05110143 CITY OF CUPERTINO �'�r^ xe I a sem»;
BUILDING DIVISION PERMIT CONTRACTOR+INFORMATON „
BUILDING ADDRESS: PACIFIC COMMUNICATIONS PERMIT No05110143
R'S NAME: PERMIT ISSUE DATE
GROSVENOR INTERNATIONAL LT 285 SOBRANTE WAY T F 01/12/2006
PHONE: SANITARY NO. CONTROL NO.
(408) 830-9550
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
X00 LICENSEDCONTRd under
DECLARATION
tuF 1 hereby•Arron that I am fdi,Bu under and
Pof provision of Chapter 9(mmmense is Job Description
Z tTj with ScorceanaffecDivision3oftW Busifv..aM Professium Cod,eMmyliccmc is
in full 11417-1 INSTALL 201 TALL GUYED TOWER W/21
^ z Liccnsc CIdss Lia A
Dam �iLfcommaor AZ DIA. ANTENNA & CABLING FOR WIRELESS COMMUNICATI
ARCHITECTS DECLA A ION/i q�sB
# V Iundcrsanamy plans shall Whand as public A ION w���ONif� S Il{lTp'1lll7t���3 (rp'7//(/���q I[�,�
itua G Lkcnxd Professional lW( vl f;"-'
3 OWNER-BUILDER DECLARATION RNALED
a�
0 0 1 Wrcny.(firm that 11. exempt from tW Contractor's License Anyc law for tW t1
20 followwhich
minion.permit
t ?cont. t.Business ma Proimprove.
le oli Cale:Any city or county Flrl f 2006
K m which requires a permit also re enmweL applicant
improve,demolish,ri repair any structure a: C
tpoor hat he its cense purstrmquime the applicant for mchparmiuoiensele a signed emcee
E C (commencingudpurssioo or the 70)fofDiviomoftWContsiness ndProclawlCode)or Sq. Ft. Floor Area VaIU id16000
y�$ that M sc
(commencing with Session and do Division 3 of the aged cram d Professions Cede)of - R 0
yes
that io u exempt any
and the beers for the alleged exemption.Any l Fa uon of 1�•i It FI P I It . .t tI d/
Section.1.. them by airy applicant for apermit subjects ft applicantmadevil pevhy of APN Number a�GuLS y
rot mare thm r nnnarca aatlam(ssoB). Occupancy Type
31606046 . 00
El LotOwner of.die property, re is employees with wagens r then sale compensation,
will Pr fework,and e: he Cim is not intended Law ed dos not apply t oan Business
and Professions Cade:The Come on,and
Law aces not apply to ri owner of Required Inspections
OwnproNny who builds or improve demon,and who sm,sumch work himselrorthroude his
Own employers,provided that each improvements are an year
fc orofferadmplcdon.for sale.r-
however.she building or improvement ishut within can you of meow:for
the ase of
builder will haus dm burden of proving than he did rot Wild or improve for purya¢of
rats.3.
❑1,as owner of Ne property,am exclusively contacting with licensed mntretots b
Construct din project(Sec.3044,Business and Professions Code:)The Contraction's U.
cense law doss not apply in an owner or propeny.who Wilds or improves thereon,and
who contracts for such projects with a contremKs)licensed pursmntto the Contactors
License law.
I am exempt under Sea .B&P C for this mason
Data
WORKERS COMPENSATION DECLARATION
1 hereby of irre under penalty of posj ery one of the following declanuom:
l have and will maintain a Ceniricate or consent to self-insure for Worker'sCompcn-
raion,as provided for by Section 3700 of dm labor Code,for the performance of the
wont for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as impaired by Section
3100 of the labor Code,for she perfomuntt of the worse for which this permit is issued.
Workmen Compe seuo�glu�avygntama ani and Policy numberare:
amyer*A; •�+ie�kW RcyNo,:20010593 SI
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section road not W completed if the permit is for one hundred dollars($10d)
m ksa)
I anify dont in Ne performance of the work for which this permit u issued,I shall not
employ any person in any member so az to Wcomc subject in the Workers Cumpemation
Laws of California.Data
APplicam
NOTICE TO APPLICANT.If.after making this Cenificam of Exemption.you should
Wanton subjmt to the Worker's Compensation provisions of the tabor Chile,you mass
.,O fornwith comply with such Provisions or this permit shall W doomed revoked.
'z CONSTRUCTION LENDING AGENCY
[—� I hemby athrm that them is a cotutmctioo lending agency for the Performance of
C the wish for which this permit is issued(Sec.3097,Civ.C.)
0. Lenders Name
=z Lender's Add.
U Q 1 certify that 1 have mad this application and sate the the shout information is
D.F correct 1 agree m comply with all city and county ordinances and sat laws relating to
0 U building eunsuucuon,and hereby euthorire mpraenmiva of this city m enter upon she
above-mentioned Property for impaction which a.
H C (We)agree tip save,indemnify,and keep harmless the City of Caparison agaimt
I;') hateflincoiues,jnce of theeostsang apenscawhich may in my way accrue against said City
U z mconse ANT of UNDERSTANDS
of this permit.
APPLICANT UNDERSTANDS AND WIL��''iOQQMPLY WITH ALL NON-POINT Issued by: 60 Date �/ 2-
I
^(/
SIjM�E ULATION£r. _ I r�66 Re-roofs �—
sagausentre of App.... OCmracmrl� —`/ �—
HAZARDOUSMATEBIAISDISCLOSURE Data Type of Roof
Will the applicant or future Wilding occupant store on handle haya does material
as defiaad by dtc Cupertino Municipal Cod,Chapter 9,11,and the Health snd Safety
^.,Section 35532(a)?
❑Yon )(No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building amupaut um equipment on devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha srdom air contaminants in defined by the Bay Area Air Quality Management
District? all new materials for inspection.
❑Yon Nu
I have mad the hmus madt amfials reyvimfbents under Chapter 6.95uf the Califor.
.is Health&Safety Cod,Sauom 255()5.35533 and 25534.1undcrsand thatifthc Wilding
dues cartons awamnant that it is my red 'itynno".themcupantufthc
R nLf mY51 W or Rath 0f Q aM.
Signature of Applicant Date
Ondlir authorixd agent Date All roof coverings to be Class "B"or better