08060017 CITY OF CUPERTINO
BUILDING DIVISION PERNUTC,n` rlTl`�A.C�,., 01 N.�' ATIO
PERMIT NO.
BUILYIU¢ApQR N TANTAU AVE OPI COMMERCIAL BUILDERS 08060017
'R'S NNAUMEE: PERMIT ISSUB DATE
20CKWOOD CAPITAL, LLC 445 LEIGH AVE 06/13/2008
PHONE: SANTIARY NO. CONTROL N0.
(408) 377-4800
ARCHI ECUENGINEEK: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
I� 0 0 1�
?o0 LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby arBmr Nan 1 un litsmcd under pmvisiansof Chapter 9 menemenersy P
with Socam7")efDivision 3 ofthe Business and Professions Cods,and my it"=is REVISE HANDICAP STALLS,RAMPS & SLOPE. ADDED
?<u, in mull foroe and arc
apzLicence ue.11 HANDRAILS &WHEELCHAIR CURBS ON SIDES OF WALKWY
n p
Co.
Conuecwr
eFFW7 ARCHnEcTsDECLARATI ORIG#07100042-NO NEW PERMIT.
WU 1 understand my pla^a Nsil W stud as public records
k G l- Licensed Professional
�N5 OWNER-BUILDER DECLARATION
'yy�f 1 hereby alTimm that I am camp,from do Contractor,License Law for she
O O following inawn.(session 7031.5,Busncss and Profeasions Cole:Any any of county
u$ which requiresa Permit m comemenl.slier,improve,demolish,or repair any mructure
_Z< pdo,M its Women.else Intel.thc,pplicand far such Permit to fileasigneJ stammend
Nat he is licensed Percent W du previsions of rhe Conmeturs U..faw(LT,puFt
r 9 Sq. .Floor Area Valuation
st (commencing wish Seen,700M of Division 3 of the Business and Professions Cone)or $0
t F_ dust ha Ie exempt denominate and the b..:t for me alleged eaemption.Any Holauon of
Seems 7031.5 by any applicant foe a Permit subjects Ne applicant to a civil Penalty ofNUmbet OCCU
nal main than five hurdind delldollars,(S50m. 316 019 0 61 Occupancy Type
I,as owner of me Properly,or my employees with wages ai thew ale eorpenuJon,
will da dm wait and theme me.is hot mounted in offered for sale(Sec.7014.Business
and Professions Cadc The Contractors License Law don ail apply in an owner,of Required Inspections
property who Wilde orimproves Nmasm.and who does suehwoekhinuee forlluough his
own employers.provided marim:h improvements art no,intended aroRarm forsale B.
however.the building or improvement is fold within am year of completion.tha miner.
builder will have the b mdse of Proving dun W did ml build or improve far purpax of
sale.).
❑1.u owner of the property.Me exclusively contracting wits licensed mnosesom us
constm t she Project(Sec.7r314,Business and Professions Cade:)The Communes U. .
cera law does not apply to M Owner of property who Wilds or improves dereon,ad
who contracts foe such pmjeets with aconuxtor(s)licensed pursuant to the Contractors
Lt..Law.
I oro exempt under 5 ,B&P C far the m sten
Data
War WORKER'S COMPENSATION DECLARATION
I hereby siren under Penally of perjury,one of the following declarations:
1 hamand will maintains Certificate ofConsemmself-insure forwwd sComPeo-
sedan,as provided for by Section 3700 of the Lobar Code,far Jte perfannana of the
wart far which this;Permit is issued.
❑I have sed will nommen Workers Compematlon Warrants,u minimal by smom
37W of the Labor Code,for the Performance of the wart for which Nis Permit is Wind,
My Workmen gemination.hissmana carrier sed Policy number am:
Cartier. SAICsYi2 Nst`.L PoliyNo.: LSI t���SU
CERTIFICATE OF EXEMPRON FROM WORKERS—T—
COMPENSATIONINSURANCE
mussis don recd not W completed BNB permit is future huntheL clothes;($100)
t Tru)
1 certify deal in the perfmmence of the work far which this permit is issued.I mall an
employ any Person in my immerse an m Weomc subject no the Warkers''Compewdan
Laws of Ca ifamia.Data
APPIi ant
NOTICE TO APPLICANT:If,after making this Certificate of Umainion,you should
become subject in the workers Compensation provisions of Ne labor Code,you am
.J z foMwius comply with such Provisions or this Permit shall W deemed invoked.
EV; CONSTRl1CnON LENDING AGENCY
t-a I hereby aRrm Jun there is construction lending agency for the Performance of
Ci
Use work fm which this Permit u issued(Sts.3097,Civ.C.)
�W Q lender's Name .
7 z Lenders Address
U 0 1 acetify and L have end this application and sou Jw the above infirmities is
Iy F carrot 1-Inca m comply with all city and county ordinucn and state laws testing m
OV Wildingco.do..and hembyMusda rtpreuntadves,if Nu tiny m caterupon da:
,m anove.mcndanea ds.cnyfadinspersion looPewhich a
a (We)agree m Save.indemnify and trap heard.the City of Cupertino agunst
h Ira consequence fdo,cut,nand npwnwlnich may in any nyaccme ngunstseid City
V z in consequence of civ:emoting of Ni,permit. a
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 6 L3•�0
SOII(tS REGULATIONS. _ ��
,1`�`Qu-a" �^ 4.1-- Re-roofs
tart ofAp Ircan AZARDommemr Dau
OUS MATERIALS DISCLOSURE Type of Roof
Will she applica,utfuture Wilding CUupansmin or Monte hamNan material
Rncd by the Cupertino Municipal Code.Chapter 9.13,and the Health and safety
.section 15532(a)?
❑Ter 16�oAll roofs shall be inspected prior to any roofing material being installed.
'
If a roof is installed without first obtainingan inspection,I agree to remove
Will the aPplinnt or(uwrt Willing=open,era equipment or devices;which Pe
emit hvamnns air contaminants in dcOned by Ne Bay Aum Air Quality Management all new materials for inspection.
Dtsuia7 P
❑Yrsu
L have mad the haardons materials mplocamets ruler Chapter 6.95 of ire Glifor-
nuHcaiNd:SafmyCadc,Sao.25505,15533 and 25534.1 uMmmard Natsite Wilding
Jan not cunendy have a tenses thea it u my imponsibility to aadfy,the m,nPum of the
rcgmmcnu which most W met prior w issuance of a Ccatifeu aat ry
+Cmumy.
)SAI-4 M n a.s�_ LI-0�a Signature Of Applicant Date
b 7
r,rtha n gen, vete All roof coverings to be Class'W'or better