08070155BUILDING DIVISION PERMIT
BUILDING ADDRESS:
20450 STEVENS CREEK BLVD STE
PHONE:
ARCHrIWT/ENGINEER
185 LICENSED CONTRACTOR'S DECLARATION
1. hereby affirm that I are limned under provisions of Chapter 9 (commencing
Tj � rich Secdm 7000) 3 of Ire Buainns ad Profesaiona Code. ad my fitxase is
� � Im�(dl rotes artd Lie. t
� � .. Date Cmntraaor
8 � � CHIIECI'S DELLA
1 ulderaand ter plena shall be mud as pehlk raotdt
�d
Limited Professional
5q
OWNER -BUILDER DECLARATION
iI hereby affirm dial I am exempt from the Contractor's I iecnm Lar for the
O following reason. (Seetimm 7M 1.5. Business and Professions Code: Any city or county
aL $ which esquires a permit to mm eruct, aider. Improve, dwdlsh, or repair any nruemm
= prior to its in -ane also requires the applicant for such permit to file a signed statement
< that be is licensed pursuant to the pmvisbna of do Contractor's Limns Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Prefmions Code) or
that be is exempt then Toss and the basis for the allegd exemption. Any vioWbn of
Section 7031 A by any applicant for a permit subjects the applicant to a cavil penalty of
mot mos data five hundred doll= (5300).
❑ L as enc of the property, or my employees with wages as their sole eomprmmdott.
will do the wort, and the structure Is not ima ded or offered forte (Seo.7044. Busies
and Profession Code: The Coutracmfs License law dors not apply to an owner of
property was builds aimpoves thermos. and wbo doesinch wort himadforthrough his
awn employees, provided that such improvements am est hater I oroBaad for sale.I.
however. the btdlding or improvement is add within am year of completion the owoer-
builder will have the burden of proving that be did not bxdld or impute for purpose Of
side).
❑ L as owner of the property. um exclusively contracting with Hemmed contractors to
construct the project (Sce. 7014. Business and Profesiloro Code) The Comocmes Li•
cavae law don not apply to an owner of popetty was builds or inpoves thereon, and,
who contracts for such projects with a condraclor(a) licensed pumamt to the Cmmaemrs
T ken Laws
❑ 1 um exempt under See. B R P C for this reason
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Own" Data _
WORKERS COMPENSATION DECLARATION
I hemby aM m under penalty of perjury an of the following declaralkns
❑ 1 bas and will maintain a Certilleam of Consent to self-buture for Wadxr'sCompen-
adme, as provided for by Section 3700 of the Tabor Coda for the performance of the
wart for which this Permit is iasned
❑ I have and mill maintain WmrMs Compo cation Im ema ce, a regtmd by. Samna
3700 of the Iabor Code, for the pmformarce of the wart for which this permit L issued
My Worker's Compensation lana ce atria and Polity muopa
._ _-- A,�• t/ ..-ore
,man �L
COMPENSATION INSURANCE
(This sccdma need rot be completed irthe permitis formate hundred dollars (5100)
or less.)
I cur dfy that in the performance of the wart for which this permit is issued. I shall not
employ any person in say ntamnerm 1111 In become subject to the Workers' Compensation
Lars of California. Date
Applicant
NOTICE TO APPLICANP. V. after making this Cemificao of Exemption. you should
banns subject b the Worlds Compensation prodaiona of the Labor Code, you aux
forthwith comply with such provisions or this paTil shall be darned tevoted
CONSTRUCTION LENDING AGENCY
1 hereby affirm that dem is a construction lending ap mT for the performance of
the wart for which this permit Is Wood (See. 3097. Civ. C)
Lt:ndds Name
Landes Address
1 mdfy that 1 have rod this application and state Rha the above information is
correct. I agree to comply with all city and aunty ordinances and sate laws relating to
building construction. and hereby amthoise tatiw or this city te enc upas the
she—domed ptopery for itopection
(We) agree to save, indemnify ad harmless the City of Cupertino against
Iiabili"Jdg ments, eats and expenses • may in my way amore against add City
in eonagmmm of the grating of this
APPLICANT UNDERSTANDS AN LL COMPLY PITH A�.l. NON -POINT
SOURCE REGU s�T'^..: - I
Signature gk4qo I - I Date
US MATERIALS DISCLOSURE
Wi or future building occupant atom or Mndle haatdo s material
as defined by ole C=oo Muniy"a"'Cade. Chapter 9.12. and ole Health and Safety
Code, Seedon 23332(x)? 1�]/
❑Yea No
Will the applicant or futum bud occupantoccupant— equipment or devices which
emit hLvAton air comare;nmts a tned by the Bay Ana Air Quality Mamagerasm
District?
❑ Ya No
1 have toad ole hazardous requ under Chapter &95 of the Califor-
niaHalthdSafetyCodoSwdmna 25533 25534.1umderttamndtluti[thehuildiog
docs not currently have a It is my biddy notify aavpatt of de
req ptiorte or.
mf
C ?�
PWUWWr No.
HILLHOUSE CONSTRUCTION 08070155
1670A ZANKER RD
(408)467-1000
PERMIT ISSUE DATE
07/22/2008
SANITARY NO.
CONTROL NO.
REJUDLNG PERMrrINM
Job Description
COMML TI NON-STRUCTRL& E/MECH AS NEEDED
$30000 Valuation
36901028:
Required Inspections
Issued by:
Re -roofs
Type of Roof
Date '�/- Z 2
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant
A 11 --_! Le 9+11 ---
Date