06050190 CITY OF CUPERTINO �t I�'7r�y�'r7"% V-`. "�y�,� T
BUILDING DIVISION PERMIT kCONT4[S q I,' 0RUNT'tFO `y, '
BUILDING ADDRESS: DADE BEHRING PERMIT No.06050190
20400 MARIANI AV
OWNER'S NAME: FERMITISSUEDATE
DADE BEHRING 05/23/2006
7�RCHITECT/ENGMEER:
NE: SANITARY NO, CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
l� � (� 0
3o LICENSED CONTRACTOR'S DECLARATIONIOb DeSCrIpOOn
1 hereby ararm Wt I un Ilcmnow under provisional of Chapter 9(commencingSatwn70R)afD)vWan3oftheBuanwand ProfcumnsCak,aMmylkctsxblforestndefren. COMMERCIAL TI• SPACE .NON STRUCTURAL ADD ADDITION
j urc Clain, Uc,Y
Dam Comranor OUTLETS . REMOVE NON BEARING WALL
ARCHITECT'S DECLARATION
1 I understand my plana still he used u public rands
SU
s ala Licenand Professional
5
OWNER-BUILDERexemptDECLARATION
I hereby,.(lien on 1 em exempt from the diamentsC t :Any c TAW for the
O O following Memo.a(Sadat 703 1.5.Business and PmkWav Cute:Any city summers
which requires issuance,permit w emMhe atwr,improve,dFormal,ore A sig any tuement
iy thit Ire isl sedfremstto to the applicant for sachpermilwk..anedmwver9
that wth Seanant m the provisions arae cnnracwr'and Ima aw(Chrpmr9 Sq.Ft.Floor Area Valuat x800
2 th(commencingaisamwith Sec4on7000)ndth Divisionaper ahem Businmuwon.Any
Chat)or
e $ set he b exempt distribut®r and the bub it the subjects
alleged eacmant to Any l penalty
of
Section 7071.5 by ury applicant for a pump vbjecu the applicant m a civil penalty or ppppNN NN rrT�I Occupancy Type
mut marc than Rw hamamd dollars($5017. 316 2 20 18. 0 0 ecu arse e
0 I,v owner of the property,army employees with wager u mahmle compeivadon,
will do Newark and the mature b noUnended arorterW formic(Sm.71344,Business Required Insr�CCUODS
and Philistines CaIL Th.CamMa(t License LA.does J ml apply w an awOf l Inspections
Impmesthumn.andwhodoesinchwohhi vfnUwughhis
man employees,the es,ping or I prsuch improvememsarc not earordaroRertd pursue.lr. (;�� �t� rH`�
Wildbovara
have the bunimprowrmant b that
he did Ore year or mmpktim,the encs of IIWT v yyyYYYJJJ I{M,la sI18IdIraaP/\yes
builder aiB have the bwdcn o(provine sat k did not build or improve fa puryom of
alk.).
v Owner of the property am euluslvely canueaing with licenrzd cmnhaclars m
vtmct the pmject(Sec.7044,Betaines sed PmfeWons Code:)TSB Comracwfs U. I I i^) Q AC{. �OQC
cave Law does not apply w an Owner of property who builds or improver thamn.road. N J U
who contracts for such pmketa with a mntraclartO licensed puravnl w an Conuacwr's '
O..."atruss,Law. C�res ,r I Llr�ra.,�,, I
❑lamr/7775--r_
eunda See B h P C far this mason 'I'�^}JS)AptI/jgl ') JJ
Owner %�`��`�� Dam �2 3—O L/
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty a(perjury me of the fallowing declarstims: -
I lawand will.&main a Certificate of Coercntw self-kers for WOrknes Comper,
mthm,u provided far by Section 7700.1'the Lab"Code.far the perfor v.of the
work for which this permit is issued
0 1 have and will maintain Worker's CompevWan Insurance,as required by Section
7700 of ac Labor Coda,for the performance of the wale for which this permit is lased
My Worker's Compensation Insurance carica and Policy number ate:
Cartier. Pollry No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITbsenim need net baeompkmd i(art permit Is farm hundred do0ara Dim)
or kat)
I canary that in the performance or the wart f"which this permit is Isaacs.I mail nu
employ anyperson in my m rulOp eo_uwba nle svhjen w the Workers'comps e..am
Laws of Califamiu D•
APPI
NOTICE TO APPLICA .If.Marauding this Ocniftdifix,of Eaemption,you should
become subject as the Woraer's Compensation provisions of the labra Code,you am
.J 0 forthwith comply with inch provisions or ab permit shall be deemed invoked.
CONSTRUCTION LENDING AGENCY
[.w► Iherehyatrirm that them it a construction lendingagency for the Performance of
x> the work far which this permit b issued(sac.7097,Cb.C.)
W�Q Lender's Name
7 2 Landers Add.
U0 I awry that l have mad this applicadm w awe don am above mramtaam is
cortect.I agree in comply with all city and county ordinances and me lows relating m
OU building convection,and hereby amhorim representatives of ads city to enter upon the
L$I above-mentioned property for inspection purposes
G (We)agme to save.indemnify and keep hannleu the City of Cupertino against
r.i
IA Iiebilities,judgmenb,costs andencesou which may In my way accrue against said City
UZ in consequence of the gnWng of this Permit.
,..i APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURcfgEpDLAnorr.�
Sites es,of Apppv�lica--U—Contracclarr, MRe-roofs
Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicantorfutum Wilding acupant tare or handle hanaNOns mawdci
as derned by the Cupertino Municipal Cade.Chapter 9.11,and the Health aid Safety
Code,Section 75572(a)? - All roofs shall be inspected prior to any roofing material being installed.
Oyes ONO
Will the applicant or fmum building occupant us,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hemrdous air con sminmu u darned by the Bay Area Air Quality Management all new materials for inspection.
District?
CYes 40
I have awl the hvarMty maadds requirements under Chaps"6.95 of the Cal I fon
nlrHealth&SaretyCodc,SeWuu8505,75577and25534.1unacnwdauifde hiking
doer nes currtndY Nvea Ldot its my msW
paMlirym mufy the aavpantof the
myuimmcnuw bcmeipdertgisauma5r.crnincamaramprmy. Signature of Applicant Date
Owner or,uthorbed agent `'C�`-� Data All roof coverings to be Class nBn or better