06070113 CITY OF CUPERTINO 'C
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BUILDING DIVISION PERMIT COt'�,TRA.C;I'nTZ TN ,�< TION '
BuaDINGADDREss a BERG CONSTRUCTION """TNo.06070113
10745 S DEANZA BLVD
OWNER'S NAME: PERMIT ISSUE DAIS ,
ORECK 221 N WILLOW 52RING DR 07/18/2006
NE: SANITARY NO. CONTROL NO.
(619) 540-4370
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
PLUMS
t� MECH
t�
C LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby&farm that I am licensed under provisions of Chapter 9(commencing P
with Section 70110)of Division 3 of the Business and Professions Code.and my license is
infnafarmandefrea REMODEL - COMMERCIAL TI BUSINESS SPACE
Z License Class Lis..
Dow ARCHITECPS DECLARATION
1 undermod my ph.slull he used as public retards
r U
r vd Licensed Professional
m
OWNER-BUILDEReseemp DECLARATION
I.9 I hereby&)Tum Nm 11. exempt from the fessionCo License law for de
:.g
0 O following uirea a Perot
I em 1.5. mans and Profession Cade:Any lily at county
I$rE
which rtquira&panto re uiruwa eller,hnprow,h permit t Il mpaig any avunent $25000
-Z S° dod hor e its ieemne0.alsoant to amres the
ovisio s of for such Contrarmitro al rme Law statement
Nommen licensed pursuant to am of Dialonsof CanContractor'sBusiness Licenselew chapterCook)
Sq.Ft.Floor Area Valuation
S $ that he h Commit,
wi,t Sectionrom and the
Division u the
al eged exemption.
on.An Professions Code)or
7�� Net he 4 emmpt Nert(mm and Ne ba4 for Ne&lisped esempdon.Any violatlun of
Section 7031.3 by any applicant for a permit subjects the applicant re a civil penally of AFN Mrhder u u Occupancy Type
ret mare than live handed dollars(5.700).
❑1,u weer of thro pmpmty,a real roploym aiN nga u Neo cele cmnpenssdon,
will do the wart•and dmmonature la notinunded aro@ted fwade(Sec.70th,Business Required Inspections
and Propagation,Code;The Convectors License Law does ret apply toe an owner of q P
propertyown= lay b,proorimprowach improvements
dmatchwmk hi seffor offcmdWaugh 64
however,
provided that such improvements are ret year
Intended maQewb lmstla r.
builder.Ne buildingderor improwmmt 4 sub within am year of mpro a for the owner.
builder haw Ne Wrdcn of WaWM Nn he did not build m Improve far purpose of
me,). P/
❑1.u awns of that properly,mo emealwly commuctirtf,
Wilds
with licensed enrmxmra d `
LanstNCl Nc project(Sea 7014.Bualness sed Preeaalons Cade:7The Canmcrets Li-
who c new am f not apply c an with
a of properly who sed p or improve thereonCantru and /
whonse Lace far such projeeu wIN aanuanartll licensed pursuant re the ConvaeNr's
License new.
❑lam aempt undo Sea .BhPCfm Nis memo
Owner Dma 6
WORKER'S COMPENSATION DECLARATION
1 hereby afiim under penalty of perjury one of that following declerWom
1 haw and will maintain aOrrull of Consent he self-Insure for Workers Compcn-
103701'0
on,u provided far by Section 3700 of de Labor Cede.fm W performance of de
for which this permit 4 ismN.
1 haw and will maintain Workels Compensation Insurance,u mquied by Section
of the labor Code,for Ne performance of the work for which this permit b issued.Worker's Compensallon Inurance carrier uW Poliry number am:
rtier. (�!; 9 / Poliry,No.:
COrF MOF FROM WORKERS'
COMPENSATION INSURANCE ,
(Thisseason mad was be compleed time permit 4 franc hundred daRara(5100)
nr Tau.)
I anify that in the perfamamo of the work 1p which this pannit 4 issued.I shall not
employ anypermn in any r e jrI re Ne WmYcni Compcnsaon '
Lawn of califomia.D
Appliunl
NOTIC PKJCAW.If,&Tier m ing this Ceniacae of Ere mplion,you should
Immerse subject no the Worker's Compensation provisions of on,labor Cade,you muss
0z forthwith comply with such provisions or this permit shall be lamed rtrmkcd.
.zi CONSTRUCTION LENDING AGENCY
(� 1 Mosby affirm Net there 4 a Construction leading agency for the performance of
p(^ the wank for which this permit 4 mused(Sec.3097.CN.C.)
[g7 0 L.cndaes Nam:
h`7a. z lender's Address
U O 1 certify Nat 1 have mod Nis implication",Use Wt the&bow INormadu,4
0,F enmcL 1 agree re comply with all city and county oblrwrcv orb sum laws relating to
OU building cooruucnion,aM hereby authome represcmatives of this city to enter upon the
i•'0. above-mcnliancl property for inaPcctiun purposes.
F-+ (We)agree to save,indemnify and keep h unnims the City of Cupcnina aeeinat
ern liabilities.judgmcnu,casu and expmues which may in my way accee agairst saiA Ctry
U z in consequence of the granting of this permit.
'•" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE U TI S.
Re-roofs
ignuueo lira, an Cor Dare
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant m future building aceupwastore arbandle havrlou material
a deam0 by tie Cupenina Municipal Code.Chapter 9.13,and the Health and Safety
Cade,section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
Yu 2<
Will the applicant or future building occupant um equipment or cosmos which If a roof is installed without first obtaining an inspection,I agree to remove
it hmordna air comaminanu u defined by the Bay Area Air Quality Management all new materials for inspection.
District? —�/ '
❑Yes m4f.
1 haw mad the hvaNnus materials, men
requirou under Chapter 6.95 Chloe e Califor-
-is Health de safety cede.Seen.25505,25533 and 25534.1 undersand than if to building
door nal Commonly haw a unapt,Net it 4 my responsibility 1,ratify the accupmt or Ne
rtgalrtmcnu ' heat mel re' uerccafaCcrtilkaua Oce Signature of Applicant Date
,er lir as rod start Dana. All roof coverings to be Class "B"or better