08050209 CITY OF CUPERTINO �'
BUILDING DIVISION PERMIT CONTRAC"TO,RjI 4FQRMAT-10
BmL.Dlfigp¢a PRMIT N0.
FORGE DR STE B OPI COMMERCIAL BUILDERS 08050209
NEER''S NAME: PERMTIMUEDATE
PANATTONI DEVELOPMENT ERIC 445 LEIGH AVE 06/05/2008
PHONE!" 6' SANITARY NO. CONTROL NO.
(408) 377-4800
ARCHITECT7ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Sapp LICENSED CONTRACTOR'S DECLARATION Job Description
w I thereby affirm that 1 am li¢nud under provisions of Chapter 9(mmmeming
with sectiot 7")ofuivislon 3 oflba Business and Proressfom eode.aM my license is REPAIR BOTTM SEPATTION OF GLU-LAN BEAM
to in full form and enecL
p v�_ LkcnzC Limit
Dam Caner
e RCHITECCo DECLECL
ARATIO
I understand my Fads"I be used as public records _
pLLF Licensed Pnomed.nal
uD5 OWNER-BULLDERDECLARATION
a� F 1 hcrohy aRrm that 1 am ucmpt from the Canuactofs License Law for the
00 following reason.(Section 71131.5,Business and Poefessinu Code:Any city or county
52� which mquires a permit to conatrml Aber.improve,demolish.or repair any Nmctun,
prtafb its muaMe.also requires;dlcappllcant fortieth xurnitur Ne asignedslalemcnt
ss<
that lic is licensed Forearms to me provisions of the Contractor's Uccourc Law(Clbapter 9 Sq.Ft. Floor Area Valuation
^ F� (commencing with Section 7000)of Division 3oron,Business and ProfessionsCode)or $1500
Q that he u exempt donationsandthe basis for the alleged exemption My violauan of
Semon 7031.5 by any applicant for a permit Sabjecu the applicant e a civil penalty of umber Occupancy Type
not comm than five hundred dollars(5500). 316 0 9 0 3 0 . P Y YP
will
1,u ewrcr of Loc me Moe,rn my uoptoyeu with wgca u am'v(Sec.
compensadan,
will da 0.leado.ands: swmumisnminmrcenseind ave do lar an,apply
in(44.an owner
Required Inspections
and Professions Code:The ComrMerm License Law docs not apply e an owner of Q p
property wine
yehuildiviimpmvu Norton and a ho Lowsstilt work himfelf edduougb his
own ver.th w,provided that sheh improvement am not inmeded moRered fortift.the own If.
however,Lothbuilding orimprowmmnismide din one icour ldorcprovi,fartheowner-
Sam).r will have me burden ter proving that he did rot build m impure(w purpose of
ase.).
0 1,as owner of the property,am exclusively contracting with licensed contactors in
construct the project(Sec 7061.Business and Profusions Cade:)The Conmeer's U,
«ase Law darn mot apply us an mother of property who builds or improves mmmn,and r -
who contracts for such prejeou with a conuamans)licensed pursuem in the Con aurones
License Lw.
❑lamemetptundm Su ,B&PCImudS on
nm Date
WORKER'S COMPENSATION DECLARATION
1 bemby affirm under penalty of Injury..of du following declarations:
I haveSed will mudinam a CartiOcaeof Consent o self-insure fm WarknraCompcn-
When,as provided far by SeNon 3700 of the Labor Cade,fm me performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation luuranm,as ox,fired by Stenion
37W a the labor Code,for the performance arms work for which this permit u issued.
my Cartierrny Ic auy number
on Inst L� Policy Noere:
CERTIFICATE OF EXEMPTION FROM WWW(S/
O_ EEIRXcRRSS'
COMPENSATION INSURANCE
(This sectio heed rot becomple¢d if me permit is fmone hundred dens n(3100)
or leas)
1 certify,that in me performance of lee work for which this permit is Wood l"I her
employ My permn In NY mMlMr M aS in became subject in the WarkCIS'L'a111pCrl5adom
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL arm,making this Cenilmme of Exemption,you should
become subject in Ne Worker's Compensation previsions of the Lahnr Cad,you most
.JO forthwith comply wit such povisimu or mu permit mall W deemed revoked.
E^ CONSTRUCTION LENDING AGCY
[-+rte+ l history affirm urn mem its eomwctinn lendingageENnry to,the pinfurmatwre or
air7 me work for which mu permit U issued(Sec.3097,Civ.C.)
lender's Name
� A
= z Lenders Address
U O I cerufy that I have read It.applleuim s cad We that me above inromuden is
gk.E torten.l agree to comply with all city and county omilnawxs and sum laws relating to
0 building construction.and hereby Summon reprocnutivea or mu city to enter upon the
H CMove-menudgm property for a pecnim proposes.
(we)agree m Save,indcmNfy and keep harmless me City of Cupertino a4inst
^ to to consequence
of the
and expcmesmit. may in my only ucsm against Said City
(,)z m PLICA We of me panting of this permit.
^ APPLLC UNDERSTANDS AND WILL COMPLY WITH ALL ON-POINT Issued by: Dale
SOUR REGULATIONS.GULATIONS.
T 6 til'
si ofMp � uacorV�``Lh� ate Re-roofs
US MATERIALS DISCLOSURE Type of Roof
will me appliant or future building occupant stare or handle harardens mum aid
SU defined by the Cupcome Municipal Cade.Chapter 9.12,and the HWM and Safety
. on zss3z(.)7 /7 All roofs shall be inspected prior to any roofing material being installed.
Y. a
Will mea licant or future building awns cat Sart If a roof is installed without first obtainingan inspection,I agree to remove
fT L W cumpment or devices which p
colt hazardous air contaminants an defined by the Bay Area Air Quality Management all new materials for inspection.
Diatrict7 P
DYm
I Svc mol the Wood materials mquimmenu under Chaper 6.95 ofthe Cdifor.
nu licalth h SaMyCode,Sredwo 25505.25533 runs 25534.1 unlentand mat if the Wilding
doss m curmplly have•mnanL Lout it u my maponsibiliry a notify me occas t of the
mqul nu which m met poor a issuanecof a Certificate of span .
Q/ '�- Signature of Applicant Date
Owmr w..tlum c ag cal am All roof coverings to be Class'RS'or better