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CITY OF CUPERTINO
BUILDING DIVISION
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BUILDING ADDRESS:
PERMIT NO,
946 NOVEMBER DR
TBD — TO BE DETERMINED
07060146
OWNER'S NAME:
PERMITISSUE DATE
ERNEST
NO. CONTROL NO.
ARCHnECrfENGTNEER:
BUILDING PERMIT INFO
.
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapur9 (commencing
with Section mid e) of Division 3 of the Business and Professions Code, and my license is
ADDITION OF A 366 SF FAMILY ROOM AND A KITCHEN
and in full force treats -
Liccnsc Class sec.
REMODEL
Date Contractor
ARCHITECTS DECLARATION
1 understand 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 70313, 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, sho requires the applicant for such permit to rile a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
Sq, Ft. Floor Area
Valuation
(commencing with Section 70D0) of Division 3 of the Business and Professions Code) or
$7 5 0 0 0
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Number
OCCU
Occupancy Type
Section 703L5 by any applicant for a permit subjects the applicant to a civil penalty of
not mole than fiars rive hundred doll(S500)_
36213029 U
❑ L as owner of the property, or my employees with wages as their sale compensation,
will do the work, and the structure is not intended or offered forsale (Sec, 7044. Business
Required Inspections
and Professions Code: The ContractorLicense Law dots Dot apply to an owner of
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property who builds or improves thercon, and who dotssuch 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 act build or improve for purpose of
sale.),
❑ 1. as owner of the property. am exclusively contracting with licensed contractors to
construct the pro)ect (Sec. 7044, Business and Professions Code:) The Contractors U.
tense Law does not apply to an owner of property who builds or improves thereon, and.
who contracts for such projects with a contractors) licensed pursuant to the Contractors
License Law.
❑ I am exeigpt nder Sec- , B
under penalty of perjury one of the following declarations:
-
❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compcn-
salon, 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 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 Worker's Compensation Insurance carrier and Policy number arc:
Carrier. Policy No-:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
,
(this section need not be completed If the permit is for one hundred dollars (S 100)
or less.)
I certify that in thego.ich this permit is issued. 1 shall not
mancc f the to4,—"M;bjcct
employ
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 (Sec. 3097, Civ, C.)
Lenders Namc
-
Lender's Address
I certify that I have read this application and state that the above information is
correct I agree to comply with all city and county ordinances and state laws rcWing to
building construction, and hereby authome representatives of this city to enter upon the
above -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
inconsequence of the granting ofS this it
APPLICS
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, Scction25532(a)? \ /
❑ Yts o
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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 the applicant or future 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?
❑ Yes u
l have read the hazard materials requirements under Chapter 6.95 of the Califor-
nia th & Safety Code, Sections 25505.25533 and 25534,1 understand that if the building
"
dots n c tly have a
.
Signature of Applicant Date
All roof coverings to be Class r'B" or better
Owner Wauthod7zu
agent a