05090095 CITY OF CUPERTINO
BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: _ BEST INVESTMENT CO PERMIT No.05090095
OWNER'S NAME: PERMIT ISSUE DATE
E: SANITARY NO. CONTROL NO.
(408) 966-6443
ARCHMECM/ENGINEER
08 966-
ARCHITECrIENGIrNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECN
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LICENSED CONnsedCad., DECLARATION 0�����® O
w❑ 1 hereby affirm that 1 am CONTRACTOR'S
under provisions of CWpmr 9(commencing Job Description rani
6W with Section 7010)or Division J of the Business add Professions Code,and my license is
in full force and effect 1' I
-r�_ LIC[nsc Clavi' LIL.Xs J e Z CONVERT SUN RM TO DEN (140 ' )
-c Dam Contractor ADD FOOTING WALL CEILING
sF m ARCHITECTS DECLARATION ' / S 30 1005
< 1 undcrsmnd my plans shall W used a public records NOVs911 [ J
�yU
;moa Licensed Profeconnal ® (y��p,�,
0 S OWNER-BUILDER m the Com ION ®Y ■��
0 I hereby maso alum that 11. exempt from Nc Common's Co License Law for the iWg'�0 V y
o O followingmason.a Permit
t 71y3LA Business and improve,
de loos Code:Any city or county
x m which acquires a pnmit m cnnsuud alcor,improve,h srokt or repair any structure
y i y prior m its censed e.pursuant
nt to IMres the applicant for sucCOMM rmiuo censele a Law(Cha mem
z < that ndencccnwit punuam to the of Diviom of the Com sines cleanse Law(Chapmr9 Sq. Ft.Floor Area Valll f�001.1.
�$ (Commis sem with Section 7")add thD Division rMthe aged Business and m.An,vi Crude)or
y 3- dot he u exempt thrscfrom and the hose far the alleged eumpoon.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more Nan five hundred dctims(850)).
❑1,u owner ofthe proprny,m my employees with wages az shelf sole compensation, 31628035 . 00
will do the work,and the structure is not intended or.ffe¢d for Sale(Sec.70u,Business
and Profrssidm Cade:The Comeactor's Licene,Law dors not apply to an owner of Required Inspections
progeny who builds or improves thereon,end who does such work himself or through his
awn employ=.provided Nal such improvements arc not intended or offered for sale.If,
Wrxwwr,the building or improvement is old within one year of completion,the owner-
builder will have dte burden of proving that be did not Wild or improve for purpose of
sale.).
❑1,as owner of dK property,am exclusively contracting with licensed contractors in
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
come Law docs not apply to an owner of propeny.who Wilds or improves thereon.and
who contracts for such projects with o e.ntracter(s)licensed pursuant to the Convenors
License Law.
1 am exempt under Sec. B At P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following d¢lantiom:
1 ham and will maintain a Ccnifica a of Consent to self-insure for WorkersCompen-
So.d.as provided for by Section 3700 of Ne Labor Codc,far the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compemation Imurana,a"could by Section
3700 of the Labor Cook,for Ne pnfarmemec of the work for which this permit is issued.
My Worker's Compensation Insurance artier and Policy number am:
Cmrier.3TA7F- SONO Policy No.: y<1 '3F 277
CERTIFICATE OF EKEMPION FROM WORKERS'
COMPENSATION INSURANCE
(Thu scedium moil not becamphood if Ile,permit is forces,hundred dollars($100)
or las.)
1 ardfv that in the performance of the work for which this permit is issued.I shill not
employ any person in any mannerso as to become subject m the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:It,after making this Cci ifinm of Exemption,you should
become subject in the Worker's Compemation provisions of the Labor Codc,you mut
aZ, fordwith comply with Such provisions or this permit shall be deemed m died.
'ZO
'r+� CONSTRUCTION LENDING AGENCY
IWhet, Hot.Nat then is a coatruainn lending agency fm the perf.rource.f
Ix a> the work fur which this permit is issued(Sec.3097,Civ,C.)
W Q Lender's Name
1, Lander's Address -
a 2
L)O 1 Codify that I have mad this application and slam that the above information is
ly H correct 1 agree to comply wish all city and county ordinances and sum laws relating to
p U building conswction,and hereby authorize representatives of this city to enter upon thc
4 above-mentioned pmNrly for inspection purposes.
(We)agree to Save,indemnify and leap harmless the City of Cupertino agaimt
F+In liabilities.judgmenu.eosts and expenses which may in anyway acerae against said City
U Z in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR GULATIONS� ��/ [ �
Sign Applicant/anv anvv ,, -�C
a�ccior" /—C - - L��L no Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will due applicant or fuluro building occupant nom rehandle haaudous material
az deflacd by the Cupertino Municipal Code.Chapter 9.12.add the Health and Safety
Cade.Section 2553200? All roofs shall be inspected nor to an roofing material bei.
gym �( p p y g g installed.
Will the applicant or future building occupam use equipment or dcvias which If a roof is installed without first obtaining an inspection,I agree to remove
it P.O.Amn air Contaminants as defined by dm Bay Area Air Quality Management all new materials for inspection.
District? , /
❑Yes gyp(
1 have mad the haaardous materials requirements under Chapter 6.95 of the Califor-
niaHcalthX:Safety Codc,Scctiuns25305.255JJ anJ 25534.1 undcrsmnd mwif the Wildimg
Jas not currently have a mnam.Not it is my nmp.mibility m nodly the acupam of dK
mquiremenu which must IS,mel Poor missumme ore CenlflCffi of Occupancy. Signature Of Applicant Date
a -
Owner m awhori'red agent All roof coverings to be Class"B"or better
ate