04060081CITY OFCUPERTINO -
�^`•"�"°^ '� 7
BUILDING DIVISION PERMIT
j4CONTA&C-TQR�INF,U'RMA'CTON:*
BUILDING ADDRESS:
SAARMAN CONSTRUCTION LTD
PERMITNE04 0 6 0 0 8 1 "
19608 PRUNERIDGE AYE
OWR'S NAME:
PERMIT ISSUE DATE
'SFC ARIOSO INVESTORS L.P.
683 MCALLIS
Eo
SANITARY NO. CONTROL NO.
(415)749-2700
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm Nat 1 am limnsed under previsions of Chapter 9 (commencing
-
with Section 7000) of Division Sof Ute Business and Pmfessiuns Cod,. and in, license is
in full force and effect.
REVISION --IN HOUSE USE ONLY
License ClaseLic.p
Dale Contractor
NO NEW PERMIT ISSUED/ ORIG. #04030161
ARCHITECTS DECLARATION
1 understand my plans shell he used as Public me.,&
Licensed Promasional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contmmnr's License Law for the
a "
following moon. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to conduct. alar, improve, demolish. or repair any slruclu d
prior In its issuance, also requires the applicant for such Permit to file a signed sutement
Nal he is licensed punuent to the previsions of the Commuter's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation $0
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he Is exempt thcrefmm and dm basis for One alleged desorption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit sublime, the applicant to a civil penally of
not more Nen five hundred dollars ($500).
31645016.00
❑ I,as owner of the property, or my employees with wages as Heir sole compensation.
Required Inspections
will do the work end Neswnue, is nm intended ar offered for sale (Sec. 7044, Busirteo
and Protme ons Code: The Contractor's License Law does not apply to an owner of
property who builds or i m proves themon, and who does arch work himsel f or through his
own employes, provided that such improvements are not intended oro0ered for ole. If.
however. Ne building or improvement is sold within one year of completion, the owner.
builder will have the burden of proving Nal he did not build or improve for purpose of
sale.).
t1 as Owner of Ne property, am exclusively connecting with licensed contractors to
onatmet the project (Sec, 7044, Business and Professions Code:) The Committees Li.
cove law docs not apply to an owner of property who builds or improves demon. and
who contracts for such profeem with a contraclor(s) licensed pursuant to the Gonlmclor's
License Law.
+
❑lam ex7ddtunder Sec. B & P C for this mason
Ow ate ' 9-0 V
WORKER'SMPENSATION DEC ION
Ihemby4WimunderpmultyofpedjuryamofA followingdecWxiom:
have and will maintain aCcAficate of Cou sentmself-insure for Worker's Compere
sation, as provided for by Section 3700 of the Labor Code, for the Performance of the
work for which this permit is issued.
Ej 1 have and will maintain Worlds Compensation leamance, as required by Section
3700 of the Labor Code, for the performance of me work for which this permit is Waed.
My Workers Compensation Insurance carrier and Policy number am:
Cartier. Policy Na.:
+
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu sectio need indlWcompleted if the permit Is forane hundred clotlars (51 W)
od leas.)
I certify that in the performance of the work for which this Permit is owed. I shell not
employ any Nixon in any mannerso as to become subjecOo the Wmkcn' Compensallon
.
Laws of Califomia. Dale
Applicant
-
NOTICE TO APPLICANT: It, after making hits Candidate of Exemption, you should
Wcome subject to the Worker's Compensation provisions of Ne labor, Cade, you must
Forthwith comply with such provisions or Nis permit shall Ire deemed revoked
CONSTRUCTION LENDING AGENCY
I hemhy anon that Nen is a construction lending agency far the performance of
Ila work for which this permit is issued (Sec. 3097, Civ. C.)
Lendela Name
Lender's Address
I minty that 1 have mad this application and stale that Ne above information is
correct 1 agree to comply with all city and county ordinances and sole laws nlming 10
v
building construction. and hereby amhortre repmsenutims of this city to enter upon the
almvcmemmus! properly for inspection p mimaes
(We) agme to ave, indemnify and keep harmless me City of Cupertino against
liabilities. judgments, costs and expenses which may in any way seem against said City
in consequence of the gunning of this permit.
APOPL NT UNDERSTANDS AND WILL COMPLY WITH ALL NON -P NT
Issued by: Date C6 1/116
SU CE EGULATIONS.
Re -roofs
Type of Roof
Sig arc of ApplicanUCon Dal,
HAZAR US MATERIALS DISCLOSURE
Will Ne applicant or future building mcupantatom orhandle harardous material
as defined by the Cups:nino Municipal Cade. Chapter 9.11, and the Health and Safety
ado, Section 15531(¢)?
All roofs shall be inspected prior to any roofing material being installed.pre
coo
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building oecupam use equipment or devices which
t hazardous,ir contaminants as defined by one Bay Area Air Quality Management
all new materials for inspection.
District?
C] Yin. tyfNo
I have mad the handers materials rcquirannow under Chapter 6.95 of the Califor.
nia Health & SafetyCode. Sections 75505,15533 and 25534.1 undersand Net if the !wilding
does oat tly have a mnanL Nat it is my responsibility w notify me occupant of the
myvire na mAmraatn �t ortoiaaaanceafac,ddrdateorcdl`-cy��
Signature of Applicant Date
f
All roof coverings to be Class "B" or better
a�Dow
ncror authorized agent
M
i55
CITY OF CUPERTINO
Ci.1leITRACT.ORYNk�()'I2Mt1,TI`ON °'
BUILDING DIVISION PERMIT
DING ADDRESS:
SAARMAN CONSTRUCTION LTD
PERMITN904060081
608 PRUNERID
PERMIT ISSUE DATE
R'S NAME:
SFC ARIOSO INVESTORS L.P.
