08040011CITY OF CUPERTINO
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BUILDING DIVISION PERNIITCONTRr1CTQRII�FFQRMA.'TNµ
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L,1'nnpV'kEVENS CREEK BLVD
TBD - TO BE DETERMINED
PERMITNO.
08040011
:R'S NAME:
PERMIT ISSUE DAIS
CONOCO PHILLIPS
07/14/2008
NE:
SANITARY NO. CONTROL NO.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG EIFCT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
Job
1 hereby allowsntat 1 am thousand! undo provisions of Chapter 9 (commencing
with Section 7aflB)oDivision 3ofwaBudnevand P�ro��fr�ssyionsCode.mdmylic..is
ENHANCED VAPOR RECOVERY SYSTEM INSTALLED AT
.fliuc.♦ �T1r)Q� �'S
to rull�IARCLH7Z
EXISTING FUEL STATION. CONOCO PHILLIPS. FIRE
DamCI'SDConDECu)unbN
—,;5
PERMIT 08 1591 SENT TO CONOCO PHILLIPS, 76
used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 Wreby .ffirm that 1 am eumpt from tie Canwnors License Law for thn
i Manuring won. (Section 7031.5. Bud. and Profoo io. Cale: My city or county
which on,mms a permit to construct, alter. Wpmw, dcmnitsh, or .,air any smetu.
prior to its issuance. sou.quires the applicant for such pemtit to ran. stand] amement
r ConOxmrsLicense Law 9
Sq. Ft. Floor Area$17000
Valuation
thud hulicensed purmumtothe provisions ofthe (Chapter
e Division Sof Business Professions Cade)
(commencing with Section 7000)of the and or
Nat he is eumpt therefrom and the basis for the alleged ca.mption. Any violation of
3 6 9 0 6 0 0 7 AkN�IBher
Occupancy Type
Section 7011.5 by airy appliant for. permit subjects the applicant an. evil penalty of
not mom than raw hund.d dalla. (Ma
❑ 1, as owner of die property, a my eroplayeon with wagon as their mu compensation,
Required Inspections
will do the were. and thtswcm. is not amended a afhred for We (sec. 70th. Business
and Pro&asions Cale: The Contractors Lime Law does mot apply to an owner of
property who Wildscrimproves dement. and whodoessuch wok himvlfa tlwugh his
own employers, presided But such impmw ants me not ineMed ao0ered forsale. If,
however. the Wilding an improvement u sold within ate year of campletion. the owner,
W ildm will luw the Writer of proving WI he did not build a impmw for purpose of
ale.).
Q 1. as owner or the propert, w muc usinly ca.=a., with EcensN mnuacmrs an
construct me project (Sec. 7044, Business and Pmfmssioes Cade:) The Comommes Lt.
cense Law damsoat apply Man ower of property who Wilds or improv thereon, and,
who contracts for such projcm want a contncm(s) limnad presvant to the Comractors
Lt. Law.
esempt under Sec , B & P C for this mason
or Dat
'
WORKER'S COMPENSAnON DECLARATION
1 hereby a1Bm under penalty of perjury one of Ik following decler.tions:
I haw all] wall maintains Certi6mste of Consent half-insum for Woremrs C'mnpeh
=am, u provided for by Satire 3700.f the labor Code. for me perfomame of site
'
work for which this permit u bound.
1 base and will maintain Wak s Computation Insamce, as acquired by Section
3700of Ne LaWrCede, for the Wr(owanec of the work forwhlch this permit is issued.
'
My Waitecrfs Compensation uaannce canna and Policy number are:
C.r1O921t 71�O�
CaMm / u lc:.h PolyNo.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section mcd not W completed if the permit H for ane hundred dollar ($100)
ar less)
I emirs that in the performance of the work for which this Permit is issued. I shall not
employ any pmmm in my maturer an an or become subject to the Worken'Compensmlon
Laws or Caltfomia Dam
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you should
baane subjat to the Worece. Compensation provisions of the labor Code, you must
'
' foMwith comply with such provisions or this permit shall W d¢med.vaked.
j
j CONSTRUCTION LENDING AGENCY
1 hereby cut dee tea co nn lending agenry loathe perfomaa. of
which (ane.
' the work (a which Thu permit u toted (sec. 3119'!, Civ. C.)
Lenders Name
lmndersAddw
j I certify that I haw rond this application and auto and the mon information is
town. l agree to comply with all city and county ordinances and state laws relating to
Wilding construction. anal hereby mthotia.prescntatiwts or this city tocorer upon the
a Ww-mentioned property for inspection pugwea
(Wer) agree to aw, indemnify and keep hamuss IW City of Cupertino against
j liabilitiajudgmcots.eore andapences which may in any may a aeue agunst wend City
in consequence of the granting of this permit.
C7-
i APPLICANT UNDERSTANDS AND WILL COMPLY WITH A NON OINT
Issued by: Date l /'
SOURCE REGULATIONS. p f
Re -roofs �—
Type Of Roof
PYt.t.c 11.,. 4 , llklft„,A 'i 4 4 /CTs
Sigatum ofApplidardoc uamor Dim
HAZARDOUS MATERIALS DISCLOSURE
Will theapplicmt m fuum Wilding oaupmt rtore arbandla haardons matoriL
Boned by the Cu Orman Municipal Cade. Chum. 9.13, and IM Health and Safety
.S..6.25532(.)? ,�
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection, I
Wall me applicmtorforum Wining us, equipment
agree to remove
P g
by ft Air QuilJmanawhich
hvardons air canuminsnts u defined by thm Bay Area Air Quality management
all new materials for inspection.
mi
Cl yes fa Nb
I haw read de har:tdaas materials requirements, under Chapter 6.95.1' the Califar-
niaHcalN& SdelyCode, Sdcannas NI3, 35533 and 75534.1 understand and. ifthe Wilding
does rut camomly haw, a tenma that It is my rapomibuity to notify dr r the
regviamcnts whkh mttst e�met prrorm amen an c%ted'
Signature of Applicant Date
Iy
9 t tJ
All roof coverings to be Class';T' or better
Owner ammorindaccm Da