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08090225edz op ar p U aLu 'a< ,UJU .aF W n IMa ,ya 1a� i^rn :za :Yp OC z� aQ �z UO u. F OV Ha U CITY OF CUPERTINO777777 BUILDING DIVISION PERMIT AT. C��I2�:CTC1R Z�QiVY1���Q11. BUILDING ADDRESS: PERMIT NO. 20450 STEVENS CREEK BLVD STE ATLAS PELLIZZARI ELECTRIC 08090225 OWN SANITARY NO. CONTROL NO. (650)364-1204 ARCHITECr7ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Chapter 9 (commencing Job Description I hereby affirm that I am licensed under provisions of with Section 70W) ofDivision 3 of(he Business and Professions Code, and my license's DEFERRED NON -R3 INSTL ELECTRCL/RLOCT DWN in full force iceneClasndcffec c�pp License Class l � Lic. p �7C�Y? Co z LIGHTS, SWTCHS, LIGHTS&RECETS ORIG#08070155 Date Contractor ARCHITECT'S DECLARATION I understand my plans shall he used as public records Licensed Pn)fcssional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, -alter, improve, demolish, or repair any structure ' prior to its issuance, also requires the applicant for such permit to file a signed statement chat he is licensed pursuant ho the provisions of the Contractor's License Law (Chapter 9 Sq, Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $5000 that he is exempt therefrom and the basis for the alleged eumption. Any violation of OCCU Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty orNumber not more than rive hundred dollars ($500). 36901028 . 0 1, az owner of the pmperty, or my employees with wages as their sole compensation, Required Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to -an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 1, as owner of the property, am exclusively contracting with licensed contractors to construct the pmject (Sec. 7044, Business and Professions Code:) The Contractor's U. cense law does not apply to an owner of property.who builds or improves thereon, and who contracts for such pmjects with a contractor(s) licensed pursuant to the Contractor's License law, 0 I am exempt under Sec , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: , ❑ I have and will maintain a Certificate or Consent to self -insure for Worker's Compen. sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. r (� f have and will maintain Worker's Compensation Insurance, as required by Section •700 of the Labor Code, for the performance of the work for which this permit is issued. ' My Worjl�'s Com ensaton Insurance carrier and Policy number arc: 1 Carrierl6l �- d d' L oliry No.: Z W O1(4-1 CERTIFICATE OF EX ON FROM WORKERS' COMPENSATIONINSURANCE (This section need not be completed if the permit is for one hundred dollars ($ 100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constructnn lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) - Lender's Name ' Lcndces Address I certify that I have mad 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 building construction. and hereby authorize representatives of this city to enter upon the . ahove-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. NDERSTANDS AND WILL COMPLY WITH ALL NON -POINT APPLnIE- Issued by: Date Re -roofs Type of Roof - - ci"30-V.6 Signatu a Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE 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 Code, Schon 25532(a)9 OYes FN / o 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 Will the applicant or future building occupant use equipment or devices which remove emit hazardous air contaminants as dcrhned by the Bay Area Air Quality Management allterials for inspection. District? 0 Yes P(Nu , I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505.25533 and 75534.1 understand that if the building`, does not currently have a Tenant, that it is my responsibility to notify the occupant of the requiremen prior to issuance of a Certificate of Occupancy. Sig of Applicant Date All roof coverings to be Class'" or better - Owner or aur r .cd agent Date '