683 MCALLIS
2
SANITARY NO. CONTROL NO
PHONE:.
(415)749-2700
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
Chadic'
1 hereby Affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 70(111) of Divixion 3 ofdee Ousittsxan0 Prufcssinns my bosmae is
in full force and effect.
REVISION --IN HOUSE USE ONLY
License Class Lic.Ndr
NO NEW PERMIT ISSUED ORIG. #04030161
Contractor
ARCHITECrS DECLARATION
I understand my plans shall he used as public records
LiccnuJ Pmfeuionel
OWNER -BUILDER DECLARATION
I hereby affirm 1 exempt from the License LAW for the
Cole Any city or county
1. firsons Co
i (Scotian 71131.5, Business and
on
uires
-
improve, demolish,
1 which requires a permit m construct, alar, improve, demolish, nr repair any xuucmle
which re a
+ prior m its issuance. also requires the applicant reasuch Permit to file a signed statement
Area
Valuation $0
I that he islicenseJpursuantmthepmvisionsnftheContractor'sLicari. aw(Chepmr9
(commencing with Section 7") of Division 3 nfthe Business and Prafculons Code) or
3 Nm he is exempt therefrom and to basis for Rte shaped exemption. Any violmion of
Eor
mber
OccupancyType
Section 7031.5 by any applicant for a Permit subjects Ne applicant to a civil [actually of
oat more Nan fare handled dollars ($500).
16.0 0
❑ 1, as owner of the property, or my employes with wages as their sole compensation,
Required Inspections
4
will do the work and Ne awclow is nut intended or offered far sale sou. 7144, Business
cmr't Licu Law does not apply to an owner of
and Prors&ioro Code: The Conuaen
prapeny who builds or improves thereon, and who does such work liberator through his
own employes, provided that such improvements are not intended or offered for sale. IL
however, the building or improvement is said within one year of completion, Ne owntr-
builder will have the burden of leaving that he did net build or impm n, for purpose of
.it.).
lye 1, as owner of the property, am exclusively contracting with licensed contractors to
banswct Ne project (Sec. 7044, Business and Professions Cade:) The Contractor's Li-
cense law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects wide a contractor(&) licensed pursuant to the Contmcotes
License Law.
I am exempt under Sec. B&P C for this rcsson
C 9-0 W
ION
WORKER'S C MPENSATION DECLA ION
I hereby affren under penally of perjury one Of following declensions:
❑ 1 have and will maintain a Ccnifiam of Consent to self -insure for Worker'sCompen-
satlen, as provided for by Section 3700 of the labor Code. for Nc perfmmanct of Nc
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
.
3700 of the Labor Code, for the peRormenee of Ne work for which Nis permit is issued.
My Worker's Compensation In... cretin and Policy number are:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This auction need mAlaceenilemd ifthe Permit is feronchundred dollars($10)
ar less.)
I certify Nat in the performance of the work far which this permit is issued, l shall not
employ any Person in any rom merm as to become subject to the Workers Compensation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT. IL after making this Cenificam of Exemption, you should
become subject m the Workers Compensation f rovi&ions of Ne Labor Code, you ..at
Z fonhwdheamPly with such provisions or Nis permiuhAll be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby shine that then stern agency Int Ne Performance of
(Six. Ban,
> the work for which this permit Is issued (Sec. Jo9T, Civ. C.)
aLenders Name
Lenders Address
�
ti1 unify Net 1 have read rt this application and soNut rho above information is
correct. 1 agree to comply with all city and county ordinances and state laws relating to
v
rom Ne
Cits city menteno
amhom<eep
far
J building eenswee
shove-bacntiuncd property mspcelion purposes.
Cupertino
ago
to save, Inde hebleas the against
y (We) agree to save, indemnify and kith harmless the City of
A liabilitis,judgmcno,cos¢and expenses which may in any way eccme against said City
Z in consequence of the granting of this permit.
APPL GANT UNDERSTANDS AND WILL COMPLY WITH ALL NO NT
SOU CE EGULATIONS.h '�JeP
Issued by: Date
`�
`� -
Re -roofs
Type Of Roof
ig arc of ApplicanUConuanoi Data
HAZARDOUS MATERIALS DISCLOSURE
7m:011
Will the applicant or future building Occupant store or handle havafdous material
s derined by the Cupertino Municipal Code, Chapter 9.13, and the Health and Safety
ado, Section 35532(a)?
All roofs shall be inspected prior to any roofing material being installed.
�•�1
❑Yes (YNo
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building recapant au cqulPment or devices which
emit hst.weaus air conthromm o as Jefned by the Bay Arca Air Quality Management
all new materials for inspection.
District'
El yes QLNu
I have mad the havardeas materials requircmenB under Chapter 6.95 ditto Colima.
me Health G SafetyCode, Sections 25505,25533 and 35534.1 undersand that if an building
dos not needy have somata, that h is my responsibility m nodl'y the occupant of Ne
requirt o oh must Iral santssuance'f.Cemnatedracapantr.
Signature ofApplicant Dale
All roof coverings to be Class "B" or better
✓O
dl�ur; orommoredcom Date