conswct, al�cr, improvc, dcmolish, or rep�ir any suucturc
° Z} prior ui i�s issuancc, alsa rcquires ihc applicant for such permii to filc a signed statcmcn�
< �hat hc is liccnscJ pursuant lo thc pmvisions oC thc Conuacwr's Liccnse Law (Chaptcr 9 Sq. Ft. Floor Area Valuation
u I s -� �(commencing with Scction 7000) of Division 3 of Ihc Busincss and Prokssions Codc) ar $ 1. � � 0
�, �.. that Ae is exempt Weiefrom md We basis for the alleged e�cemption. Any viotation at
Section 7031.5 by a�ry applicant far a pertnit subjecu the applicant to a civil penalty of Number Oeeupancy Type
not more than fivc hundred dollars (5500� 3 7 5 0 9 0 0 9��
❑ I, u owncr o[ tl�e property, or my employces witp wages az their solc compensation,
will do thc work, and thc sauawe is not intendcd or of[ered for salc (Sec. 7044. Business Re uired Ins eCt10I1S
and Professions Code: The Conuacwr's Licenu Law docs no[ apply w an owner of 9 P
propeny who builds or impraves thereon, and who daes such wort himsel[ or Uwugh his
own employccs, providcd that such improvements are not intended or o[fered for sale. I[,
however, the building or improvemen� is sold within one year of complcGon, the owner-
builder, will have the burden of proving that M did not huild ar impro�rc Cor puryax of
sak ):�
[�I, as owner of the propeny, am exclusively conuuting wi�h liansed rnntractors m
construct the projea (Sec. 7044. Business and Profrssions Cade:) The Coatnctors Li-
cense Law dacs aot apply in an owner of propeny wha builds or improves �Ae�eon, and .
who conuacts for such projects wiW a comraaor(s) licensed pursuant w the Con�ruror's
License [.aw.
r"1 [ am uempt du Sec. . B& P C for this rcason
�er Date �,Q�d� ^ . -
ORKERS COMPENSA'I'[ON DECLARATION
1 reby um under penalty a[ perjury onc o[ the foltowing declaratians:
❑ I hsre and will maintain a Certifica�e of Canscnt to sel(-insum far Worlrers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the pedarmance ot the
work for which ihis permit is issued.
❑ I have and will maintain Worker's Compensation (nsurance, as �equircd by Section
3700 oC ihc Labor Code. Cor We performancc of �he work for which �his permit is issued. '
My Worku's Compensation Insurance cartier and Policy number azc:
Carrier. Policy No.:
CERTIFICATE OF EXEMPf[ON FROM WORKERS'
COMPENSATION INSURANCE •
(ihis secUon necd not be complcted if the permit is for onc hundred dollus (5100)
nc IcssJ •
I cenify that in ihc performancc of thc work for which this permit is issued. 1 shall not
e.^.iploy any persan i any manner sq az W bc subject to the Workcrs' Compensation
Lawsa(CaliComi atc �� ��
Applican
N017CE NT: If, aC�cr making lhis CertiGca�c of ExcmpGon, you shoulJ
become subjc�t io Nc orker's CampcnsaUon provisions of �hc La6or Cadc, you must
� O (oMwi�h co ply ' such provisions or this pecmit shall be decmed n.woked.
z ""' CONS7RUC1'ION LENDING AGENCY
(-r i-�. I hereby affirm ihat there is a conswction knding agency Car the perfortnance u[
LYi � ihc wurk far which this permit is issucd (Scc. 3097, Civ. CJ �
W� Q Lendcr's Namc �
� z L.ender's Address
U � I ceni(Y Iha� 1 have rcad this applieation and sta� that Ihe above informaliun is
w ► - ' correc� I agree io comply with all city and county oreiina�es and su�e laws relating to
� U building conswction, and Aercby authori�e reprcsenu�ivcs of �his city to cmcr upon thc
� a abovc-menuuned property for inspccuon puqwses.
(Wc) agrce to save, indemni(y and kecp harmless the Ci�y of Cupertino against
„F"„� � liabiliuu, judgmcnts, cos�t and expenscs which may in any way acccuc against said City
(,} z in consequence oC �e gnnting of this permit. J /
�"'� APPLICANT UNDERSTANDS AND WILL COMPLY W1TH ALL NON-POINT Issued by: Date �/L �' �
SOURC GULATTONS.
�`�' `� ° Re-roofs
ign of plicanUConuutor Datc j
�`� HAZARDOUS MATERIALS DISCLOSURE Type of R�of � �
%� applicant or futwc building occupant storc or handlc harardous matcrial
de by the Cupertino Municipal Codc. Ct�apter 9.12, md the Hcalth and SaCety f
�-i�. SecUon 25532(a)? All roofs : hall be inspec[ed prior to any roofing material being installed.
❑ Ycs �o
Will �he applicant or tuture building accupant uu cyuipmcnt or dcvices which If a roof i: installed without first obtaining an inspection, I agree to remove -
emit harardous air contaminants as dcfincd by thc Bay Arca Air Quality Managcmcnt all new m, iterials for inspec 4l0[l.
Disvict? �
❑Y� LJn�
I havc rcaJ the hvardous ma�crials rcquircmcn�s undcr Chap�cr 6.95 a( �hc Cali(or-
nia Hcal�h & Sa(cty Codc, Sccdons Z5505, 25533 and 25534.1 undcrstand �hat iC ihc 6uilding
docs rrcntly havc a tcnant, ihat it is my responsibili�y to notify thc accupant of thc
� ��� Wnxh m� x�� P�o<<� �u� er a c�wr�a� ara�P��r. Signature �f Applicant Date
�•
Ow rora �horizcdagcnt � o,� All roof coverings to be Class "B�� or better
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