08070042CITY OF CUPERTINO
BUILDING DIVISION pERMIT
aCONTRACOR INFUATION
BUILDING ADDRESS:
PERMIT NO.
1.0355 N DE ANZA BLVD
SOUTH BAY CONSTRUCTION CO
08070042
iNUFERMI
ISSUE DATE
TPI?ISI?
170 KNOWLES DR
08/18/2008
P :UNE:
SANITARY N0, CONTROL NO.
(408)379-5500
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED
ofTaupper 9
Job Description
I herby arertat am II aeneed underr anneiisimuis (commencing
wiNSccdon 70d1)ofDivnlof theBusiM.. and Profeuions Cod, dmylic..13
T.I. ON 3RD FLR. BLD NEW OFFCS & CONSTRUCT
in full fame ane error
f
Licenm Lia, all
SECURITY DOORS.
Dow Coruncwr -ff
DECLARATION
1 udderstand my Plans shall o used a puhlic records
Licensed Pmlcumnal
OWNER -BUILDER DECLARATION
I hereby affirm Nal 1 am exempt from to Convectors License Law for to
following reason. (section 71171.5, Budrcss and Profesaum Cade: Any city or county
which re uiras a pmmil w conslmck Aber. imTuve, demolW, m minor any tonsure
prior w Its IYYarlee, alta "uthes the applicant rarauch Permit to rile a sighed sYlemmn
he is licensed to Commences License Law (Charter 9
Sq. FL Floor Area
Valuation
Lind pursuant in the provisions of
(commencing wit Section 700M of Oivuion 7 of to Business and Professions Code) or
$75000
dial he is exempt therefrom aM to basis for dm alleged ascription. My violation of
ypN Number
Occupancy Type
Section 7071.5 by any applicant for a permit subjects to applicant to a civil penalty a
not more ten fve hundred dollars (5300).
32633113
❑ 1,uownerafteprWcny,mmyemply withwagwul mkcmnpo=don.
Will do to work and to sWcam, m moimended m oRoreal fmnle (gee. 7(Ia4.Bushea
Required Inspections
and Pmfeasi0v Cade: The Conuacwei Li.. Law does nal apply In an owner of
pmpeny who builds ori reproves lAetmn, and who does such mark himself or duough his
own employ=. presided tat such improwmanu are not intended reoffered for sale B.
bawowr, chs Wilding m unpmwment umld within arm Scar of completion. to owner.
.
Wilder will haw to burden of mvi, tat W did nos Wild ar improve for purpose of
Sole.).
❑ L u owner of the PrepcnY• w racloiwly conuanrdng wit trended conhanrors w
common to project (Sec. 7044, Business and Professions Code:) M Coobanmh Li.
ce= law does not apply an an owner of progeny who Wilds or improms tannin. cod.
who contracts fm such pmjeen wit a eontracears) licensed purmanl w to Generates
s
Licenm law.
❑ lamexemptunder See ,B@PCfortismoon
Date
WORKERS COMPENSATION DECLARATION
1 W¢by arm under penally, of perjury one of de fallowing declarations:
❑ I him and will maintain •Certirscamof Consent in self-Insues for Worb:esG afxm-
adion, u provided for by Section 37013.f to labor Code, fm to perrormanes of to
an tic for which this permit is issued.
0 1 have and will maintain Worker's Compcmadon insurance. as mquimd by Scnkn
7700of de labor Code, for de Performaneaofdes wort forwhich tis .I, I. Wood,
'
My Wm' Comperu'j''on Iruuona eartio end Policy aumher am: L p
Gmicr. Iff�el'; Ci Policy No.: I&III 2
D
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
.
Thissecdon reed not hecomplesed if lW .it is foorc hundred dollars (SIM)
or less)
I eardfy tat in to performance a to work for which tis Perrot is issued. I shall no
employ any person in any manner an as in become subject n de Wortus' Compansmlon
laws of California. Date
Applicant
NOTICE TO APPLICANT: IL after making chts Ccnifuw of Exemption, you should
become subject in to Workar's Compensation previsions of to tabu Code, you mute
foMwit comply wit such provisions or this permit shall W dcomed mwke,d.
CONSTRUCTION LENDING AGENCY
I hereby 'firm tet dome is a cooaucdnn lending agency for to perfunna ec of
to work fm which this permit It issued (Sec. 71197, Civ. C.)
lender's Name
lender's Addreas
1 certify on, I haw read tis application arta sate cher to eWm infonamon. is
correct. 1 agree w comply wit all city and county ordinances, and male IYM relating w
Wilding continued... and hereby m lumse mproesu ma of chis city in cawn ran to
move-menuaned property for impaction PuTOSCL
(We) agree la saw, indemnify and keep harmless to City of Cupertino against
liabilidea,judgmcnu,cnsuamina, aeuvt hmay'.-'-
ay'. any, way—agaimlsaid City
in eo to granting of tis pc
APPLI NT U ERSTANDS AN L COMPLY WITH ALL N N-P�O NT
Issued by: ffi f �6
sOUR1ONg,
Date
' / ib��Vr�
^t� (�(�((!�� G
_
Re -roofs
Slgnu ofA uCARDOU Data
HAZARDOUS MATERIALS DISCLOSURE
Type Of ROOF
Will l m future Wilding mapantswm m handle
y the Heat anmawrial
"-defined de Cupertino Municipal Code. Chapter 9.11, and IW Hdt and! Safety
section zss7zp)7
' rea �a
All roofs shall be inspected prior to any roofing material being installed.
I�
Will the applicant or ulu Wilding mcvpanl = cyvipmenl m Jevim which
If a roof is installed without first obtainingan inspection, I agree to remove
p
emit hanNods air conuminanu as defined by to Bay A. Air Quality Management
all new materials for inspection.
Disuict7 r, �
CYcsu
Thaw mad chs svvTTi maerials mpuiremenu under Mpwr6.95 of to Wild!,
Toric." Soft ve.Qyliol thadu .1 MY and 25574.1undcrsuMtuiftc Wil ding
doeYhawa �j ltuit' y mihilit Toff do ac tori tc
n'n Y
//tI
f, O�
V
requirtmen which melpriI
notio era Z0ryaao
Si Applicant
%� 8'/Dow
of Dat
0ammormlhakmdegent
All roof coverings to be Class'W' or better