04010068CITY OF CUPERTINO'rcn�m
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'�COt\TRACTOR.l�p
- BUILDING DIVISION PERMIT
�If��IN:
BUILDING ADDRESS: _
SOBRATO DEVELOPMENT CO.
PERMIT N%4OlOO68
ERS NAME:
PERMIT ISSUE DATE
SQBRATO
ONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
LICENSEDCONTRd underSDEConsof CON
1 hereby affirm that 1 am Licensed under Provisions of Chapter 9 (commencing
lob Description
p
With Section Division of the Business and Professions Code. and my license is
Laooocesndaffect.
scls ue,o
TI -2 STORY LOBBY REMODELING &
Dole-
DaCOnraetar
ORIG. #03070067 EXPIRED/PAY 1/2 PERMTI FEES
ARCHITECTS DECLARATION
I understand my plans shell he used ea public records
Liccnxed Pmfeasional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following mason. (Section 703 1.5, Business and Professions Code: Any city or county
which requires a permit to construct, eller, improve, demolish, or repair any sbunum
prior o its issuance, also requires the applicant for such Permit to rile a signed statement
that he is licensed pursuant to the provisions of me Contractor's License Law (Charter 9
Sq. Ft. Floor Area Va#rjtpq 000
(commencing with Section 901 of Division 3 of the Business and Profusions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 9031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not come than live hundred delta.(S500).
ApN Number
Oecu ane
p y Type
❑ 1, s owner of the pmpcny, or my employees with wages s their sole compenaetlon,
31606051.00
will do the work, and the structure is not intended or offered for sale (Sec. 71394, Business
and Pmrasians Code: The Contractor's License Law does not apply N an owner of
Required Inspections
property who builds or improvesand who does suchhis
or
own employees, provided that such improvements are not ofle edthrough
ch improvements am ended
tl or offered for
building improvproviis ear of manor.
however,illhaw not yearorcompletion. Neowner-
the uor
builder will have the burden of proving this he ditl not builtl or improve for purpose of
hathe did
sale.).
1, as owner of ct property.. B excl. ad commcting with licensed mirsemmrs to
co 1. as the project (Sec. property.
a Business and Profusions Cade:) The Conrmtoor to
O
canoe law does not apply to an owner of property who builds or improves daemon. and
whoacu for such projprojectswith $ eontnetor(s)licensd pursuantto d¢Conractah
Licenses Law.
❑lam exam un rSec. ,BAPC(or Nis recon
err Data
(�
J�
W KERC M NSADONDEC ATolq
1 by affirm under penalty, of perjury one of the fallowing declarations:
Iha and will maintain a Certtfieem Consent of Conseno self-itaure for WorkehCompen-
talion, ss provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for Its performance of Ne work for which this pmmit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Cartier'. Polity Na:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nm be completed if the permit Is formic hundred dollars (SIM)
nr box.)
1 certify Nat in thc performance of Ne work for which this permit is issued. l $hall not
employ any person in any manner so as; to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: IL after making Nis Certificate of Exemption, you should
become subject to the Worker's Compenstian previsions of the Labor Code. you must
forthwith comply with such provisions or this Permit shall he deemed trimmed.
CONSTRUCTION LENDING AGENCY
1 hereby affam that there is a conmuction lending agency far the Performance or
the work fur which this permit is issued (Sec. 301 Civ. C.)
Lender's Name
Lender's Add.,
I cenify that 1 have read this application and sum that the above information is
correct I agree to comply with all city and county ordinances and suite laws relating to
building construction, and hereby authome representatives of this city to enter upon the
above-mentioned property for inap action purposes.
(We) agree to cave, indemnify and keep harmless the City of Cupcnino against
liabilities, judgments.cosu and cxpuucrue s which may in any way accagabousid City
in conscyuene of the Bmming of thi mail.
(
APPLICANT UN RSTAND ILL COMPLY WITH AL NON -POINT
Issued by: Date /
SOU CER U [ON
Re -roofs
Type of ROOF
sisnatu A pp maHAZARDOUS MATERIALS DISCLOSURE am
I the applicant or future building occupant store or handle harsNom matenai
radefine by the Cupenino Municipal Code. Chapter 9.12, end the Health and Safety
e, section 25532(a)9
❑res rYNa
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant ase equipment or devices which
If a roof is installed without firstobtainingan inspection, I agree to remove
it hazardous air a mmimanu as defined by the Bay Area Air Quality Management
all new materials for inspection.
Wiwi? L
,
0Yes QryU
I have madthe hvardoustraterials requiremenu under Chapter 6.95 ofthe Califor.
-
nix Health 6Sa tyCede, toreons 25505.25533 and 25539.1 undcrsNnd that foe building
does nm cu tly%%w a lease is / ponsi,i1ity m nodl'y the cec pen of the
requitement hi�)Jfmust be✓ orlu is 'CcnificmeaOceu an
p �y�
Signature of Applicant Date
All roof coverings to be Class "B" or better
ower nod ase ,
am