06110082 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
c�acR I `�IiIY�ATI�IY
PERMIT NO.
BUILDING ADDRESS:
20955 STEVENS CREEK BLVD TURNER CONSTRUCTION CO 06110082
PERMIT LSSUE DATE
?R'S NAME:
PAUL & BARBARA WEISS 142 W SkNTA CLARA ST _ n2/21/2007
SANITARY NO. CONTROL NO.
PHONE:
(408) 295-7598
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0 0 a
p p LICENSED CONTRACTOR'S DECLARATION Job Description
m I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z with Section7000)ofDivision3oftheBusinessandProfessionsCode,andmylicenseis REVISION EXTERIOR SECURTIY GRILLE & STRUCTURAL
<Q. in full force and effect
1 z License Class Lic•S SUPPORTS ONL`.'
t p Date Contractor
ARCHITECTS DECLARATION ORIGINAL PERMIT #06020008
7�< I understand my plans shall be used as public records
)WU
IL yLicensed Professional
0,
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors license Law for the
poefollowing reason.
� (Section 7031.5,Business and Professions Code:Any city or county
<$La. 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 Valuation
°Z< P Ft. Floor Area
O s that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq• $7000000
ar (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
L that he is exempt therefrom and the basis for the alleged exemption.Any violation of epi
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 32619020 .
(7U Number Occupancy Type
not more than five hundred dollars(5500).
❑I,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 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 be did not build or improve for purpose of
sale.).
m L,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
C31 am exempt under Sea �y(� .B&P C fa-this on
r. 1�eQL Date _
WOR 'SMpENSATIO DEC 1FAIYON
affirm I hereby arm under pe alty of perjury one of the following declarations:
❑I 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:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(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 m subject to the Wo ompcnsation
Laws of Calif D
Applicant
NOTICE TO APPLICANT:If.after nfaking this Certificate of Exemption,you should
become subject to the Worker's Comp6risation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z'"' CONSTRUCTION LENDING AGENCY
(~-t CA 1 hereby affirm that there is a construction lending agency for the performance of
pC> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
04 Lender's Address
V 0 I certify that I have read this application and state that the above information is
L1+ correct.I agree to comply with all city and county ordinances and state laws relating to
building construction,and hereby authorise representatives of this city to enter upon the
U
U above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
Hliabilities,judgments,costs and expenses which may in any way accrue against said City ^�
U Z in consequence of the granting of this permit Date r✓��� /
►' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SQLIRCE REGULXnONS.
L9 Re-roof:;
Signature ofApplicamiContrackbr Dare Type of Roof
HAZARDOUS MATERIALS DISCLOSURE yP
Will the applicant or future building occupant store or handle hazardous material
--defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
ie,Section 25532(a)? All roof shall be inspected prior to any roofing material being installed.
❑Ycs No
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 Arca Air Quality Management all new materials for inspection.
District?
❑Yes Nu
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenant that it is my responsibility to notify the occupant of the
ircments which must be et prior to issuance of a Certificate of Occupancy' Signatul e of Applicant Date
91 All roof coverings to be Class"B"or better
Owner or authoriA d agent ate