06010038 CITY OF CUPERTINOt.y;.. A a •
BUILDING DIVISION PERMIT tCONTRACTOR-�INFORMATION
«.= any�,^ .¢ _
Buao1NGADDRESS: WHITING-TURNER CONTRACTIN PERMIT NO-06010038
745, STRURNq rRRRW MAP)
OWNER'S NAME: PERMIT ISSUE DATE
TARGET CORP 7011 KOLL C 06/2006
E: SANITARY NO. CONTROL NO.
(925) 485-0800
7ARCHITECTENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
. LICENSED CONTRACTOR'S DECLARATIONIobDescri tion
I Washy affirm that 1 am licensed under provisions of Chapter 9(commencing pection 70M)of Division 3 oftW Business and Professions Code,tad my license is
fomeaneeRect 30-DAYS TEMP PERMIT.
e CI Lk.M1 contractor EXPIRE 02/05/06, ORIG. #05080124
ARCHRECTS DECLARATION
W I undcrwnd my plans shall W TS u public mcmrds
aa.
pt' Licensed Professional
5 OWNER-BUILDER DECLARATION
<E 1 heathy affirm that 1 am exempt from tW Contractor's License Law for she
00 following reason.(Section 7001.5,Business and Professions Cole:Any city or county
K$� which requires a permit in construct.eller,improve,demNiffi,or repair any amuctum
Lig prior to its issuance,also acquires she applicant(orsuch permit to rile a signed statement
< that W is licensed pursuant she provisions of the Conuxtori llcen¢law(Chaprer9 Sq.Ft. Floor Area Valuation (]
y�0 (commencing with Section 7")of Division 3 M the Business and Professions Code)or
y $ thm he is exam at therofrum and the basis for the alleged exemption.Any violation of
Section 7031.5 by any appliaamfor a permit subjects the applicant in a civil penalty of APN Number Occas an
rwt mot than five hundred dollars(S3(% P cY Type
01.as owner of the property,or my employees wish wages as their sale compensmion, 32632054 . 00
will do the work,and the structure is not intended or oftemd for sale(Sec.7(l4,1,Business
and Professions Code:The Comrac of L.iatue Law does not apply to an ower of Required Inspections
Initiatory who Wilds or improves demun,and who dassuch work himselforthrough his
own employees,provided that such improvements sae not intended oraRered for sale.If,
however,Ne buildingamor den of paving said within idut year of completion.the owner-
abler will luso the burden of proving Nu ha did trot Wild a improves for purpose of
sale.).
❑1,as Owner of the propctty,am exclusively contracting wish licensed comnents in
construct the project(See.7044,Business and Professions Code:)The Conuacton's Ice-
c law dos not apply in Owen
r of property Wilds or improves thereon,and
who \
Who cantata for tan projects with a eonuacsorts)lea leaved pursuant to the Contracsoh
Lkenm
❑lMan exempt
mpt undo Sec. ,B&PC for Nis moon
Owner Data
73011 WORKER'S COMPENSATION DECLARATION
1 hereby Mom under penalty of perjury ore Of the following declinations:
am and will maintain aceaufats ofcomem m self-insure for workers Compen-
,u provided for by Section 3700 of the LOW,Code.far the No.....of the
for which this permit is issued.
have and will mountain WOrkena Compensation Insunna,u sequined by Section
of Ne Labor Code,for the performance of the work for which this permit is issued
ork 's Compensation Insurance carrier and Policy number amr. yl=tG�f A1t4Q. t/'j% yNo.: LO Sr46
CERTIFICATEOFEXEMPTIONFROM ORKERS'
COMPENSATION INSURANCE
(Thusccria used OWN camPlemd if the Permit is fm oa hundred dollars($IW)
or Ices.)
1 certify Not in she perfurmence of she..,it for which this permit is ismcd,I shall nus _
employ any person in any manarso as an become subject o the Worlmil COmpewlion
Laws Of Califmmia.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ccniricam Of Exemption,you should
become subject 10 the Worker's Compensation previsions of the Ichor Code,you most
.J,Z foMwith comply wish such provisions or Nis Permitshall W deemed¢voted.
ZO CONSTRUCTION LENDING AGENCY
,e+ I hereby olrrm that mem is a construction lending agency lar the Performance of
Ci r1 the work for which this permit is issad(Sec.3097,Civ.C.)
W
0 lander,Name
Z)
z Lenders Address
U0 1 cattily that I have read this application and scam Nu dm above information is
Iy f' correct.I agree to comply with all city and county Orourso s and sum laws relating to
0UWilding construction,and hereby authoria representatives Or this city in cnmr upon the
shove-mentioned pmKrty for inspersion purposes.
H y (We)agree to save,indemnify and keep bumless the City of Cupertino against
rA liabilities,judgments.costs and e.,.which may in any way seem against aid City
U z in coveganee of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE LATIONS. /
Signature of Applies¢ �-Y� ��.� -hxr r/�(D�� Re-roofs
HAZA DOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant Mom or handle hxrardous material
u deftad by dm Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)?
QYns IR�Hn All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use cquipmear or devices which If a roof is installed without first obtaining an inspection,I agree to remove
7dm
h lardous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
ict?
❑Yes YIN.
I have mal the harardnvrmaterialsmquimments under Chap rr6.95of the Califor.
ealth&Safety Cede.Section 255(15.25533 uu1755M.lundcrstax!Nuifthe Wilding
not curcntI have a¢nam Nat it u my responsibility m notify the occupant of the
remcmu in met pnnrrni onceutsCcnifnm raapacy. Signature of Applicant Date
>s�o(0
owner pr anthnrived asenr Dare All roof coverings to be Class "B" or better