07070026 CIT�' OF CUPERTINO ` ' T
BUILDING DIVISION PERMIT �������� y �������� !
_ •�
PERMIT NO.
BU1 �1 ���t5 l `PUGGLE AVE TBD - TC BE DETERMINED 0 7 0 7 0 0 2 6 •
pERMiT LSSUE DATE
10/01 2007
— SANITARY NO. CONTROL NO.
NE:
BUiLDING PERMI'I' INFO
ARCHITfiCT/ENGiNEER: BL E� PLU�MH ME�CH
i p o LICENSED CONTRACTOR'S DECLARATION JOb D05Cilptl0❑
: m� I hcreby alYrm that I am licenscd unAcr provisians of Chaptcr 9(commcncing
; Z� with Scction 7000) of Division 3 of ihc Business and Profcssions Codc and my liceiisc u S FDWL -1 � 7 � 2 ' GARAGE 4 2 0'- SAN I TARY I s SUNNYVALE ' s
;� y in full foree an d cffec� Lic. N JUR I SD I C' T I ON .
� � ? Licensc Clus
• p Da�c Contractof
:� � ARCHITECI'SDECI.ARATION NEED COr1TRACTOR INFO
i� a
a I undcrswnd my plans shall bc uud as public reconLs
)yU
� u. y Liccnscd P[ufcssional
: � a OWNER-BUILDER DECLARATION
j a� 1 hcrchy alTirm that 1 am ezcmpt Crom �he Convactor's Liccnse Law for the
: p o following rcason. (Scction 7(131.5, Busincss and Profc.ssions Codc: Any city or rnunty
�,°, �'i which rcquires a pertnit to consuvct, altcr, improvc, dcmolish, or repair any wucture
� Z y prior w ils issuancc, also rcquires �hc applican� for such pertnit ta filc a signed s�ammcnt c Ft. Floor Area Valuation
< �ha� hc is liccnscd pucsuant to thc pmvisions of thc Contractur's Liccnse [aw (Chaptcr 9 9� $ 3 8 8 5 3 7
��� (commencing with Scction 7000) of Division 3 of ttic Busincss and Profcssions Codc) ur
°�� �ha� he is exempt thcrefrom and the basis Cor the allegcd ezemption. Any violation o[ Number Occupancy Type
Section 7031.3 by any applicant (or a pertnit subjects the applicant w a civil penalty o(
not more than Crvc hundrcd dollars (5500). 3 7 5 3 3 � 6__�
❑ I, u owncr of ttrc property, or my cmployces with wages az iheir salc compentaGon,
will do thc work, and the sttuc:ure is not in�endcd or offeced forsalc (Sec. 7044. Busimss Required Inspeetions
and Professions Cade: The Conuactor's License Law daes nat apply w an owner of
propeny who builds or improves thereon, and who does such work himselC or �hmugd his
own employces. providcd that such improvemen�s aze not intended or otiered for rak. l[,
however, the building or improvement is sold within one year oC wmpleuon, the ownu-
builder w have Uu bu�den ot proving �hat he did not build or improvc Cor puryase of
sale.).
(, as owner o[ �he propeny, am ezclusively conuacting with limnsed rnnuaaors W
conswct the pro' ct (Sec. 7044. Business and Professions Code:) The Convaew�'s Li-
cense [aw d t apply to an owner af propcny wha builds or improves �hnean. �nd ,
who convacu such pmjects with a contractar(s) licensed pursuant to the Coovactors
License Law.
❑ I am ae i under . B& P C far this mawn
- , x �(f� � .
�,� Date � V
WORKER'S COMPENSATION DECLARATION
I hereby afCirtn under penalty of pc�jury orc of the follawing declaration�
❑ i hs+e and will maimain a CeniGcate of Consent �o sclf-insure (or Workc�s Compen-
sarion, as providcd far by Secdon 3700 of the Labor Code, far We pedormaMe af �he
work for which this pe:rtnit is issucd.
❑ I havc and will mainiain Workcr's Compensauon Insurance, as required by Scction .
3700 0( the Labor Code. Cor the performance of the work for which this permit is istued.
My Worker's Compensauon Insurance cacricr and Policy num6er aze: —
Cartier. Policy No.:
CERTIflCATE OF EXEMPfION FROM WORKERS'
COMPENSATION lNSURANCE
(This scction nced not bc completcd i[ the pccmit is for onc hundccd dotlars (5100) ,
or Icss.)
I certify ihat in thc perfortnancc of thc work for which ihis permit is isaucd, I shall not
employ any person in y manpc�� az to bccomc subjcct ia the Workcrs' Compensation
L,aws of Califomia. �� ° , � f-1
Applicanl �,r
NOTiCE TO A�P�ICANT: If, aftcr making �his Ceni�caic of Ezemption, you should
become subjcct w �hc Workcr's Compcnsation provisions of �c Labor Codc. you must
� z farthwith comply wi�h such provisions or this pccmit shall6c dccmcd revotcd.
Z O CONSfRUCT10N LENDMG AGENCY
F r .�-. I herehy affirtn that thcre is a cor�strucuon Icnding agcncy for thc performa�c o( �
a� U�c work fur which �his pertnit is issucd (Scc. 3097, Civ. C.) ,
W Q Lendcr's Namc
� z L.cnd�r's Address
f ceni(y �hat I havc rcad this applieadon and siate ihat thc above in(ortnauun is
� O cortcct. I agrce to comply wi�h all city and county ordinances and sute laws mlaiing to
rJ U building conswction, and hcrcby authori�e represcntativcs of this city to cntcr upon lhc
� W ahovc-mcn�ioncd property for inspcc�on purposes.
a (Wc) agrce eo save, indcmniFy and kecp harmless �hc City o[ Cupertino against
�� liabilities, judgmcn�s, cos�s and expenscs which may in any way acccuc against said City
(� z in consequcnccp f thc granting oC ihis permit. Da[e
r'" APPLICA ,NNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by
SOURCE EGULATIQNS.
.,� c� Re-roofs
Sign urc of App�icanUContrnctor �� T of R oof
HAZARDOUS MATERIALS DISCLOSURE YP
Will ihc applicant or futurc building accupant storc or handtc harardous matcrial
az dcfincd by the Cupenino Municipai Codc. Chap�cr 9.12, and thc Heal�h and Sakty
coa�. Sccuon 25532(a)? ��-- 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 ihc applicant or futurc building occupant usc cyuipmcnt or dcvices wh�ch
emit harardous air contaminan�s az dcfjncd hy the Bay Area Air Quality Managcmcnt all new rr aterials for inspec�ion.
District? _ _ /'�
❑ Ycs lJ�u
1 havcJ� ad U�e ha�arCous matcrials requircmcn�s undcr Chap�cr 6.95 of thc CaliCor-
nia Hcalth & Cadc. Scctions 255i15, 25533 anJ 25534.1 undcrstand thatiCtM building
docs not c rYently havc a tcA#n4 lhat il is my responsiAility to notify Uu occupant af �hc
rcyuire . n�s wh�ch musi met prior u� issuance o[ a Ccnircam o�occup • SigIIatllIe Of AppI1C3IIi Date
6 � All roof coverings to be Class "B" or better
Ow cr or authori•r.cd agcnt Datc