06070218 CITY OF CUPERTINOsF.+ni- ��y
BUILDING DIVISION PER NIIT CO��'1 y2CMGT`p'. klTf�>� �'Tl ,;�.
BUILDING ADDRESS: BIUAN MARIDON PERMIT NO.O f)O 7 O Z 18
10745 S DEANZA BLVD
aNER'S NAME: PERMIT ISSUE DATE
s
BIUAN MARIDON 09/07/2006
SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECN
fop LICENSED COMBACIOR'S DECLARATION lob Description
i U�FF{ 1 hereby affirm that 1 me Ilcevni under provisions of Chapmr 9(Comm aurin{
with S.m..70m)af Division 3of the Business and Profession Cade,and my lknnseb
SSS in fell fineeandeffecL pZ TI COMMERCIAL OFFICE SPACE
j Eq- License Class Lle.N
Dau 4/ —Cantraemr
—rCTS DECLARATI N
j 1 undcrs and my plans shall be used a public records
id
10
Licensed Professional
OWNER-BUILDER DECLARATION
I o O 1 M1erthy affvm en 1 ren exempt from de Canuattofa Lke y C Law O far Nc
.e o following roam..permit
In
713 13,Business seband Pmfdedoli Cole:My ally ar county
I$ which roquims•grounded,also re trued ft alar,improv,demolish.t m repair any tuucturo $180000
_Z�,
prior to its iensedp)msas he ats pro inion o for each Conductor's
astgaed w(aWcmcnt Valuation
3�GIMtheilieenseithSceantmtheprovivionofNeConusidem LicensclsweCodc)Cbapw 9 Sq.F[. Floor Area
that(cohe is exempt
add
bailofrde nd alegeinexceptoand n.Any viCnde)of
Net io ts 3 L5 b therefrom and Ne bub for Ne alleged exception.to Any it penalty
of
Section 703 LS five
nary applicant fora Permit mbjo<u the applicant Ise a civil penally of er Occupancy Type
oat more than five M1undmd dellvs(f5m). ,
❑1,at owner of the property,Or my employees with wages as their=Is demperuadon,
will do the work.and the structure b flat landed or offered for side(Sec.7044.Budneas Required Inspections
and Profession Cade:The Condemnee License Law does net apply m an slater of 9 P
property who Wildsorimyrnwa thermn,and whndoessuch work himalf of through his
ownemployen,provided Nm such improvemmU art did immmd dI orolfered for We ff,
however,the Wilding or improvement is sold within arc year of mrepleder.the owned-
dinkier
wnerbuilder MB haw the burden of proving that he did not build or improve for propose of
salt.).
❑1,as Owner of the property.am nm
clniwlY contrsing with licensed WRr a
c...tm t tM project(Side.70x4.Businessland profession Cada:)The Consorts I.I.
come Law does not apply m an motor of property who builds or Improves the con,and,
who contracts for such projects with aconsacmR)licensed pursuant m Ne Contractor's
License Law.
❑1 am exempt under Sec. .B A P C for this mann
IF Data
WORKERS COMPENSATION DECLARATION
1 hereby,affinr under porosity of perjury,one of the following declarations.
1 haw and sill maintain a CeNOmmaf Consent la se1R Wart(ar Workers Compcm
vile.,as provided for by Section 37m of the Labor Code.for the performance of the
work for which Nis permit is Wood.
❑1 haw and will maintain Wafker3 Compenadon Introduce,u required by Section
37W of the Labor Code,for the performance of the work for which this permit Is bawd.
My W. Cam enmd p Imursnce toric,and Policy number art: /� �
Grtler. Polley Nat�: � T 10-1
CERTIFICATEOFEX ON FROM WORKERS'
COMPENSA NINSURANCE
(The,m,flon need act Wcomplem,Ifs permit is farmm hardeddanas(elm)
mlaaa.)
I certify Not in the performance of the work for which this panels is broad,limit stmt
employ any Poland in any murder so as to become subject to Ne Warkem'Compewdon
Laws of California.Dam
Appllunl
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
Weems Subject m the Worker's Compensation previsions of the Lebo Code.you most
wJ O forthwilh comply with Such provisions or this permit shall be domed lowland.
Z ti CONST RUCr10N LENDING AGENCY
'r+ I hamhy affirm Nm then is•eomtncti.n lending agency far Ne perfurm ume of
Ci the work for which Nts permit Is issued(Sec.7097,Civ.C.)
Uj
Q Lcndces Name "
Q Lcomes Addams
O Q I cdrfify Nal 1 hew mad this application and sum Nat No ahow information is
IL F correct.I agme to comply with all city and county ordinances and anal,laws relating le
Q U building construction,and hereby awhorin representatives or this city to enter upon the
,7+ W ahow-mentioned property for inspection pugmses.
(~6m (We)agree 1n save,indemnify and keep homeless the City of Cupertino against
h liabilities,judgmenu,costs and expenses which may in any way acemc against said City
V 7 In conaquence of the gaanlingt Ni permit. �J
r7 APPLICAN UNDERSf ND fD WI LY WITH ALL N N,POINT Issued by: Date /��✓C�
SOUR �GULATI
.. ��� Re-roofs
S�ipi umof Applian onuxmor Da¢
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
W111 ax applicant Or forum bulldidg aavpenlmro er Modic havrdam material
as dented by the Cupertino Municipal Cade.Chapter 9.13,and the Health and Safely
.Section 35533()? All roofs shall be inspected prior to any roofing material being installed.
0 y Ro
uutIf a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building rampart oda egwpmcart of devices which
emit hazardous air conuminnu as dcnmd by the Bay Aloe Air Quality Management all new materials for inspection.
District?
Cl yes � O
I have rnd Nd hasaadj` mriabrtyuilomonu un der Chapterti.95ofNeGlifor-
nbHeslth&SafctyCade,Sccti ,35577 and 355M.I underaund thaifge,building
dace nal c oily haw a a It my n Nt nobly the Occupant of de
loyal which cof Nncauo! SignatureofApplicant Date
Owner or eta or'vcd a n, Delo All roof coverings to be Class"B" or better