08030147 CTTY OF CUPERTINO Y�ta,g� •a *Y!'kr� .s. •.z; 7-T��}�k� ' �Y
BUILDING DIVISION PER-MIT
PERMR NO.
emLD 6'ffi4ESkEVENS CREEK BLVD TBD — TO BE DETERMINED 08030147
R'S NAME: PERMIT WTIE DATE
STEVENS CREEK LLC 03/25/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHIIECi'/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
30o LICENSEDCONDIACORSDECLARATION lob Description
rd 1 beroby afnne that I un Iiaomm under provisions of CIQPta 9(emnmeneing
z1 wins Smile.70M)of Division l of the Bustneu and Prokaions Codc,and my lkcmis COMM'L TI TEMP PERMIT GOOD THRU 4/25/2008
In full If...am f -
Licen¢ cr3 U N
Dam Can r
ARCeall wmS DECLV ION
luodcnum my plans MallWuadupublic mso
a
k G Licensed Professional
OWNER-BUILDER DECLARATION
E 1 hereby afr m Nu I am mtmpt from the Conlrsmors Licca¢Law far Be
COO following mason.(Section 70 i.S.Business and Pmfesdons Code:Any city or county
$ftii which requirm a permit to consumes.alar,hnprove,mmolub,or mpak any sinecure
min he isl iauanee-aleentto me provision
of fm aehpennitroies Law(uumot
'�FFEo (commecccn¢dpur¢ae70MofvialomafNheBusimrsticcmebonsCodtm9 Sq.Ft.Floor Area Valuation
5S
(commencing cro pa Scoriae70Mof basisonlnf al Business radon.AnynnaCmt)or 10500
3 nsu io .7 asempt d¢mtrom and de EPer fm de alleged e¢mer,to.civil
l ponaln of
net.
Section.7031.5 five
ary, reddantforapemlt subjects de applicantmacivil pemlty of .ep�I1ar ,�n�
net roam that five Eumad mlbn(s500). 20289 ST>rvelv'�°•t:'rcaEK BLVD Occupancy Type
0 I,u owner of the gvpmy,m cost wPlaycu wins wgm u thek¢le campemdm,
will do the wart.and the swnum isnotintended oranend(Muds,(See.7044,Business RC uired Inspections
and Profession,Coe:The Conuatara Lt.Law dom nut apply se an owner of q P
property wbo Wilmorimprnm narrow.andwhodoesaah wmkhiwuelforuMugh his
ownnmPlaym provideddasohimpr =uasemtinramm moRenlfinale If.
however.Ma Wilding or improvement is sold within am year of emnpkdan.IW awner-
builder win have the burden of proving Na W did net bold or Improve for purpose of
ak.).
0 1.u owner of the Property,am ealuiwly manurial with licensed comwe.be
construct the pro)mt(Sea 7044.Business and Prorrmdom ems:)The Cmuators U. .
«ma Law does not apply to an oma of property who wilds or hnmoves durance.am.
who romans for such projeeu MM a couacnaeu)licensed pummnt as the Conuanara
Licence Law.
0 lameacmpimuse Se, ,B&PCAorthbmann
40- Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury oro of Me following declaaimtr
0 1 have and will Maintain a Cardfimmaf Consent an self-Imum for WartersCompen-
sa)on,as providod for by Section 3700 of do labor Code,for Me ptrfomann of that
work for which ibis punk is ism 1.
0 1 have anal will maintain Workers Compemsdon Insurance,as required by Section
3700 of the Lswr Cam.far the performance ofnse smile forwhich Nis permit is issued. '
My WMIme.Oompewtian Ino.ca�nyine and Policy Mn Mrr.:p,./�-�-•�
Carom/L'� EM Polley No.:_a OMERS'
7 CFRTIFl COMPENSATION
WORK• S' /e-67
COMPENSATIONINSURANCE TP�Y
rlhbacdmmodnotbccomplemd BlW M mittsfmmcbmdeddwltaa($IMI
or los.)
1 calify that In Me performsnce of the rah fm which this permit b issued.I"I an,
..play any person in any manner an as to become subject m the Workers'Compena0m
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If,after making this Cenifinm of E¢mpmn,you should
bmome subjem as the Wor e s Compamadon P.W.of duo Lothar Cam,you mon
.J O forthwith comply with such ProHsiam Or nsb Perml Mall Womed revolved.
'�
^ CONSTRUCTION LENDING AGENCY
I-+ Ihereby aRinn oar dem is constructive lending agency for da perfarmmco of
a Me work for which this permit Is W and(Sec.3097,Civ.C.)
W� Lenders Name
7 Z Lenmrs Addrw
U O 1 earl fy that 1 have rad this sppliadon and sum dust the salve michoado b
IL^. corrin I agrm in comply with W city and county andinauss am sum law relating to
O rV^ Wilding cosuumion.and henby¢darin representatives ofthis city to murupm de
LT7 above-mentioned Property far imPemlaa Purpmes
a (We)agree to save,indemnify ad keep harmuss Me City of Cupertino against
y lisbilides,Jodgmenu.com and cape•au which may in my way accoe agalmt said City
UZ in consequence of the granting of this pamiL 2 f
�.r APPLICANT UNDERSTANDS A WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURQP,JIiiin TIO
Signature ofApprmnvc em am Re-roofs '
ARDO ATERIALSDISCLOSURE Type of Roof
Will Ne appli rot or Iota Iding acupantaanaNndleh done mamrial
Fund by Be Cupertino Munaipal Com.Chapur 9.13.¢d the Health¢d Safety
k.Section 15733(.)7 All roofs shall be inspected prior to any roofing material being installed.
[:]Y.
Will de&Mina i or Abort building occupant ata cqulpmot or mviw which If a roof is installed without first obtaining an inspection,I agree to remove
Whit hawdnm air conuminou u mfimd by de Bay Area Air Quality Managemeal all new materials for inspection.
Disuicr7
0Ym 94 .
I have mm the hander mandate requimmeu un&,CMpmr6.95 o11heCalifon.
nia Heal&SafetyCode.Sectors;35505.75533 am125534.1 undcnurm nsaiAde building
does an,currently have a went.dun B u my responsibility m ratify de oxam.of de
mquimmcnu which mm,W prior iab ofa cc'lia:morpcc,9.mj Signature of Applicant Date
Ower orwmarind,gem ' ZDae l All roof coverings to be Class'W'or better