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080400080z zC F� ID UC � L LL a UZ CITY OF CUPERTINO�7a,���:a Now BUILDING DIVISION PElVYJ11��11� BUILD FSS• M SERENO CT #25 HANKINS CONSTRUCTION INC PERMIT NO. 08040008 38227 FREMONT BLVD 05/16/2008 PHONE: SANITARY NO. CONTROL NO. (510)795-9654 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Chapter 9 Job Description 1 hereby affirm aw I am licensed under provisions of (commencing with Section 700tn of Division 3 of the Business and Professions Code, and my license is 5 ' 0 " X 8 ' " HND I C P RAMP , ADD 11M I C P DOOR in full force and cffwL License Gas Llc. I Date Contractor rl'ECTS DECLARATION 1 undcri6nd my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors 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, demorah. or repair any structure prior to its issuance, also requires the applicant for such permit to rile a signed statement is licensed Contractors License Law (Chapter 9 Sq Ft. Floor Area Valuation that he pursuant to the provisions of the Section 7000) Division 3 the Business Professions Code) . 10 0 0 0 (commencing with of of and or Char he is exempt therefrom and the basis for the alleged exemption. Any violation of 34254999 AYNumber Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500). - ❑ 1, as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work- and the structure is not intended or offered for ask (Sec.7044, Business and Professions Codc The Contactorensoes s Lice Law dnot apply to an owner or property who builds or improves thereon, and who does such wort himself or through his own employcet, provided that such improvements are not intended or offered for salmi 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.). ❑ 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- ccnm Law does not apply to an owner of property who build& or improves thereon, and. who contracts for such projects with a contractor(s) licerrttsed pursuant to the Comacoes License Law. ❑ 1 am exempt under Set , B & P C for this reason Owner Date WORKEWS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Worlc esCompen- sadon, as provided rot by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and vnH maintain Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My WoekeME3KMnMI;ATE and Policy INSURANCE (Chia section need riot be completed if the permit is formic hundred dollars ($100) or less.) I cenif�v that In the performance of the work for which this permit is issued. I shall not employ arty 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 became subject to the Workers Compensation provisions of the Labor Coda you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY ' I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sea. 3097, Civ. C_) Leader'a Name , Lenders Address I certify that I have read this application and state that the shove information is cornet I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby aulhorim representatives of this city to enter upon the above -mentioned property forinspectiom purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, touts and expenses which may in any way accrue against said City in consequep6c of the gaoling or7AWILL it.APPLIC, UNDERSTAN COMPLY WITH A 0N- 1NT Issued by: Date SOUR NS. Re -roofs / the applicant or future b ding occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑ Yea No If a roof 'is installed without first obtaining an inspection, I agree to remove Will the applicant or/futurem building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑YesNo I base read the ousmaterials requirements under Chapter 6.95 of the Califor- nia Health & S cry Coda Sections 25505.;W3 and 25534.1 undo and that if the building dots not cy ndy have a tenan4 that it my responsibility to ratify the occup t of the mqulre ' m be QPp issuance roof coverings to be Class 'n" or better w r or auth ..ca a>;en Detc .