04090239 •CITY OF CUPERTINO , , 1 - a a '• A.T ."2-1
;�''&^ �-
BUILDING DIVISION PERMIT' CQ ()R . FOol,
BUILDING ADDRESS:' - HOWARD WRIGHT CONSTRUCTION PEBCSI.NO. 4O9O239 -
OWNER'S NAME: _ _ FERMITISSUEDATE -
SYMANTEC PIER 9 , THE EMPARCAD�RO /28/2004
Eo A GARY 0. CONTROL NO.
(206) 447-7672
ARCH1=/ENGINEER
06 447-
ARCHITECT/ENGINEER: - - BUILDING PERMIT INFO
RLDO ELECT PLUMB MECH
u o O LICENSED CONTRACTORS DECLARATION Job DBS
rd 1 hereby affirm shat 1 am licertsed under previsions of Chapter 9(commencing. - ,
with Section]B)(1)nfDmaion 3 ofthe Business and Professions Code,and my license is
mmuforce and efrect. Z ( ' TI=-OFFICE`SPACE�RECONFI
- Z Licenm Clas Lic.g
ED
nF4 (munttor h' -
7 ARCHIIECI'SDECLAR IGN. , -- -'JAN--
1 undersand m lana shall M used as ublic acords
ixh rp p 1005
3 wO Licensed Professional ■
OWNER-BUILDER DECLARATION 'L
0 I hereby affirm on 1 em exempt from the Contractor's :Any c Law for the - ' -
i❑O which
mason.(section 7113).5,Business and improve,
de its is Code:Any city or county
which its ism a permit re construct,plop improve,demoluR ore a sig any structure
Z'an
prior to itscensed e,almmquithe movisio antsof for such the Connector's
Rlcasigaed w(Cha mem
Z<
that hcincing with Sectiopursuant n
lhcpmviviormn of the
Law(Chapter Sq.Ft. Floor Area _ _Valva ton
�1-$ (commencing with Sectlon]Oo0)nf DivisionJof the Busincsa end Professions Coda)or
5 that he a exempt therefrom and the basis for the alleged exemption.Any violation or
Section 7031.5 by airy applicant for a permit subjects the applicant o a civil penalty of 3 8'�8i]Piifd'IberO 0 Occupancy Type
not mon than five hundred dollars(5500).
❑1,u owner of the property,or my employees with wages as their sale compensation, -
will do the work.and the structureis real intended or offered torsale(Sec.700,Business
and Professions Code:The Contractor's License Law does not apply to an owner of - .-- _'Required Inspections
property who buildscrimproves thereon,and whodommch work himselfm through his
awn employees,provided that such Improvements are not intended oroRered Intends.It,
however,me building or improvement is sold within one year of completion,the owner. - - - - - - - -
builder will have the burden of proving that he did not build or improve far purpose of
ail.).
❑1.as owner,of the property,am exclusively contracting with licensed contnctom to
construct the project(Sec.]Odd,Business and Professions Cade:)The Contractor's Li. -
censeLawdossnotapplytoanownero(property who builds or improves thereon,and, - -- � -
who contracts for such projects wife acommoners)licensed pursuant to the Convector's
License Law.
❑I am exempt end.SSa�c. B&P C forthis..an
Owner 1� Data
WORK 'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury can of the following declarations:
I hawmd will meinuina Certificate of Conunuo self-insure far Worker's Compere "'-" -'
sation,as provided for by Section 3700 of the Labor Code,far the performance of the -
work for which this permit is issued. -
❑1 have and will maintain Worker's Compensation Insurance,m requited by Section
3700 often labor Code.for the performance of he work for which this permit is imued. -
My Worker's Cnmpensadon Insmance artier and Policy n`u`m•''ber aymo: unr�an -
Carrier.�p u.�( P Htl,No.: W V^O yjQL✓2"1
CERTIFICATEOFEX ON FROM WORKERS'
COMPENS IONINSURANCE
(This section need not he completed it the permit is for one hundred dollars 1$100)
nr Ices.)
1 certify that in the performance of the work for which this permit is issued.I shall not
employ any Person in any manner an as to become subject o the Workers'Compensation -. -
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,ager making this previsions
of fee
Labor io dyou should
becomes comp y it Worker's Compensation provisions of me Toed Code,you must
�z forthwith comply with such provisions or this permit shell M deemed mvnked.
7O CONSTRUCTION LENDING AGENCY
[-i l hereby affirm that Nen is a construction lending agency lot the performance or
a > the work for which this permit is issued(Sec.3097,Civ.C.)
V40 Lender's Name
Le
Z nder's Address
U Q I certify mat I have read this application and sate mat tW above information it
Uw H cored 1 agree to comply with UI city and county on inances and sale laws miming m
O C) building construction and hereby amhame rcpmsentedws or this city la enmrupon the
Uabove-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep brtmleas the City of Cupertino against
rF"y y liabilities,judgments,costs and expenses which may in any way accrue against mid City
C) in his PCMIL
APPLICANTucDS
eUNDERSTANof the Starting Of tAND WILL COMPLY WITH ALL NON-POINT 'Issued by; Date
SOURCE REGULATIONS. _ -
Re-roofs
Signamrcof ApplicaDem
HAZARDOUS
US MATERIALS DISCLOSURE Type of Roof
Will the applicant or Tuan building occupant store or handle Health
sdSafety material
u de0Sed Section
the Cupertino Municipal Code.Chapter 9.12.and me Hcalm and Safely
Code.semen 2353xa)? �� - ._ All roofs shall be inspected prior to any roofing material being installed.
Yes
� � -' ...
Will m applicant or mmrc building attapant a equipment o devices whish `-If a roof is installed without first obtaining an inspection,I agree to remove
it ha ardous air conaminantsn�cd by the Bay Area Air Quality mmagcmem all new materials for inspection.
Diatnn?
Yes
I have mad the theardousmaterials requirements under Chapmr6.95 of the Califon
nia Health&Safety Code,Sections25505,25533 and 25534,1 undersand malifine Wilding '
does nut currently haw a terns that it Is my responsibility m notify the aempam of the _
requircm mchySL metpnormissaanrearaeeni0uaarOce ancy. Signature of Applicant Date
--
Ownr � All roof coverings to be Class or better.
oe aumodzcd sgcnl- Dam -