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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
HOWARD WRIGHT CONSTRUCTION
IMITN004 04 0 151
ER'S NAME:
PERMIT OUR DATE
SYMANTEC
PIER 9 THE EMEARrAnR RO
2004
NE:
SANITARY NO. CONTROL NO.
(206)447-7672
ARCH ITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I bemby affirm IMI I am licensed under provisions of Chapter 9 (commencing
P
with Semion ]agO of Divisian3of the Ousine se Professions Cndc.mdmylicenseis
m mlP{.Is¢nna «eel.' p (o$J%31
DEMO--PRMO LOBBY MEZZANINL
Licenas�l� s
Dale uU i C vector ^
c< .
ARCHITECTS TION
",andun my plans shall be used a is «cords
Lwimsed PmIAAx1... I
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
following maxim. (SeNun 7031.5, Business and Prufewinas Code: Any city or county
which acquires a permit in construct, eller, improve, demolish, Of repair any structure
—
prior as its issuance, also requires the applicant for such permit to file a signed Statement
that he is licensed puniant In the powmiooanf om
the Commuters License law (Charm,9
a
Sq. Ft. Floor ea
'p(}'�
Valuation
(commencing with Section 7) of Division 3 of the B usiness and Pro(cminna Cook)or
000
l
Net he u exempt thcmfrom and the basis for the alleged exchaptlon, Any violation of
`� 1 Y"" `'\ 1 'i 1
�\ /�3 CrO.O- Occupancy Type
I P Y yP
Section7031.5 by any applicant far A permit ubjects the applicant,. Asian, pxrm.RyrnA
not more than five hundred dollars (5500). I
/1 i /`(
I, As owner of the property, m my employees with wage. as their Is compensation,
1 .--mss
will do the work, and the stmmum is not intended or offered for sale (See. 7w, Business
and Professions Code: The Convector'. License Law docs not Apply lf m owner
de: no
iof
property who bulldaor ares Neuron, and who does such work himulfoanownhhis
s
own employees, provided Thal such tmprosemeou ase not intended oro«ecol formic. If.
however, the building or improvement is mid within ane year of completion, the owner.
builder will have the burden of proving that he did act build or improve fm purpose of
sal..).
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
consumer the project (Sec. 7044. Business and Professions Cade:) The Contractor's Li.
cense law docs not apply to An owner of property who builds or improves themon, And
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor'
License Taw.
1 iso exempt under Sec. . B 6 P C for Nis recon
Data
WOR KER'S COMPENSATION DECLARATION
1 hereby aff na under penally of perjury one of the following deductions:
I haat and will maintain a Certificate of Consent to self-Insum for Worker's Counti
Edon. u provided for by Section 3700 of dte Labor Code, for the performance of the
work for which this permit is issued.
1 have And will maintain Wake . Compensation Insurma, m mquimd by Section
3700 of the labor Code, for dre performance of the work far which this permit is issued.
My works'. Com nsa'on lnsumntt terrier end Policy number am:
cr. T v Polis Ny o.: �%t� I�YY��7 Y
CERTIFICATE OF EXE PTIO W RKERS'
TE
COMPENSA ON INS
/D L
f I/p/
(ITU section recd nmbecampleted if Ibe permit is (arae hundred dollars (SIW)
or kis)
I ttnify that in the performance of the work for which this Permit is issued. I shall am
employ any person in any manner m As to become subject the Workeri Compensation
Law, of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Ceniriicam of Exemption, you should
become subject to the Worker's Compensation provisions of the labor Code, you must
forthwith comply with such Provisions or this Permit dall be deemed mwkcd.
CONSTRUCTION LENDINGAGENCY
I hereby affirm that them is a construction lending agency for the Performance of
Ne work for which this permit is issued (Sec. 3W7, Civ. C.)
Lender's Name
Lender's Addacu
I certify Net 1 haw rad this Application and sure that the above information is
coaect. I agree to Comply with all city and county ordinances and sure laws relating to
building construction, And hereby authodae reprcunutives of this city to enter upon the
show -mentioned property for inspection purposes.
(We) agree to mac, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way Acemc Against said City
I. cmnuqueace of the graining of this perm, I.
UNDERSTAN S AND WILL COMPLY WITH ALL NON -PAINT
-Issued by: Date
OUR
OUR EREGULATI " /
i/�T
- y
Re -roofs
Type of Roof
S naurcof Applma m
onuter w DA
HAZARDOUS MATERIALS DISCLOSURE �
Will the applicant or fuum building weupant Store or handle hawdous material
As definc l by the Cupeart, Municipal Code, Chapter 9.17, and the Health and Safety
Sc❑]Y.s 25531(e)? &�
All roofs shall be inspected prior to any roofing material being installed.
11!,
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment or devices which
h.,`Aodpu. air contaminants m defined by the Bay Area Air Quality Management
all new materials for inspection.
District
❑Yes axd
1 have mad the haeaNnus materials mquinemsnu under Chapter 6115 of the Califon
nia Health ffi Safely Code, Securers 25505,15533 and 25534.1 understand that if the Wilding
dues not currently hew A union. in., it i, my hu,nonsihility m nattily the uecupant of Ne
requiremenuw' meIprior1.imu.n.a.Cerligcatc.ffkc.p'cf.in/
Signature of Applicant Date
r� 4fDi
All roof coverings to be Class "B" or better
o er Authorircd agent