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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
77
BUILDING ADDRESS:
PERMrr NO.
18922 FORGE DR STE B
TBD TO BE DETERMINED
08040150
OWNER'S NAME:
PERbvffr ISSUE DATE
PANATTONI DEVELOPMENT ERIC
05/07/2008
77tilD C,
?HOr?F
SANITARY NO. CONTROL NO.
ARCHITECTfENGINEER:
BUILDING PERMrr INFO
BLDG EL.ECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Cbaptcr 9
Job Description
I hereby affirm that I am licensed under provisions of (commencing
with Section 7000) ofDivision 3 ofthe Business and Professions Code, and my license is
T.I.-EXPANSION OF(E)COMPUTER SRVR PM,REQ'D ADA
in full force and effect.
lv)�-
License C1 Lic-
ass
UPGRADES,INCLDS MINR DEMO,ROOF MOUWED HVAC UNIT
Date C.n., F1 41YAO
ARCHITECTS DECLARATON
STRUCTURAL SUPPT,ELECTRICAL PANEL UPGRADES,MINOR
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractoes License Law for the
cu
following reason. (Section 7031.5, Business and Professions Code: Any i y 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 file a signed statement
that he is licensed to the of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
pursuant provisions
$50000
(commencing with Section 7000) ofDivision 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
3 16 0 9 0 3 0 AyMumbe,
Occupancy Type
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($5W)�
F1 1, as owner of the property, or my employceis with wages as their sole compensation,
Required Inspections
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law docs not apply to an owner of
property who builds or improves thercen, and who does such work himself or through his
own employ=, provided that such improvements are not intended or offered for salf- If,
however, the building or improvement is sold within one year of completion. the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
71 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) Tlie Contractor's U -
cense Law does not apply to in owner of property who builds or improves ffiemon, and.
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
[] I am exempt under Sec, B & P C for this reason
Owner Date
WORKER'S COMPENSA71ON DECLARATION
I hereby affirm under penalty of pedury one of the following declarations:
0 1 have and will maintain a Certificate of Consent to 3elf-insurc for Worker's Compcn-
sation, as provided for by Section 3700 of the Labor Code, for the performance or the
work for which this permit is issued.
71 1 have and will mainWn Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Worker's Co I carrier and Policy number am:
Carrier, S T7777/Z — Policy No.: 0o ?I/ -
CERTIFICATE OF EXEMPTION FROM WORKERS*
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
I ceruf�y that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers'Compcnsation
Laws of California. Date
Applicant
NOTICE TO APPUCANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance or
the work for which Lhis permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and slate laws relating to
building construction, and hereby auLhorim representatives of this city to enter upon the
above-mentioncil property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments. costs and expicniscs which may in any way accrue against said City
in consequence of the granting of this permit.
0/,
Re_rOOfS
Type of Roof
SignaLurcofAliplicant/C'ontraiiLor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant Store or handle hazardous material
as defined by the Cuperfino Municipal Code. Chapter 9.12. and the Health and Safety
Code. Section 25532(a)?
All roofs shall be inspected to any roofing material being installed.
[] Ym
prior
quipment
If a roof is installed without first obtaining an inspection,.1 agree to remove
Will the applicant or future building occupant use c or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
[] Yes )S4N.
I have read [he hazardous materials requirements under Chapter 6.95 of the Cal ifor-
nia Health & S&16L Cc&, Sactions25505,25533 and 25534. 1 understand Lhatifthe building
"�c' 'ff "'can
does not ve a risibility to notify the occupant of the
o`p`-`y or
Signature of Applicant Date