04010146 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRAOTQR INFORMATION 5
BUILDING ADDRESS: NAVICA INC PERMIT N004010146
10952 STEVENS CANYON RD
OWNER'S NAME: PERMfr ISSUE DATE
johkNAVICA INC 10952 STEVENS CANYON RD 06/18/2004
14 E: SANITARY NO. CONTROL NO.
ARCHITECIENGINEER: BUILDING PERMIT INFO
BLDGELECT' PLUMB MECH
0
La Zp LICENSED COMRACIOR'S DECLARATION
U
FF 1 hereby affirm Net I am licensed under provisions of Chapter 9(commencing Job Description
Z�Tj with Scmlan)glll)of Diviuon3of the Businusand Prufeai...CoM,and try he,..is
'^<a irffllforccmc fect. SFDWL-2 STORY (3820 .SQ. FT V N
'a- Liro °e ``'"
Dam Contractor
GARAGE 647 SQ FT
s;•
ARCHrrF..C1I S DECLARATION
I understand my plans shall be used in public nxmr
DyV
u.t; LI1C115ed PmICS{IOnal
D OWNER BUILDER DECLARATION APR o� MS
<F 1 hunch,affirm that I am exempt from Ne Conwmofs License Law for The
00 following mason.(Section 7031.5,Business and Profession Code:Any city or county
x m which".I..permit m cnwuu,alter,improve,demolish.m repair any ou new. P
poor to its ismance.alsomquimsshc applicant forsuch permiuofilcasigned comment "a IRA
< that W is licensed pursuant la the pmvisionof tW Contractor's License Low(Chapter 9 Sq.Ft. Floor Area �/ps!�u
E~3 (commencing with tio
Secn70Xq of Division 3 of the Business and Profusion Code)ar ssra v
Nat he is exempt thaefwm and IW basis for IW alleged exemp kin.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally Of APN Number Occupancy Type
not mom than fnhunarcddollars/5500). 35601044 . 00 p y YP
❑1,as owner Of the property,or my employcu with wages m their sole campenation,
will do the work and Ne s,wetu¢is not intended to oIeand fanale(Sec.7000,Business
and Profitable.Code,The Caroni Larissa law does,not apply to an owner of Required Inspections
proptay who builds or i mprovu thereon,and who does such wmk himseif or lhmugh his
Own employers,provided that such improvements arc not intended marketed forsah.If,
however,the building or improvement is sold within one year of completion.the owmr-
Wilder will have the torden of proving that M did nm Wild or improve fm purpnm of
.to)
.u owner of Ilse propenY•
nice"
contracting with licensed co ormays a
wn IW projett(Sec.7050.Business and Profession Cade:)The Conuxtari Li-
came law docs not apply in an Owner of property who Wilds at improves demon.and,
who mmmus for such projeeu with a conrnCtor(s)licensed pursuant IO the Contractor's
License Law. //P7
❑ I cert exempt under Se B&P C fm Nn azen
Owner�� Date J127/�,.[/(�j
WORK CATIDN4/ '% 7 G /Z
1 hereby affirm under Puri of petjury On of the following declaration:
I hate and will maintain a Cenificzte of Consenuo self-inseam for Worker's Compcn-
an ion,a provided for by Section 37W of the labor Code,for the petformanec of the '
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,u required by Section
3700 of th4 LaWr Coda,for the performance of the wart for which this Pamir is issued. '
My Worker's Compensation Insurance carrier and Policy number ase:
Carver: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rhes auction need not W completed if IW Permit is(crane hundmddollars(SIM)
or lass.)
1 cenify tot in Be performance of Be work for which this permit u issued,I shall not
employ any pawn in any manner to an to became subject to the Workeri Companauan "
Laws of California Dole
Applicant
NOTICE TO APPLICANT:If,after making this CcniOcate Of Eaempion,you should
became subject to the,Watkins Compensation provisions of IW Labor COO,you mum
Oz forthwith comply with such provision or Nis permit shall W deemed revoked.
Z 0` CONSTRUCTION LENDING AGENCY
.�. Ihercb aRrm that Nem is a construction lending a
F Y g tune,for the perfurmmtt of
E
work w
for which this pewit is issued(Sec.J09'!.Civ.C.)
Le /
Dd 0 Lcnds Namc V
D' I<ndeeer's Address
U 0 I certify Bar 1 have mad this application and sum that the show information is
CL F coma I agree in comply with all city and county ondinames and sou laws aiming t0
0 U Wilding construction,and hereby ambame mprolenutiws of this city to cnur upon the
ahovc es,judneg property for impaction eexpenses
purposes
F 4.
(We).9.to vs,,indemnify and keep harmless the City of Curcio...Habilsaint
In incoiduunce of thecostsand ng Of this csmit. may in any way secnm against aid City
V z APPLI ANT-of NC gSTANDfthis Permit. Issued by( Dat
^ APPLICANT $TANGS AN WILL COMPLY WITH ALL NON-POINT
M.SO EREGULA NS.
mAl_(,4 y�L Re-roofs
Stgnuum of Appy mi
HAZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will the applicant or future building acupant marc or handle Imu lous material
az,a,Z'by IW Cupertino Municipal Code.CAapter 9.12,and the HcaIN ad Safety
ode,ScOCdon 25512(x)? All roofs shall be inspected prior to any roofing material being installed.
o
Will the applicant or Put building occupant tic equipment or devices which If a roof is installed without first obtaining an inspection,1 agree to remove
It hazardous air contaminants as defined by Ne Bay Arca Air Quality Management all new materials for inspection.
Distritt? ,,g
❑Yes &a
I hove mad the hoema ms materials requircmcnu underChapter 6.95 afthc Califor,
nia Hnhh&Safety Code.Section 25505.25533 and 255]4.1 understand thm if dr Wilding
doexnose haat a in, L than a my reaponihiln,to nodl'y We acupant of the
re incmcnuwait, as(W c Ia4mmccof.ComficauofOccu cy. Signature of Applicant Date
L
Owner m.mho sent Doxf All roof coverings to be Class"B"or better