07090163 CITY OF CUPERTINO �a,g� x :'• � ir`e '� ' ^err
BUILDING DIVISION PER UT Wefli
BUILDINGqD FSS: PERMIT NO.
10600 N DE ANZA BLVD 1ST FLR NOVO CONSTRUCTION 07090163
OWNER'S NAME: - PERMIT ISSUE DATE
SOBRATO DEVELOPMENT COMPANY 1042 HAMILTON CT 01/03/2008
ONE: SANITARY NO. CONTROL NO.
(650) 701-1500
ARCHITECTIENGiNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
fop
LICENSED
>n!�� with Sectkn LICENSEDCONTRACTORS DECON
1 Mmbyafrm that 1atd andaoscifC9(commencing Job Descriptiontion
70W)a(Diviaion3ofhe Business and Prefcse;am Code,
and mylicense ts T.I . COM OFC SPACE, T-BAR, NEW LIGHTING,
ro y in full force and effec *X 'g�1022
D n 2i License Cl
U..g �//as / i NON-STRUCTL
Dale Contractor N 9 D7
��•• ARCHITECT'S DECLARATION SANITARY IS SUNNYVALE. TEMP PERMIT #07110119 EXP.
I understand my plans shall he teed as public records
7y
gted Ulcerated Prefesaional
Sy OWNER-BUILDER DE CLARATION
COO I heathy.(Rens on I am exempt from the cannons r'n License Law for dm
DO following mature.permit
7Business and ere.diunns Co de:Any city or county
COO
$ which requires a peros t re chewMconstruct,alma improv,d.ermit t of repair any structure
_4 prior mits issuance.alsoprovision offer auchpcmitmiconsle ae signed statement
�b that menikented pursuant to the provisions of dm Me
License❑w(CWpmr9 Sq.Ft. Floor Area r�7/aluation
(commencing with Section it of leads f 3 of Ne alleged
Business pt on.Any
Crude)or $110593 V
$ Nm W ts exempt any appli and dm boon for be alleged exemption.Any violation of
Section than by airy applicants(a pesmit subjects Ne applicant to a civil penalty of �D 77T�Number Occupancy e
net mom than fiw hundred dafiaa(SSo07. 316 O 21 O 3'.'l7 tJ P y 1YP '
❑L era owner of die property,army employees with wagesm their sok enmpenation,
willdoth..kandN Imctumlanotinkndedmonemdforsak(Sec.7W,Bu ream
and Profmslom Cade:The Commutes License Law Claes out apply an an owner of Required Inspections
property who builds m ins proves demon,and who does such work himsel f ar through his
own employees,provided thar such improvements art not Ina nded moRemal(orale.If,
however,be Wilding or improvement is sold within am year of completion,the ownar-
builder .will have the burden of proving that W did not Wild a improve for purpose of
aid.).
❑1.as owner of be property,am cadmively conkacting with licensed contractors he
construct de project IS".7064.Business and Intimations Cade)The Conbackr's Li.
coast Law does not apply m an owner of property who Wilds or improves Berton,and,
who contracts for such projects with acomi actorts)licensed pursuant to the Convaeror's
License Law.
❑1 am aminpt under See ,B&P C fm this mann
Owner Data
WORKER'S COMPENSATION DECLARATION
I Wreby affirm under penalty of pe jury ane of Ne following declarations:
aw and will maintain a Co dfem,orconsent to self-im e,for Worker's Compen- _
as provided fee by Section 3700 of the labor Code.for the performance of the ' ' • ,
which this permit is issued.
1 have and will mainud Worker's Compensation Insurance,as required by Section
3700 of Ne Labor Code,per the performance of be work for which this permit is lauec. '
My Workper'�s CCo�mpenmal Inwnnce evrti and Policy number ase: w e
Came gA'��I[ �4I,��s'fM�'J Policy No.: 1STO'a I'D�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This teetlan need not W completed IfiW permit Is(mane hundred do Ira,($IOIB
or less.)
1 cenify bot in the performance ar de..,it fm which this permit in issuetl,l shall not
employ any poison in any mannerm as k become subject to be Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT.IL after making this Certificate of Exemption.you should
become subject to be Worker's Compensation provisions of the Labor Code,you mute
.JO forthwith comply with such provisions or this permit shall W deemed mwked.
,zt 51 CONSTRUCTION LENDING AGENCY
[-r I Mmby aRrm that there is a construction lending agency for bo performance of
Cri de work for which this permit Is issued(Sat.3097,Civ.G
QLenLcr's Net.
Z) z Lender's Add.
fJ Q 1 certify that I have resit this application W state thin the above information Is
Iy E Comm 1 agree to comply with all city and county ordinances and state laws relating to
�(J building cnnsuactian,and hereby authodm mpresenuri of this City to enarupon de
yshove-mentimed properly fm inspection purposes
(We)agree to ave,indemnify and keep harmkss the City of Cupertino against
r y liabilities,Judgments,coals and eapenars which0'/3/05
wagalm,a id City
U z in consequence of de granting of this pethe' -
APPLICANT UNDERSTANDS AND WILL ClLL NON-POINT Issued by: Date
SOUR GULATIO:: /��� Re-roofs
Signature of Applrcan am Dein
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII tithe C tent m furan building oecupantnom m handle havudom material
C tla Zc ly the Cupertino Mumci ode.Chapter 9.12.and be Health and Safety
C.
Section zss3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ys No
If a roof is installed without first obtaining n ins ection,Iree to remove a
Will the applicant or future Wilding occupant use equipment or devices which g aP g
mar
nTdnus sir canuminants es de d by the Hay Arm Air Quality Management all new materials for inspection.
by..
o
I have mW be haardous anu risk requirements under Chapter 6.95o(the Celifor-
nia Health&Safety Cade,Sections 75505,25533 and 25534.1 undersund bis if Ne Wilding
it..not cerrondy haw an
•Contra,Nat it 4 my on fo sibilit m modify the occupant of Ne
roquUwhi maabC.eL arkiayaam.an ce 'mam ori glp3�cy- Signature of Applicant Date
�!/C All roof coverings to be Class"B"or better
Own.ronulhari cnl aid' — g