06030026 CITY OF CUPERTINO
BUILDING DIVISION PERMI r .CONTRr�. ,TORI ORMAT ON
BUILDING ADDRESS: BURKHEAD CONSTRUCTION INC PERMITNG.06030026
20640 HOMESTEAD RD
ER'S NAME: PERMIT ISSUE DATE
MICHAELS STORES 611 ROGERS CIR 04/21/2006
PHONE: SANITARY NO, CONTROL NO.
(940) 387-2703
ARCHf1ECDFNGINEER: BUILDING PERMIT INFO
BLDG 0 PLUMB HIECH O
30ZLICENSED CONTRACTOR'S DECLARATION Job Description
I U 1 Washy affirm that 1 am licensed under provisions of Chapter 9(commencing
with Section 70011)of Division of the Business and Prafoesian Code.an
d mYliconse ie
i�M
1.(.11 ram.ameffa t 8p`T3 �rj REVISION-STRUCTURAL FRAMING ON CANOPY
f5= L1Cen °it L1e'w ORIG PERMIT #05110012-NO NEW PERMIT/IN HOUSE ON
Mf q 'Date Coo At
7W ARCHIIECI'SDECLARATION BURHEAD CONST PD FOR BUS LIC 3/7/6
< i understand my plans enter he used as public mcma
o,� Licensed Profcssiorel
OWNER-BUILDER DECLARATION
i I hereby atirm that I am exempt from Ne ConuanaM1 Licence Law far the
00 following reason.(Section 7W1.7,Businees and Profesainm Cade:Any city or county
3$ which".I.a permit to construct,alter.improve,demolish,Or repair any strunum
ZSs prior w its issuance.alsu requires Ne appliunl forsuch Permit to file a signed SUMMM
< Nat he is licensed punut to the prevision of the Contractor's License LA.(Chapter 9 Sq.Ft. Floor Area Valuation
222�� m(commencing with Session 7000)of Division 3 of tit Business and Professions Code)or $0
L Nu to ls scamp,therUroe and the basis for the alleged nnmPtion Any vtWfn of
Satin 7031.5 by any applicant for a permit smjecu Ne applicant Or a civil penalty of APN Number Occupancy Type
am mart dun five hundred dollars(SSW}
1,as owner of die property,w mY wplayeas with wages u Uxbanle campemation,
will ch,the work.and Mea Moore bent Intended or offered fornla(See.7044,BusinessRe aired Inspections
and Profession Calc:The Conteaemes License Law does set apply t an Owner of q p
property who bu ilds 0r im proves fiercer.and who does such wart himalf or through his
own employers,provided that such improvements are not Intended oronered forsde.if.
however.the building or improvement Is sold within ane year ofcomple ar,theOmer-
builder MB have Ilse burden of proving that he dM nw build Or impmve far purpose of
rale.).
❑1,as Ower of Ne propeny,w eacluuwly commoming with licensed con0xmws he
conwn the project(Sec.7044.Business add Pmf elelum Cede:)DO Cntraemel Li-
come Law 4aes nal apply ed an owner Of property who builds or Improves Neeson•and,
who convects for such projects with a conuaawr(s)licensed pursuant t six CoutracreM1
Lkene Law.
❑I ern exempt under See .B k P C for this resume
erDECLARDate
WORKER'S COMPENSATION ATION
I bunchy affirm under pasty of perjury rete Of the following dalacadan:
1 haw and ids For by .Mm ant of One Labor
p.,rearreompea-
satlpn,r provided W fpr by Satiaa 1. of tK labor Code.far dm peRormswre a(dtt
west for which sus permit ts issued.
❑1 have and will maintain Wartcrs Compensation Insurance,as enquired by Satin
3700 of the labor Cade,per Ne Performance of Ne wort for which this permit is Wood
My Workces ComgeomM n IasisM1 a artier Poliand Policy number art: ?�,,v
Gamier.tL410T1 Vs143C cyNo.: ;}00I
CERTIFICATE OF EXEMPTION MOM WORKERS'
COMPENSATION INSURANCE
v
(Thu sxsi n red out be camp luted B the permit ts for ane hundred dollars($100)
or lms)
I comfy Not in the performance of the work far which Nis permit is issued 1 shall not
employ any person in any mannerao as an became subject to the Workers'Compensadom
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after mating this Cen10vam of Excmplion.you should
become subject to Ne Workers Compensation provisions of Ne labor Coe,you must
Oforthwith comply with such prevision or this Permit dull be decreed mwked.
? CONSTRUCTION LENDING AGENCY
[ti14 T hereby affirm dui Nem Is a com eaccn lending agency for tin pMarmumeof
LYi> Ne wets for which this permil is issued IS=7097,Cir.C)
0.25
i7ti
Laces Name
a Ixndees Address .
U 0 1 cerdry Nn I haw reed this pplicatin and sum that the above Infor nedua is
Ly E correct 1 agree to comply with 411 city and county ordinances and Men laws relating m
0 SV' Wilding construction,and hereby mdurim mpmemadvea of this city to enter upon Ne
W above-mentioned property farimpccImo purposes
(We)agree to save•indemnify and kap harmless the City of Cupertino agsiml
cn li.biliticsjogmnu,cow and expenses whim may N any way accrue against said city
U Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
sougp�REG{I�nyt+s � 4-eV -0 6 Re-roofs �—
Signature of ApplicanUCOnuanar DBw
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
WIII IIx applicantorfuture buildingoaupanu mmorbasset hazardous material
as deMd by the Cupertino Municipal Code,Chapter 9.13.and the Health and Safely
sed.a 255y2(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes ON.
Will Ne applicant or future building Occupant use equipment ar devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havaNnn air<nramimnts as Monet by the Bay Amo Air Quality Management all new materials for inspection.
Of'Oin7
❑Yrs ON.
I have mad the hvanlous materials requirements under Chaper 6.95 of the Cali far.
nia Health h SafetyCade.Sedada35505,25533 and 25534.1 undemmnd use if Me building
don not currently have a xn a.Nat it b my responsibility t notify the occupant or the
require tswhichm" bcmetpriarmissuaacoil Ocruncatofoccupsney. SI natureofA licant Date
�QQ "�^^" 4 Tai -0G g PP All roof coverings to be Class"B"or better
Owner ormtharin agent Dat"