05110118BUILDING DIVISION PERMIT
PERMIT
S NAME: PERMIT L'SUE DATE
CITIGROUP 1042 HAMILTON COURT 1 01 /-
nrr:uaxrrx.Tarlxdm
rd F 1 Immby affirm Wt I am licensed mole, movimms of Chapter 9 (rnmmctNing
U with Section 7") of Glen 3 of the Business and Professions Cod,, and my license is,
s In full Tome and cfGe 9
p 3
Q
lot Datd, Con t lif
RCHITECTS DECLA
f L
re U I undcu
tsnd my plain shall he used as public records
t o G Licensed Professional
g OWNER BUILDER DECLARATION
<y I hereby affirm that I am exempt fmm the Contractors License Law for the
CO following reason. (Section 701.5, Business and professor. Code: Any city or county
t wm �! which myuires a permit to eonsuuct, alter, improve, demolish, m repair any structure
dni prior to in issuance. also residues the applicant for such permit o rile a signed statement
Ei0 that he is licensed Noolmuo the pmvishm,of the ConuacmrS License Law (Chmic,9
yt-$ (commencing with Seetion]I)(K)) of Division 3 of the Business and Professions Codc) or
y that he is exempt therefrom and the basis for the slleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of
not more than five huMmd dollars (5500).
❑ I, as owner ofthe propcny, or my employees with wages as their sole compensation,
will do the work. and the swaute is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds orimpraves thereon, and whodoessuch work himself., tiuough his
own employ=, provided th nsuch improvements are not intended oroffered for sale. If,
howem. the building or improvement is sold within one year of completion, the owner,
bolder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the property. am eachuiwly emo acdng with licensed e n iacturs b
construct the project (Sec. 1(144, Business and Profnssiry Code:) The Conuacmrs U.
lne law does not apply tu in owner of property who builds or impr.aes dinners, and
who contracts for such projects with a co mdse or(s) licensed pursuant to the Conuutoes
License Law.
❑ I am exempt under S,c. B k P C for Nis mason
Date
WORKER'S COMPENSATION DECLARATION
1 hereby aRmu under Nulty of perjury one of the following decimations:
1 haw and will maintain a Certificate of Consent Id self -imum for Worker's Compen.
donor, as 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 Workers Compensation Insurance, as required by Section
""Of the labor Code, for the percemsnceof the work fa which this permit is issued.
This section recd not M completed if the permit is for one hundred dollars IS 100)
or Icd.)
1 century Nat in the performance of the work for which this permit is issued. l shall not
employ any person In ally munncr art as bb mute dbjeel to sale worked CounNuadon
SANITARY NO. CONTROL N0.
(650)701 -1500
Job Description
TI-- RECONFIG. OFFICE,
RELOCATE ATM /RECONFIG. ATM VESTIBULE
37506006.00
Required Inspections
NOTICE TO APPLICANT: If, after making this Ccniricate of Exemption, you should
become subject to the Worker's Compctumlon provisions of the labor Code, you mot
.J z foMwith comply with such prnvisirns or this permit shall be doomed awked.
Z y CONSTRUCTION LENDING AGENCY
[—� I hereby aRrm that there ism compuctinn lendingagcncy for the performance of
the work for which this permit is usucd (Soo. 3091, Co, C.)
fgd 0 Under's Name
= z U:nder's Address
J Q I certify that I have road this application and stmt that the above mrs matiun u
y corms' 1 agree d comply with all city and county ordinances and slid, laws relating o
=U building construction, and hereby aulboriae mprescmadws of Nis city to enter upon the
C[1 above- mentioned properly for inspection purposes.
r py (We) agree to save, indemnify and keep harmless the City of Cupertino agents,
t•A liebilides, judgments. casts and c., .< which may in any way acc= against said City
J z, in consequence of the greeting of this permit.
w` APPLICANT UNDERSTANDS AND WLL6COMPLY WITH ALL NON -POINT Issued by:
APPLICANT
RT UNDERSTANDS w 1
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building decupant stem or handle hmardous do d,rial
as defined by the Cottonton Municipal Code. Chapter 9.11. and the Health and Safety
P!"anrduua Sc 15572(x)?
❑yes Yea Will the applicant or future building =upant use equipment or devices which
air e.ntaminunu u defined by the Bay Am Air Quality Management
District'
❑Yea
nix Health& Safcoy Code Scctimu25505.255)3 am1255M.1 WIICISIand thazifthc building
does not currently hose a tenant tl�ui0is\my mspmtsihil,y o ondry the occupant of the:
Re-roofs
Type of Roof
occupancy
C4A
Date f J J '-0 e(
I��
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better