05080112 CITY OF CUPERTINO �tt�m •�'-k'=
BUILDING DIVISION PERMIT ,CONTRACTOR INF0�RMATION 4
BUILDING ADDRESS: TR T CONSTRUCTION CO. PERMITNOO 5080112
20300 STEVENS CRK BLVD
R'S NAME: PERMIT ISSUE DATE
SYMANTEC (1ST FL. ) 1948 MT DIABLO BLVD. 08/22/2005
NE: SANITARY NO. CONTROL NO.
(925) 946-9648
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
(� lT 0
+IOZa LICENSED CONTRACTOR'S DECLARATION lob Description
8 1 Iemby a?rm that I am licensed under provisions of Chapter 9(commencing
rtRj with Section 7000)of Division Sof 60 Business and Professions Cade.and my license is
infull alQandefrea ti 12;11. TI-CONVERT BATHRM TO FILE STORAGE
Lken LIC.g 1 e
' f ARCHITECTS DECLARATION
I understand my phos shall he used As public records
"momead Pmfeuional
3 OWNER-BUILDER DECLARATION
a� Z I hereby affirm Not I em exempt from the Contractor's License Law for the
i 0 0 fallowing neaten.(Section 7031.5.Business and Professions Code:My city or county
$ which requires a Permit On construct.alter,improve,demolish.or rePoir any structure / $117648
FZ'„^ prior to its issuance.than,requires tM applicant for such permit to file asign=d statement
£ that he is licensed pursuant in the provismsofthe Communes LiceemLaw(Chapmr9 Sq.Ft. Floor Area6 f Valuation
y $ (commencingwiNScdon7OW)of Dlvision3ofthe Bui..ndPmf d..Code)ur �f7
Thu Ise is exempt Ocref rte and gas heads for the alleged exemption.Any violation of er _1)!•
Section 7031.3 by any applicant for a permit subjects the applicant to•civil penalty of �!/y .f C .
Am team than five boMmd dalism(M), y ry' ffir,O cupancy Type
OI•uownerofthepmpeny.wmymoployeuwiNmguuNeirmlewmpenudw. O!/ µfl Y`f�r t
will do dm Amnk,md umanucuse l.notinmededwoRemdforsale(See.70N•Bus Required Inspections �-
and Profeuimu Cade:The Contractors License Law does not apply m an owner of q P
property who Wildsorimprova thereon.and who docs uch vwk himselfarduough his -
own employees•provided that well improvements are notinu nded woffemd fmsele.if.
however,the building or improvement is mid within on year o(completion,the awoer.
builder will have the burden of proving Out he did but build or Improve for purpose of
sale.).
❑1,As owner of the Property,am exclusively convecting with licensed come m us to
construct the prejen(Sec.7044.Business and Professions Code:)The Contractors U.
eves,law does not apply to an owner of property who builds or improve themon.artd
who convects for such projects with a eonvector(s)licensed pursuant to We Convectors
License Law.
❑Tamexemptunder Sec ,B&PCforthismasom
r Dam
WORKERS COMPENSATION DECLARATION
I hemby aRtm under p=utty of perjury ON of the following declantians:
1 have And will maintain a Certificate of Consent to calf-Alum for Worme,Compon-
smon,As provided for by Section 3700 of the labor Code.for um perfannanes of the
work for which this permit is issued.
❑1 have end will maintain Workers Compensation Insuraae.As required by Section
3700.f the labor Code,for the performance of Ne work for which Nie permit is issued.
My Workers Compensadw Insurance artier and Policy mother am: ../.J
Cartier. ShIITF.' FUNr7 Polity No.: /0//,j.-�1_
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section bond not Wcompleted If the Permit Is levans hundmddolive,($1011)
mu.)
1 cenify,Not in Ne perfnre...of the work for which this permit Is luwd,I Nell not
employ any person In my mmneran As r become abject to Ne Workers'Compensation
Law.of Callfomia.Dam
Applicant
NOTICE TO APPLICANT:IL after making Nis Certificate or Exemption,you should
became subject in Ne Worker's Compensation provisions of the labor Code,you mot
.,O forthwith comply wit such provision or this permit Mallbu domed revoked.
.Zi` CONSTRUCTION LENDING AGENCY
[•r I hereby affirm that Nem is com uctinn lending agency for the performance of
a> the wort for which Nis permit 4 issued(Sec.3097•Civ,C.)
QLender's Name
Z Leedera Addmas
L)0 1 certify that I haw need this application and mm that Ne above information h
LLd r' canto I Agra to comply with all city and county ordinances nd sum law elating to
0 SV^ building construction,and hereby authodm representatives of this city an enter upon the
L✓a above-mentioed proPeny for inspection PWPWOL
(We)Agree to cave,indemnify and kap bummas the City of Cupertino against
req limilldes,ludgmems.cam and expenses which may in my my mcnc Against said City
L)7 in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by;
DCIOate
SOURCE REGULATIONS. n/
?:_?/c 15' Re-roofs
Signature of Appp c Coyy ctoor
HA9ARD0 MATERIALS DISCLOSURE Type Of ROOF
Will the applicant or form building ocup ntsmre or handle hexallous..nodal
de0ned by
"'Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
DesY
. es u 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
�
Will the applicant o/form bunahg awawm nm egmpm=nt w uemw,wnmh 'If a roof is installed without first obtaining an inspection,I agree to remove
7Disisict?
t haxardnw air cu tarnmants u defiwd by tint Bay Asea Air Quality Management all new materials for inspection.
❑>cA
I haw mid the hazardousmaterialsrequimmems underChapter 6,93ofthe Califor.
Health&SafctyCode.Sec9ans25505.25533 and 75334.T Ldes tins lithe building
s not currently ham A meant,Net It h my responsibility 0 notify the mcupmt of the
uircmems which mu bumet poor to' vanes of.Certificate of Signature of Applicant Date
All roof coverings to be Class"B"or better
ncru a o and m Date