03030028CITY OF CUPERTINO
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CONTRACTOR INFO
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PERMIT Nit.
ER's NAME:
PERMIT ISSUE DAIS
,CUPERTINO CITY CENTER ASSOC
AT
ONE:
SANITARY NO. CONTROL NO. '
ARCHITECfrENGINEER:
BUILDING PERMIT INFO'
BLDGELECT PLUMB MBC”
1 E E (�
LICENSED CONTRAMWS DECLARATION
Job Description
1 hereby affirm that I am IlccmW under provldons of Chapter 9 (commmdng
with Section 7000) of Division 7 of thea And Professions Code. and my license is
m rdlrore2wndtr z2( 7_815
SIGN--ILUM LETTER ON BUILDING
LicenY G�tS PyZ
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Date
�}S n1Ac¢
CONTRACTOR: SCOTT ARCHIT 1,1RA S
los nQgy�lau slyB he still u puhliR records
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1 O ZOOS
Lkcvctl Brujuv/oioa'JOWNEER--BUILDER
DECLARATION
JUN
I hereby affirm that I am exempt from the Comnctors License law for the
following moon. (Section 703I.S. Business and Profesduns Cod: Any city or county
which mquirea a permit to cnnsauct, alter. Improve, demolish, lir repair any structure
I _
prior In its h turace, also mquima the applicant for such permit to rile a dined statement
that he is limned parental to the proviMru of the Contractor's liana Law (Chapter 9
Sq. Ft. Floor Area
- atia[ion
(commencing with Section 7exempt00) of Dof Ne Business And Profe sin. Code) or
,
15 0 0 0
that he is exempt showroom and the h for the alleged exemption. Any violation of
bah for
APN Number
Occupancy Thy
P Y'7Pe
Section 7071.5 by any applicant for a permit subjects the applicant to a civil porosity of.
oat more thio nen hundred dollars ($500).
36901028.00
.
❑I,Yowrrl otsho poopeny.eamy emplaywwith wgus uNeb Yle compewsm,
toed Ins ections
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will do thework, and the awctuw h notinunded oro@wd forsale(Sm. 7044. Business
And Profusions Code: The Contractors License Law does not apply Y an Anteater of
property who build, or improwlhemon, and whodmssuch work hlmselror dtrorsh his
101 - FOUNDA T8'N
over employ=,inm(ded thatsuch Improvements are not intended oronemd rentable. if.
103 — UFER '
howewA the building or imprewmmi is said within am you ofcomplexion. the owner-
builder will hate the burden or proving that ho did not build or improv for purpose of
104 - REBAR
.1e')'.
105 - ANCHOR BOLTS
0 1. u owner of Ilio property. am exclusively contracting with liamsed contractors to
mutineer the project (See.7Ba.a. Bulnea and Prefeadoas CWe:)The Coemewh U.
304 — ROUGH ELECTRICAL -
mean Lawdoes not apply wanmanner orproperty who buildsorlmprawsthereon. And.
505 — FINAL ELECTRICAL
who contracts for such projects with aoYnremr(s) licensed pursuant to W Contractors
License Law.
514 - FINAL PUBLIC WORKS
I am exempt under Sec. . B k P C for this won
Ar Das
WORKER'S COMPENSATION DECLARATION
1 hereby Man under pwlly of perjury, aro of the following declarations:
I Mw and will maintain •CenlOute ofC.mnat an Yl6lnsure for Workers Camper-
_.
YOon. u provided for by Section 7700 of the labor Code, for the performance of the
wok for which this peril is issued.
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0 I haw and will maintain Workers Compensation InsuYnse, u required by Section
7700 of the tabor Code, for one performance ofthe weak forwhlch this Permit is issued.
•' -
My W oke s Com�mellan lr F n mc, 'er and Policy number
1r
CaRTIF7CATE 0�7110 MWIORKERS'
`^'• A "Ni/)COMPENSATION INSURANCE
(This Yctlon need
not hocompleed lithe permit lsrorone hundred dollars(1100)Or
[an.)
1 sentry that In the performance of the work far which this permit Is Issued. I shall not
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employ any person in any manner's As w become abject to the Workers' Compensation
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Lam ofCalifomia.Dow
-
Applicant
.
NOTICE TO APPLICANT: If. after making this CenlRcato of Exemption, you should
become abject to the Waters Compensation provialons of the latter Cade, you must
forthwith comply with such provisions or this permll shall be deemed rtwand.
CONSTRUCTION LENDING AGENCY
Nal mert s tending agcnry for the perfurman. of
-
theI for whichthis
work for which Nie permit b issued (Sm. 7097, Civ. CJ
sued (S . 30
Le
Lender's Name
'
Lender's Address
I .airy that 1 haw read Nis application And stew that the sbow information Is
ConeCL. 1 agree to Comply with all city and county ordinances and stew laws m1ming to
building construction, And hereby auNorion mpwnmtws of this city to enter upon the
an paggeL
above-mentioned property for inspectioindemnifyagainst
(Wjutg m saw, Indemnifyes keep harmless the City oro
Ilaconseque. en
e and expenses Which may In eerywry accroe agalnn Yid Cay
graM1si
ogre
in PLIC n the Srabngofthis D`WI
PLIC E T DS AND WILL COMPLY W AL NON-POINT
Issued by: Date
OURC N U
V
Re-roofs
,
Type of Roof
Signal ppli HAZARDror Date
HAZARDOUS MATERIALS DISCLOSURE
Occupant lir ndle
future bulling mcupaRIu
Will NCCu
MChapter
fined sec Cupertino Municipal Code, npter 9.13. aHYN Y
Health and
d Ilrc Id Safely
Section 35573(4)?
All roofs shall be inspected prior to any roofing material being installed. -
0 ye,
❑Yes a
If a roof is installed without first obtaining an inspection, I agree to remove
Wall the Applicant f to wilding tee cyvi of which
in
Itict? ssirconuminnuYdfiabyThoBryAnaAUQualhyMmgemcni
y Ila, B it Qu Mann
all new materials for inspection.
District?
❑Yet Nu
I how read the by materials requirements under Chapter 6.95 oftho Califor.
csau25505.25577Yd2557a.1undcnundth iftho building
nh"ulffifizLijim
does nohenYL that It h my responsibility m and r7_ occupYt of the
req onrpriormissuaceora CeaiO tear
Signature of Applicant Date
Q
All roof coverings to be Class "B" or better
'
O..
44n, Date