08020065 � rNa f1CITY OF CUPERTINO
BUILDINGDIVISIAM-
ON RNkORMAT� ,
PERMIT NO.
6
UILD3NO2T)Es% DE ANZA BLVD VENTURE BUILDERS 08020065
NERR''SUNAME: PERMIT ISSUE DATE
MOISON INVESTMENT COMPANY . 1509 INDUSTRIAL RD 02/12/2008
PHONE: SANITARY NO. CONTROL NO.
(650) 598-3999
ARC HrrECf/ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
op LICENSED CONTRACTOR'S DECLARATION Job Description
u 1 hereby affirm Nat i am lieved maker proviumnsof 0t pmr 9(commeming
zj with Section 7M)ofDivluan3ofNeBusinwandProfessionsCode,aMmylianau COMM'L TI,AD'L EXTR WK, PAINTNG EXTER,WLKWY
in full Rotes and effect. /r'.'7 i5'
Lianm I Lic.g STAINING,DECTV RAIL&BIKE COLM—ORG#07100125
Dau: � Contraciar
l ARCHITECTS DECLARATION
i W O I understand my plans mail W used te public recOrsh
s
Licensed Profcaional
'y5 OWNER-BUILDER DECLARATION
I hereby affirm Nat I nm exempt from the Contraciar'a License Law far Ne
:
:00 fallowing moan.(Section 7031.5.Business and Pmfma ous Cade:My city car wumy
S$ which regniTJ a permit to Canrlmct..1@r.improve.demNlSh,ar¢peir my Mae.
-iy prior to its issumce.also requires the applicant Tot such permit to IIOle asigned amement
ego thaheisransedpmaccotmwepm.ismorofdmConttaemraLkerse aw(Chapuz9 Sq.Ft. Floor Area Valuation
(commencing
i (commencing with Section 7000)of Division 3ofthe Business"Professions Code)or $20000
15E$ Nat w is exempt therefrom and the basis for the alleged assumption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of N Number Occupancy Type
not mora than fin hundred dollars(ss ) 359 17 0��
t]I.m owner of tW property,a my employm whh cages u thdr wk eampanssdm,
will do thewarksed themuchm,I.rmtimemiadara0ered(Doak(Sec.70N,Busimaa Required Inspections
and Prokukns Code:The Com emrt License law dost nor apply man owner of 9 P
property who wads m Improv thmane and ww Eoas such wan bimmf or through his
awnemployes,pmvidedthatamhimpmwmsuartnmin aroRer (orale U.
however.the Wilding or improvement issold within am year of eompledon.tW owner.
Wilder will have the burden of proving than W did ms Wild or Improve for purpose of
ask.).
❑1.as owner of the property am exclusively contracting with Iiesasad contractors to
construct the project(Sec.7004.Buiness and Professions Code)The Cmuw.7or's U.
cause law does oat apply to an owner of property who Wilda or improwa thereon.and
who contracts for such projects with a commcmr(s)featured pursuant to the Conuauars
License Law.
❑lamcacn"mu sSee .Bal PCfmlhis.
ror'
Dam—
WORKERS
aleWORKERS COMPENSATION DECLARATION
1 hereby am.under parody of perjury,one of the falbwing deckaalmse
❑I ham and will maintain a Curti of Consentmmlf4roumfarWorkehCompen-
sation.as provided for by Section 3700 of the labor Code for the performance of lie
wan for which Nu permit is ismad.
❑1 haw and will maintain Worka's Compensation Insurance,as acquired by Section
37(10 of the laver Cods,for lW performance of the weak for which this Permit is latrA.
My Wakens Compensation hsa sora and Policy nfumberwsoc:
Cartier. awaN� Policy No.: /I7 vrsr ga 41—
CERTIFICATE OF EXEMPTION FROM WORKERS' 'r"/
COMPENSATIONINSURANCE
(Thu socamm need not W completed If the pemli Is foram hum mldellam(S10U)
or toss.)
I certify tha,in Ne Wfit rmarma of late work fm which Offs patois Is famed,l shall m
employ any person in any manner an at m Wcomc subject on Ne Workers'Compensatim
Laws of California Data
Applicant
NOTICE TO APPLICANT:If,eAct making this Cenlficae of Exemplion,you should
becorne subject to the Worker's Compensation provisions of the labor Code you most
.JO forthwith comply with such provisions or this Permit mail W dammed rooked.
z CONSTRUCTION LENDING AGENCY
(~�+ (hereby amou khathem is a comouction lending agency for Om Performance of
D$ les work for which this permit is Issued(See.3097.Civ.Q
W�Z LendeYs Nana
7 Z fender's Address
O Q 1 certify that 1 haw read Nis applica,inn and atm that the aWn information is
it,f'^ comer.I agree to comply with all city and county ordinances and sum laws relating In
JU building conswe,ian.and herebyauthocire rtprts.mivcaof this city,o enter upon Ne
W zImw-mentioned property for inspection purposes.
4 (We)agree to save,indemnify and keep hakax tha City of Cupertino againa
mrm
N1 frmOidesJudgmants.ansa and exprstses which may in any my.a ae,gaastsva City (�
U z in consequence of the granting ofthu permit lN�
�^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:. Date l
SOUR REGULATIONS.
�n_ _--� 314/60 Re-roofs
Signature afA plican✓Conuacmr ate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applies a fuuua banking mcvpststore or Ismulk havtdou material
rdefined by les Cupenim Municipal Cade.winter 9.12 and the Health and Way
u.Secron 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu
future wilding Occupant use equipment or maiesa which If a roof is installed without first obtaining an inspection,I agree to remove
Wise the applicant or f
emit haOmb ss air corrin nts a defined by rite Bay Ars Air Quality Management all new materials for inspection.
District?
❑Yu
I haw mal the w>adms materialsmquiremems mulmO mptah.95 of the Califon
ma Hui"SaftiyCade.Scums 25505.25533 and25534.I understand dutifthe building
does at ewraml,ban a tenant tat it u my responsibility to notify tha.,.of Oe
reyo' cnuwhichm�nWmetprimaniotmaofaCutfcau, Oc Signature of Applicant Date
Owner r aumori><d agsnl ger
.� ib All roof coverings to be Class "B" or better
oDam