04020142 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRAC�^TORINFORMATION "�
BUILDING ADDRESS: BEST INVESTMENT CO \ PERMIT Nb4020142
40 420 CASTINF AV
ER'S NAME: PERMIT ISSUE DATE
SHU KU 20370 TOWNC
ONE: SANITARY N0, CONTROL NO.
(408) 966-6443
ARCHITECffENGiNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
moo LICENSED CONTRACTOR'SDECI-�,RATION lbDescri tion
tit 1 hereby affirm met 1 ma licensed under provisiynop
s or Chapter 9(commencing
i wird o UIp)ofDivisionJofmc Business aM fcssimn'Code.end mylicen¢is t'j)t Q.[f(��
<n infull fo and cRccL
=N p -C.� ADD 767 SQ. FT. /REMODEL
Sq? Li<cnse Cla Lk.g
,4Fp Da¢_S�CanBaea - SSFP 152004
�� ARCHITECTS DEC I �f/e
1 un d my plans still he used u public m �Y� p 1I c A
;a.� Licensed Pmfcssional BUILDING
.s
OWNER-BUILDER DECLARATION U uC G
e1 hereby affirm that I am exempt from the Contractor's License Law for the
p o following meson.(Swoon 7031.5.Business and Prmfessiov Cade:Any city or county
K$9! which reyuims it Penna m conavm,elm,imprmot.dcmulish,or repair any anicwte
y26prior N its issuance.also requlre3111e applicant for such permit to llle a signed satamcm
mar he is licensed paament to me Provision'or the Comtmmri Licevc law(Chip.,9 Sq.Ft. Floor Area Valuation
¢mF� (commencing with Section 1000)of Division 3 araW Professions Bunim and Profesns Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of �s
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of e10 0 Occupancy Type
not mom then five hundred dollars(5500).
❑I,a Owner Ufahepmpenymmyemployceswithwagnwft" wlecompcvation,
will do Ne work and the structure is notimmnded oroRered rorsale(Sm.70414,Business
and Profession'Code:The Comment s LicenseLaenter w enot apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himselfor through his
awn employees.provided mm such imp ownents are not intended or offered for sal,If.
however,me building or improvement is sold within one year of completion,me owner.
builder will has Ibe burden of proving that he did not build or impros for purpose of
sale.).
❑1.as Owner of the property,am exclusively contracting with licensed convectors to
construct the project(Sec.1014.Bottom.and Professions Cade:)The Contra tars Li-
cense law does not apply to an owner of property who Wilds or imprasss thereon,and
who contracts for such projects with a contactor(s)licensed pursuant to the Contractors
License law.
0 1 cern exempt under Sec. .B 4 P C for this amount
Data
WORKER'S COMPENSATION DECLARATION
I hereby Off.Under pcoth,of perjury ane of me fallowing declarations:
I have and will maintain a Certificate of covens to self-insure for Worker's Compen-
sation,es provided for by Section 37M of dte IOW,Code,for the petformatrcc of me
work for which this permit is issued.
❑I bas and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for on,performance of the wort for which this permit u issued.
My Worker's CamPewtion Wuance arri.att.Pnliry number am:
¢yt�Q�SffN/ UNb Palmy Na .: ! —
/ RTIFI TE OF EKEMPItON FROM WORKERS'
(� COMPENSATION INSURANCE
(This section wed not W completed irlhe permit is formic hundred dollars($lip)
or less.)
1 certify that in me perrmmanee of the work for which this permit is issued.I shall not
employ any pcnon in any manmr m a in become subject to the Worked Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you should
become subject to the Worker a Compeno don previsions of the Labor Code,you muss
.JZ forthwith comply with such provision or this Permit shall be doemed revoked.
ZO CONSTRUCTION LENDING AGENCY
[-w I hereby alarm mat there is a con'tructinn lending agency for the Performance or
C> me work for which this permit is issued(Sce.7097.ON.C.)
W 0 Lcndcr's Name
G Lender's Address
U Q I certify in.,1 here read this application and sum mal mea Wm Warmed.is
ly H copeck 1 agree to comply with all city and county ordinances and sum laws relating to
D U building construction,and hereby authorize Minewr adss of this city to enter upon the
Y'W ahavc-mentioned ptoPerty for inspection purposes
F d (We)agrte an saw,indemnify and keep Aannlass the City of Cupertino against p
ern liabilities,judgments,cvu and .N.which may in any way...against sod City6� 1�\]
U z APPLIQ NTUof due UNDERSTANDS ANDof WILLWILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR I,ATIONS. Y/
<- We-roofs
S' nzuvof APPicanV ntrxtor Data
HAZARDOUS MATERIAI DISCLOSURE Type of Roof
Will the applicant or future building occupant stare Or hatWlc hvardous material
defined by the Cupeninm Municipal Code,Chapter 9.12,and tW Health and Safetyle.semen 2ss3zean
❑Yu All roofs shall be inspected prior to any roofing material being installed.
Will me applicant or future occupant sex equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit miardor air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
District'
❑Yes `it,
Ihawm mchmardwsmzwrialsmquimmcnuundcr Chapmr&95offt alifor
is Healet6Ssfet Code,Sttd..2 %5.25533.d7 53d,jundersunelhmifft Wilding
does tat eumm h e tenant.that it 4 my mspotuibility m mu IM mcup of of the
mOinemertaw c mm prior toisswamof.Cerilia¢ofOc pane. ignature of Applicant Date
/ C U All roof coverings to be Class "B"or better
Owner or out 'tic c Dam