06090034 CITY OF CUPERTINO PERMIT A nr�.'� Ae r'>> �
BUILDING DIVISION ( C0 ' fi.� fnR IN'B`UItMATIf3a
€•Yn9t.Rt§ "rex
BUILDING ADDRESS: PERMIAN BUILDERS INC. PERMITNG.06090034
10600 N DE ANZA BLVD
NER'S NAME: PERMIT ISSUE DATE
SOBRATO DEVELOPMENT COMPANY 4125 CLIPPER CT 09/06/2006
.,NE: SANITARY NO. CONTROL NO.
(510) 979-9081
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGO ELECTO PLUMB MECHO
ipp LICENSED CONTRACTOR'S DECLARATION Job Description u 1 Iwrtby affirm thato1 am litemad under provldons of Chepler 9(mmm-mil
!D TZn
in withSectionofessauCoge.admylleerau SOBRATO- TI COMMERCIAL SPACE NON STRUCTURAL
ItRzq oemnm til covaECWr INCLUDES ELECTRICAL & MECHANICAL.
l W -' / ARCHI'fECI'S DRATION
I 77� I undsla
crnJ my plans NW lc I used u public as
i
FCC' Licensed Professional
,An OWNER-BUILDER DECLARATION
I<Z I hereby effmrtn that I an exempt from the Canmamaes I.icenm Law for the
e G ofollowing mamn.(Stiction 7871.5,Business ad Professions Code:Any city car county
:Sr which require a permit to construct,after.impmro.demolish,or repair my structure
4iy priar W its ismace.alas requires Ncapplicanl formch permit m file.sigadSAWm.m Valu 166000
iiG that heis licensed Formal tothe,Provisions Ofthe ContraWesUciame Law(Chapter 9 Sq. Ft.Floor Area
`rs (commencing with Section 7")of Division 7 of Na Business ad Professions Cade)or
that he is exempt therefrom and the basis for rhe al4ged micupdon.My violation of
Section 7871.5 by any applicant far a permit Objects the applicant W a civil Penalty or N Number Occupancy Type
rut mom thus five hundred dollen(S50B. 3 0 2103 . 0 0
0 1.as owner of the property,m my employee with wage u their Ole mmpensadon,
will do the.,it.ad munam Is not inmMed oraaertd for sales(Sce.Insist,Budnev Required Inspections
ad Professions Cade The ContrcmYs License Law door al apply in an awry of q P
properly who Wilds mimprersthermn,and who daeauch.,it himselfr Nmugh his
ownemplayee,providedth suchimpmvemmmartnotinleededaroffetedforsde If.
howew,the Wilding or improwmunt is mid within ane your of completion,the owrr-
builder will Fuse the tarda of proving Nal be,did Out Wild or improve far pu came of
sale.).
0 L a Must of she property,am exclusively containing with IlcenOd mnuacton to
Construct the pmjen(Sec.7094.Business and Profoudons Code:)The Conuaeries Li.
came Law doe not apply to an owner or Propeity who Wilds or Improm Merton.ad,
who contracts for such projects with a com asci licensed purmam O the Contraries
Licenae lira.
O l sex exempt under See ,B&P C for this moon
fit Dam
WORKER'S COMPENSATION DECLARATION
I hereby affttm under Penalty of perjury aro of du fallowing declamlans:
0 I ham and will maintain a Cenffrealeaf Conant to self-m un fr Wodrr'sCompen.
notion,u provided for by Section 7700 of the Labor Code,for tie Performance of the
work for which this permit is issued.
0 I ban ad will maintain Workees Compensation Insurance,in required by Section
3700 of the ISWr Code for the p iformmeo of the work far which Nu permit ie luued.
My Workees Compensation Insurance carrier ad Policy number art�:.�-sem,_
Cartier. IL I>M {foRry No.:
a
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section amid nut hecompleled irate Permit Is formic hundrtddollan($IW)
or less.)
1 certify Not in the performance of the work for which this permit Is Issued,I shall not
employ any Perron in my mamrm u W become mbjcn to the Workers'Compensedon
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL after making the CoAQoule of Exemption,you should
become subject to the Worker's Corporation provisions of me Labor Code,you must
O foMwith comply wish such provisions or this Permit shall W deemed revoked.
„zv InCONSTRUCTION LENDING AGENCY
n
(-r I hereby alfnm that there is a contraction lending agency for the iterfon a m:e of
ani �: the work for which this permit is issued(Sec.3097,Civ.C.)
a Q Undoes Name
Lender's Addres
H1 cenify that F have rad this Ipplietian had sale that the have Information is
fL F' com.cL I agree m comply with all city and county andinmtts and sum laws relating to
C building conmaetian,and hereby authonto MPrs.nWiw of this city to enter uFnnthe
N0. about-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep hornless Ne City of Cupertino against
mF-m W liabilitiou,judgmcnu,costs ad eapcnsu which may In my way accmc galnst sdd City
U in consequence of the grating at this Permit
^ APPLICANT UNDERSTANX AND WILL COMPLY WITH ALL NON-POINT Issued by: Date v-
SOURCE REGU
���� Re-roofs
Signature of ApplwtOCon akener I Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant Hart or handle haordom material
u defined by Ne Cupertino Muni al Cod..Chapter 9.12.and the Health ad Safely
cede,Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yee o
If Will the applicatorforam Wilding occupant umeq.Ipmmtordevices which a roof is installed without first obtaining an inspection,I agree to remove
emir hoommous air communities as defined by the Bay Amo Air Qudity Management all new materials for inspection.
Maim?
Dyes Nu
I have mad the huaNaumuerialsmquimm.nts undero apler0.95ofNe Califor.
ria Hmlmh&S fetyCada,Sectiau25505.25573 ad 25534.1 andenund Nmifde Wilding
data Out cmmotly have a tenant thxt my responsibility in adfy the occupant of the
requirements which mussucilsiglaiia,steer Ccials.fpf ro cySignature of Applicant Date
Owner or Otltoind it.., L� ale' All roof coverings to be Class"B"or better