05080214J
CITY OF CUPERTINO
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BUILDING DIVISION PER
,Ci �NTRACTOR�INFORTl
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BUIL ADDRESS:
DOME CONSTRUCTION CORP
PERMIT NG.05080214
2DING
03 0 STEVENS CRK BLVD
ER'S NAME:
PERMIT ISSUE DATE
SYMANTEC GROUND FL.
2121 OAKDALE AVENUE
09/30/2005
ONE:
SANITARY NO. CONTROL NO.
(415)641-0800 .
RCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDOO ELECTQ PLUMB MECHO
p LICENSED CONTRACTOR'S DECLARATION
Job Description
l3
I hereby affirm that I am licensed under provisions of Chapter 9 ((((commencin{
wIN Sced )of Di salon 3ofthe Bull. and Probasionta meaymbmuc is
dery
TI -RENOVATION OF (E) OFFICE '
Lenformia �fb
?Dow. sea•
Dab
NEW CEILING/WALLS/CARPET/ELECT/MECH/PLUMBING
TSDKIr
ARCHr1ECse DECLAR !
I undtsund my pace shall un used as public records
,
Licensed Professional
OWNER -BUILDER DECLARATION
License Law for the
i 1 hereby affirm that 11. exempt from the Cssion
Profession Code: Any city or county
O fallowing reason. 1.3, Business and o
(anti. co improve. de
which myuly a permit b ennsuucL alter, improve, Jemnlah, or repair any a.uelurt
j, prior in its issuance. also requires the applicant for such permit la rite a signed Statement
Sq. Ft. Floor Area
Val$9ib8000
G thatunislicensedpuuoanuotheprovisionsoftheConuanwfsUcenmLovchapur9
$ (commencing with Section 7000) of Division 3 of the Business and Professions Code)in
dist he a exempt tlleufmm and see basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Secdon 7031.3 by any applicant for a Permit subjects tiro applicant in . civil penalty of
not mare than five hundred dollars (0300).
36901021.00
01, u owner afthe property, or my omployeu with wages as their wa onmpenss1...
%\'
Required Inspections
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will do do work. and the summit. a WtinknMdmoReud farssle tSu.704A, Businee
and Profession Cade: The CBnu.cbn, Licensendwho Law dam not apply to nS owns of
yees, pdaonimproveees tram andwho dmneueh work himwlf orSon ugh
me enywho
that sees Improvements seenot e=1 _mpl 1hZownr
me employees, Wilding
howdy, NnaveShe or improvemem is fprovingthat ewithin omyeu of onmplefor thepse of
builder will have the burdan of proving that un did not build u improve for purpose of
1
isle.).
1, connecting with licensed contractors to
❑ ss mvmr of the propenY- am exclusively
commuct the pmjea (Sec. 7044, Boniness and professions Cade:) The Contncmfa U.
tens law dna not apply m an Dancer of property who builds or improv Merton, and
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who convects far such projects with a commclar(s) licensed pursuant to the Contractor,
DI
Lice. Law.
C3I em exempt underSec. . B & P C for dlie ussonDab
'
WORKERS COMPENSATION DECLARATION
I hereby affirm under pmulty of perjury oro of Ne following declanums:
,
have and will maintain a Cenlfcam ofConwn, to Self -blurt for Worker'sCompen-
n, u pmvidcd for by Section 3700 of the, tabu Cade, fu the performance of the
for which this permit is issued
have and will maintain Worker's Compensation Imunnmi, ss required by Section
73071
of the Labor Code, far Nc wrfontrance ofNe work far which Nis permit ie issued.W
.Comps arum Inwu min and Polity n
er MIlicy N
CERTIFICATE •EXEM ONFROMWO
COMPENSATIO INSURAN b
-
mitswctim need not uncompleted dose permit Is formic hundseddullus (SIM)
or less.)
1 cenifY Nat in the perfurmarm of the work for which this permit Is Iumd, 1 shall not
employ any pawn in any manner w as to bemmesubject to be Workers' Compensetian
Laws of Caltfamia. Dam
Applicant
NOTICE TO APPLICANT: If, atter making Na Certificate of Exemption, you should
become subject m Ne Worker's Compensation provisions of the lade Code, you most
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foMwidt comply with Such provisions M Na permit Nsi1 be deemed revoked.
CONSTRUCTION LENDING AGENCY
hereby dust them its mnsSm.3 lending.) for me puformmmi or
whi0sm
dueLe work for which this permit b issued (Su. J097, Civ. Cd
QLender's
Name
Lender's Address
Z
QI
minify that l haw read this application and sub that tau Move information is
coocct, I agree b comply with all city and county Ordinances and sum laws Riling an
Ne
Wilding construction, and hereby auhoriu representatives of Nis city In enW uP m
Lil
above-mentio red progeny for beramian Pusimlea
(We) agree in an, indemnify and keep harmless the City of Cupertino against
y
llebllides,judgmentLcasundexpenses which may innywsyancweagsinstssid y
,
cense ounce of the Bm ng of Nu permit.
A P ANT U E AN A D WILL COMPLY WITH ALL N -PO
Issued by: Date
RCE REG L NS. D U
Re -roofs
Type of Roof
uu
{nrt ofAppli dAZARDOUS _ DISCLOSURE W
HMATERIALS
Will the applicant or future building rampant more or handle hamNoes material
_
as defined by the CapenlMunicipal Code, Cbapbr 9.12, and the Health and Safely
. Section 23332(.)1
All roofs shall be inspected prior to any roofing material being installed.
❑Yes Nu
a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant fmurc building mcupant sew equipment or devices whichIf
emit haemolm, air cm milormnta u JoOncd by IM Bay Area Air Quality Management
all new materials for inspection.
—
District?
❑Yon Yf�I N'u
IMve reW the hvardonsmamrisbuquiumems unJerCMpmrA.93 of lifor.
nix Health&Softly Code,SaU 503.75337awd25334.lunderSlandthatif 'Iding
d t currcnuY haw ran tit' my msponslbi111Y b naifY ace an fir Ne
rmmcntaw poor tae. a (alloUncamafOm y
Signature of Applicant Date
All roof coverings to be Class "B" or better
rm.mharevaa.ganr Dam