07120063CITY OF CUPERTINO
BUILDING DIVISION PERMIT
577777777777
BUILD
PERMIT NO.
MYTsN DE ANZA BLVD
TAISEI CONSTRUCTION CORP
07120063
OWNER'S NAME:
PERMIT ISSUE DATE
SAND HILL/1200 SAN MATEO AVE
2180 BERING DR
01/03/2008
pHONe,
SAMTARY NO. CONTROL NO.
(714)886-1530
ARCHrTECT/ENGTNEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby arum that I am licensed under provisions of Chapter 9 (commas 7mg
with section 70W) of Division 3 of the Business and Professions Code. and my license is
COMML TI , r FOOTING FOR ART WORK
in full fora and effccL
License Class Lic. N
Date Contractor
_
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following mason. (Section 7031.5. Business and Professions Code. Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to rile a signed nademern
he is licensed to the of the Contractors license Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that pursuant provisions
Section 70D0) of Division 3 the Business and Professions Code) rat
2 5 0 0
(commencing with of
that be is exempt therefrom and the basis for the alleged exemption. Any violation of
�p �T Number
3 2 6 3 3110 `..
Occupancy Type
Section 7031-5 by any applicant for a permit subjects the applicant to a civil pena4y of
am more than five hundred dollars (SM.
V
❑ I, as owner of the property, or my employees with wages as their sole rnmpeosatioo,
Required Inspections
will do the work p and the structure is not intended or offered for sale (Sec. 70". Bs
and Professions Code: The Contractor's License Law does not apply m an owner of
property who builds or improves thereon, and who does such work himself or through his
own ere oytxs provided that such improvements are not intended ur offered for sale u
how ,the buihdimg or improvement is sold within one year of txumplotioa. the .
br3pir will have the burden of proving that he did not build or improve for purpose of
2.)
I, as owner of the property, am exclusively contracting with licensed wamacim to
construct the project (Sec 7044. Business and Professions Code) The Contractors Li -
craw Law does not apply to an owner of property who builds or improves thereat, and ,
who contracts for such projects with a contractor(s) licensed pursuant to the ComracWs
L.iceam Law.
❑ 1 am exempt under Sec , B & P f
Owner Due o7n
WORYCERSICOMPENMO DECLARATION
I hereby affirm under penalty of perjury no of the following dedaratioms
I hsve and will maintain a Certificate of Consent to self -insure for WmWs Compere -
cation• as provided for by Section 3700 of the Iabor Code, for the performance of the
work for which this permit is issucil.
❑ I have and will maintain Worker's Compensation insurance, as mquired by Serrion
3700 of the Labor Code, for the performance of the work for which this paria is issued
My Worker's Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKEPZ
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundmd dollars(S100)
or lets)
1 unify dun in the performance of the wo or wh' h this permit is issued. I shall not
employ an • person in an manner so as m�ir}b�' t to the errs' at
Laws California. Date / � �
Applicant �
NOTICE TO APPLICANT. If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you mom
forthwith comply with such provisions or this peanit shall be deemed mvolted_
I
CONSTRUCTION LENDING AGENCY
I hereby affirm that them is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
i Lenders Name
Lenders Address
I certify that I have read this application and state that the above information is
' cored I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorire representatives of this city to enterupon the
above -mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino agai¢u
liabilities, judgments, costs and expenses which may in any way accrue agatustsaid City
in consequence of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-P�@fT
Issued by: Date
SOUPCE REGULATIONS. " D j
YLl1
I 1If (1�(
Re -roofs
/
Type of Roof
Signature of Applican /Conlraetor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hauardous material
as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code. caches 25532(a)7
`I��jNo
All roofs shall be inspected prior to any roofing material being installed.
DYa
If a roof.is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment ordeviceswhich
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ ❑ /)
Yes
.
I have read the harardousmaterials requirements under Chapter6.95 of tlx Califor-
nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand dun irthe balding
does not currently have a tenant. that it ism responsibilim ty to notify the orpant of the
requirements which must be met prior to a ce or a Ccrtifc t pr
Signature of Applicant Date
I J
All roof coverings to be Class "B" or better
-
Owner or authorized agent Date