08080128 CITY OF CUPERTINO '^rte-nrae 701&4 r^ -" �"" = "•
BUILDING DIVISION PERMITCONTRAOMA INFORMATI,ON ,
94 t'xSm?S
BUI IN RESS: PERMITNO.
�8�A�4 FORCE DR SYL-MAR CONSTRUCTION 08080128
ERS NAME: PERMIT ISSUE DATE
N Ex9'L;N 1310 TULLY RD 08/28/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 293-7969
ARCHMCZ/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u O p LICENSED CONTRACTOR'S DECLARATION
ZC 1 I¢mby af1Um that 1 sm licensed under provisions of Chapter 9(rnmmcncing Job Description
<b TINSectionTIX11I)ofDivision3ofNCBudrcssa�ProfcscamCad dmyliccr�cu COMM'L TI, INSTALL 2 HVAC UNITS, & ELECTRIC POWER
^ se in full fort rad enett
pqz Line a. �_Lm.t _ F� NEW SERVER ROOM.
ppp
Contractors.DECLARATION
EC1W f
'-� ARCHITECTS DELLA re '
1 understand my plane Shall he used as,public recmrN
s
Licensed PmfcssionM
SN3 OWNER-BUILDER DECLARATION
sC a E 1 hereby slam that 1 am1. exempt from to Cssions Co License taw for Ne
CaO following moon.(Section 7031.5.Buchu. and wn.de suns Code:Any city orcaunre
$�i which reyuims•permit o conswcL alms.improve,Qcmnikdt or repair anY structure '
Zi prior to it.issuance,al.oxi.in.the,pplicant for such permit to fiile.signed comuntl
that he is licensed pursuant h the provisions of the Contractor's License Law(Chapter 9 Sq.F[.Floor Area $88250
Valuation
y�g (commencing with Section 7")of Division 3 of the Business am Pro
fessions Code)
5 that he u exempt therefrom and the but$for the Waged exemption.Any violation of
Section 7031.5 by any tppliunt for a permit ubjecu the applicant to a civil penalty ofNumber Occupancy
not mom than 0vehundred dellaa(Ly1)0). 31609030 . Pane Y Type
1,as owner of the pmpmty,or my employe.win wages u their sole compenerhm.
will de the work.and the structure is.1 intended or onemd for sale(Sec.70N,Butircss
and Professions Code:The Conmcors License Law don not apply as an owner of Required Inspections
pmpeny who Wilds or i mprovu hereon,and who does uo:h wars himsel f m through his
own emplayoms,provided that such impmvemmu art not inunha oroRered for sale If.
however,the building or impromnent Is mid within one year of completion.the names.
builder will have thee homeless of proving that he did rot Wild or improve for purpose of
sak.).
1,u.vans of the property.am eeelusively contracting with licensed conerutas W
construct the project(see 701x,Buinm and Profusions Cade:)Mie Countesses U.
comes Law does not apply m an owner of property who Wilds or improves thmenn.and
who contracts for such projects wit a eanme mr(U licensed pursuam to the Commissars
License taw. -
lamuemptunderSee ,BAPCforthi.masom
A
Dau
WORKER'S COMPENSATION DECLARATION
I teemby of loo under penalty of perjury,ooe of the following declarations:
❑Iha.md will mahomt.Cmtnccnuof Conamnself-insure far Workers Compen-
.don,u provided for by Section 3700 of Ne Lebo Code.fordm performan¢of he
work for which this permit is issued.
I have and will maintain Wortrls Compensation Insurance,as mquimd by Section _
37W.f he tabor Code,for he perfor omec of the wort for which this permit u issued
My We, f Campeva I lnsurame and Put Ism,
Carrier. yt'7tRTNarohNXEMMON Olel MER
CERTIFlCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thin section need wt be completed if tle Permit s forooehumbed dollar(5100)
or kat)
1 Mmfy Not in the performmce of he work for Which this permit u issued.I shall not
employ any permn in my msmer.se an to become subject to do Workcn'Compensation
Laws of Catifomis Dau
Applicant
NOTICE TO APPLICANT:IL after maWng this Canincate of ascription,you should
become subject to the Workers Compensation provision,of the labor Code,you most
.J O forthwith comply win such provitlons or this Permit shall W deemed mvoked.
„zh h CONSTRUCTION LENDING AGENCY
l.+ Thereby M.that there u,commuctinn lending agency for the performance of
Ci that work for which his Permit u issued(Sec.7(197,Civ.C.)
Q Lenders Name
z tender,Address
V Q I certify that 1 have read this applievion and sum that the above information is
corm.I agree In comply win all city and county aminencs and sum laws rtuting at
.p Wildingcommotion,and hemby autWdm mp.Wivcs of this city oenmr upon the
W alove-mentioned pmperty for inspection purp.es
F (We)agree to save,indemnify and p burnt the City of Cupertiro against'V traliabilities. cote and exponent which may in my way accrue against said City
C.)z in conseq a of the tranti 11 of u look
APP UND A DS ND WILL COMPLY wITN A NOtI-POIM Issued by: Date CO�--071
SO CE GULA
the..- Re-roofs
Shgnaturoo ppticsnnCmarectnr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the ap,11.1 or future Wilding oceupantmee Or handle hoodoos outmost
fined by the Cupertino Municipal Code,Chapter 9.13,and the H.Ih and Safety
.SCWen 155324)7
❑ties 94o/ All roofs shall be inspected prior to any roofing material being installed.
Wit the, Beset or Whoa wildin ams ant am If a roof is installed without first obtainingan inspection,I agree to remove
pP f P ea Air Quality Management
h P
eDm,3trict? ns ser canumhnanu u deBucd by the Bay Area Air Quality Man,gcmcm all new materials for inspection.
❑Y.I It to dtheyymnsIn No
nu H.Ithd Saf�Cad iS .25505 2553imhmwusia 1 omnhd"�aaqd lw fuj lbt ldi
rdoesatio my h u// =1h=1 fl'u my rtryoruibi0ly o mnfJ the ocNPanl of he
myu hk''mu lomat priormissuance ofacmdre.polOcc amr.8 Signature of Applicant Date
Owner or&miecdagent am All roof coverings to be Class'W'or better