08030049 CITY OF CUPERTINO .a >',««'�cr.«a't,.a4.�'.i ^r" `e `+? �'
BUILDING DIVISION PE CUNTRACTEZR�YNEOILMATIO, , •`
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"u`u111!1Es9xIDGEVIEW CT RC08 BSIDE SOUTH BAY CONSTRUCTION CO P�08030049
NER'S NAME: title FERIM ISSUE DATE
APPLE 170 KNOWLES DR 03/13/2008
ONE SANITARY NO. CONTROL NO.
ARCHRER/ENGINEER: BUILDING PERMIT INFO
REVISION-HANDICAP PARKING BLDG ELECT PLUMB MECH
o o LICENSED CONTRACTOR'S DECLARATION
r� 1 henry atm to 1 sm II¢mcd under provisiesas of Chapter 9(an cannot ng "^^^n n n^n -... -.-.... -.-.^.lob-Description
Z with Sccdon70110)of Division7ofdtc Busiacuand NofassiomCotl,a.dmyliconcei,
^p N in full fortnd e aeRnt g 'j
�'�3 Lieenso 1 Lle.R
E Deu Contramar
ARC be,T5 OECIARATION
1 uunderstand my plans shallall M uaetl as public rsord,
{u� Licemed Pmfauiooal
OWNER-BUILDER DECLARATION
Si I hcmby aRnn tat 1 am exempt from dee Contractor's License Law for da:
❑O following mason.(Section 7071.5,Eastman and Profusions Calc:Any city at county
3$ea which acqumn•permit in canawcL alter.improve,chromium.or club soy ummum
Zi prior u its iuwnee.slot acquires the,pplinnt for such permit to Bk,a signed nutemenl
F� than W is licensed pmaent u to pmvialomaf dee Contecur's Ucmom Law(Chapter 9Sq.Ft.Floor Area Valuation
C8 (commencingwith Seetlan7000)of Divbion7of Ne Buinessand Profouiom CatIor
3 Nat he h eumpt IMmfmm u
and the basis far the alleged empdan.Any,violation of
Section 7071.5 by try applicant for a permit subjects Ne applicant m a civil penalty of APN Number Occupancy Type
out come dun five hundred dolWa(ML
0 1,as owner of site property,or my employes wide wartime u Lack sole eompeuaton,
will dot owalk.and the mamme b nest Intended car offered far sands,set.70,14.Basimaa Required Inspections
and RafesJOu Cads,The Contractors Lkvm ue law dnal apply u an owner of q P
property Wbuild,aw tM
icoproeon,andwW dnesnuch arae,himself.mou{h his
awnemploymed, vided dant such improveroenu art mu launched steamed(mule 11.
Wwew.Ne building as,improvement Is sold Whin art year of compledm,to awur-
builder will 1uve the burd^n of proving out W did not build or improve far purpose of
ssleJ.
0 1.a,owner of dee property am inclusively contracting will,Recosed ctntacun t
comment the project(sec.7W.Business and Professions Code)The Cootaeer',U•
ave Law date sot apply w an owner of property who builds or Improve deeman.and
who contracts for such projects wit a eontncur(n)Iicensod purotum no the Contactors
Lieenm law.
0 l aco exempt under Sc .B l P C far Nu,.••^o
rte Dec
WORKERS COMPENSATION DECLARATION
1 hereby Affirm antler pemlty of perpty,arc of dee following declar.tam:
0 I have am will malnu t a CeNMmaf Cavern in selGinsum far water.Catalan.
sults,u provided for by Section 7700 of the Labor Code,for dee performance of Ne
wart for which Nis permit is issued.
0 1 have and will maintain Workers Compensation Insurance,u acquired by Becton
77W of to labor Cale,for the performse ce of dee work fawhich Nu permit is luted. '
My Worker',Comps uta Luau¢carries atW Policy number ere:
Carrkr.�TION FROM
t7LKFRS'11 't 3
ER77 COMP FSATION1I NFltAN WORKERS'
COMPENSATION INSURANCE
(Thassemion need rot Ix canplated If the .it t(mane handed 011.(5100)
or less)
1 noir,Nal in the performanu of the wart for which Ni,permit In issued,l shell not
employ any person in any mannerm u e became subject to the Workers'Compenat at
law,of California.Dam
Applicant
NOTICE TO APPLICANT.It,afar making Nu Ceniliou of Exemption,you should
become subjm m us,Workers Cincinnatian provision,of the labs Cat,yes mut
.J 0 farthwit comply wit nKh pmvisiov a deer peanil"I be dumc l mated
CONSTRUCTION LENDING AGENCY
y
[-• 1knothy,Rrrm than dem is.comtumint lending agency for site perlamame of
Q't> Ne ware,for which Ni,permit t issued(Sec.7097,CN.C.) . .
W�Q Lcntlers Name ,
5 z Leaders Address
U Q I certify,tan I have read td,application sod suer thin the above information t
I7. correct 1 agree m comply wit all city and county ordinance,and sate laws misting in
Q building construction.and hereby aumorim repmsonutw of to city in cora upon ere
W marl-mcnuaned property for Inspeadon pubposos
(Ws,)agree in save,indemtdfy and keep homeless dee City of Cupertino against
ay fn li.blllikajudgment6custsodeapaw which maymanyw,y,amus,against City ^
in conxq granting of Nu permit
w� APPLIC U ERSTANDS ANO OMPLY W17H ALL NOPOINf Issued by: Date r
SOUR ECU Odes. S r3
/OfRe-roofs _
Si{nuurt of AppUwntContacmr Dat
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will to applicant or futum building occupant naso or handle hauNou material
u tle0vd by tM Cupestna Municipal Code.Chapter 9.13,and site Halt and Safety
Sector,Must 255324)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya No
Will me"]i., bar Wilding occu som use equipment m dcvlces which If a roof is installed without first obtaining an inspection,.l agree to remove
amit huaNas,or cono mime u de0netl by dee Bay AmaAir Quality Mamgemem all new materials for inspection.
Diotict7
°ye,
IhavetcadlhehuSwanmsu05. 5533 ad
n Chapter Sof to,Califon
nice Hcal1 m"ity ave Swansea anJ 755shly in Marts cesue Wilding
Jaen rest ntl ave,IaanL that it my miMlily m mtfy Ne mupanl of Ne
trim nuwh' muukmet dor anof.Camnaateoraa / Signature of Applicant Date
All roof coverings to be Class'%W'or better
Owvraw oriudagmL Dau'