04110124 CITY OF CUPERTINO
BUILDING DIVISION PERMIT - xz,CONTRACTOR INI+URMATION
BUILDING ADDRESS: THERMA CORP PERMITNqb4110124
10340 BUBB RD
OWNER'S NAME: PERMIT ISSUE DATE
DURECT CORP. 1601 LAS PLUMAS 11 /19/2004
i -. SANITARY NO. _ -- CONTROLN0.
(408) 347-3400 -
ARCHITECI'IENGINEER: BUILDING PERMIT INFO _
' - - - BLDG ELECT PLUMB MECH
=oo LICENSED CONTRACTOR'S DECLARATION - "" -" _ - - " '-
G I bemby an.that I am licensed under provisions of Chapter 9(Communing
Job Description
O withgcction]IXp)of Division 3 of the Basin.and Pmfcisi s Code.and my license is
ria
in lid anyyS �y y? UPG. SUPPORT TO AHC MOTOR AMP EX. FAN
5qi Lmenu Clux t—yjtDt uc.x 27od ti�
fDam
'py ARCHITECTS DECLARATION )/
I understand my plans shall be used as public records
odD CL, t n
;p� Licensed ProfessionalL,. r�R
5 OWNER-BUILDER DECLARATION �
i7 1 herchy at7in that I om exempt from Be ComracmYs Lictom Ur,I'.,the \a jl
no following moon.(Semon](131.5.Business and Pmfessiom Code:Any city of county - a < / J
2 which rtquirts•Permit to entuwucL alter,improve.demnluh,m repair any structure _ - _ ,'C A" r - _S2000-0 : -
Fzi priortni¢issuance.ilwrequi.0m...he.,for such permit w file asilood statement )
that be is licensed pursuansIn the powliens.10.Comnctor's License Law(Chapter 9 - Sq. Ft. F100r�Areai�yn C60/rj .... Valuation -
¢� (commencing with Section'IOW)of Division 3 of NC Berinc.and Professions Code)or — `�•f
i $ that he is exempt therefrom and the bull for Nn Weged exemption.Any violation of -
Seeion 7031.5 by any applicant for a Permit suhjccu Be applicant to a civil Penalty of e '��`, y Occupancy Type
not in..Nan Ove handled della.(SSW).
❑L o owner of the pmpeny,or front
nt immocq with wages ss their sok campers inns
will do thcwork.and tW swnute ones inr,adW or offered for sale(Sart in aa,owner of
and nywhiom Core:The Conu¢wrs License law aces set appy lf an rougler .. .:. . Required Inspections
own employ Wilds. rovirid Out u thcrmrowrono doessuanii tendo himselfor Borough his
however,
the es.ping or iilumnhimpmamwsamne intended for Owner.
Wilder win for building orimproarovingsat within one year of completion.pu owner.
Wilder win have tW WNcn of proving that he did nos Wild m improve for Puryme of ---�--
sale.).
❑L as..at of she property a axclusivcly emanseting with licensed conveners to
construct the project(Sec.]Odle,Busing and Professional Cade:)The Contractob Lt.
cc=Taw docs not apply to an owner of property who Wilds at improves thereon.end. -
whoconuactsforsnehpwjeeuwithaeontractor(s)licensed pursuant to the COOwaCtOr] -
License Ls'
I am exempt under Sec. .B&P C for Nis reason
Owner Date
WORKER'S COMPENSATION DECLARATION
41 1 hereby effort under penalty.110.1 one of the following declarations:
❑I have and will man W n a Cer rfC.mof Couent w self imum fm Work esCompen-
.i.e.ss provided for by Secsian 37W of the IaWr Code,for the ptdormance of the -
workforwhichOisPermitisixsued. -' -
Iy have and will maintain Workers Compensation Insurance.as required by Section
9)W of Ne laWr Code,for Ne performance a the work for which Nis permit is issued.
My Worker'
C//9mpenration Insu.n'a�,Ycomer and Policy number am:
Card al�.�irCf OC///.+//✓PvOImYNO: G 1<':Z30"0-7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed if the PCnnit is Trane hundred dollars(SI W)
or less.
1 cenifv Nat in me perrormana of the work for which Nis permit is issued,11.11 not -
employ any peon in any manner sn as in bunmc subject in use Werkeri Compensation
Laws of CaliTrnie.Date
Applicant
NOTICE TO APPLICANT:If.efwr making this Ccnifcaw of Exemption,you should
became subject to NC Workers CamN.don provisions of the Labor Code,you must
.JZ forthwith comply win web pmvisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
.�-• Ihereby affirm that here isacouwninn lending agency for dm performance of
(Y the work fur which nil permit is issued(S.,3897.Cih,C.)
W Q Lender's Name -
]Z Lender's Add.
U Q 1 comfy nm I have read nil application and star,rat tW a Wve infmmadun is
fig.(•^ =HCCI.Ia$=w comply with all city and county oninsecesand sum laws mlating to
DU Wilding censutm,op.and hereby suthodva repmmmadves of Bis city to cover upon the
r W above-(W)agremned to ertylow,sen emnify zepurposes. !
(~0. m,ju agree m Coal indemnify and keep harrelcur;
an the City of Cupe.ino against
y to Consequence
ofs.crosandof Oil cawhich may in anYsvaYaccrue vgdnv said city
U z APPLI ANT of ne grardiFIS this per mit.
^� APPLICANT D RSTA D AND WILL COMPLY WITH ALL NON-POINT Issued by: Date TL
SOURCE
VA
Re-roofs
Al
Sign m of ApplidknUConn"mor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will do,applicant or future building Occupant store or handle hat ardous mar,rial •
u defined by tW Cupenino Municipal Code.Chapter 9.13,and tW Health and Safety
Code.Oy.255331a)? QD'dr, All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or future building Occupant use a If a roof is installed without first obtaining an inspection,I agree to remove
00 gea Air Qu or Mara which
mit havardnus air conuvninanss u defined by the Bay Area Air Quaky Management all new materials for inspection.
District? —'/
❑Yes lu
I have mad the hvarnms mar,nialsmquilemensunder ,Chapter 6.95 of the Califor-
niallulth&Safety Code.Sadou 25505.25533 aru12553a.[underlaid thwifthc Wilding
does note tly yr,.recant.that it u my ,,oulin"m notify the acupant of the
lequtmro JfI in t tPriorwirruaneeafaCetdfieawnrocCtirrey Signature of Applicant Date
Ow ori id /�" Dam All roof coverings to be Class"B" or better