08030072CITY OF CUPERTINO
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BUILDINC DIVISION PERMTT
BUILDING ADQRESS:
10435 N TANTAU AVE
NOVO CONSTRUCTION
PERMITNO.
08030072
OW HER'S NAME:
PIINOT ISSUE DATE
COMPUTERS INC
1042 HAMILTON CT
08/26/2008
NE
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SANITARY NO. CONTROL NO.
ARCHmiCTWIGINEER:
COMM'L TI, FITNESS
BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATON
'
Job Description
1 hereby sitansNat 1 are licensed under provisions of Chapmr 9 (commencing
wilbSeelion7IXg1)at'Divition 3 ofine Busin Professieo�nsrC7ode, and my liewsm is
in full toren and efr=L-' G!/
.
License a s Lm. p
V
Dam 9�R1�__ CO.
T' MCH1TEX S DECLARATION
1 understand my plans shall be used as public mceras
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Licensed Professional
OWNER -BUILDER DECLARATION
1 Imeby aRnn that i stn exempt !mm the Contractor's License Law for to
following mason. (Section 7031.5, Business and Profession Cafe: Any city or coumy
which mqubm a permit to construct, alcor, hnproe, demolish. or mpairmy struetum
prior On its issuance. am requires the applicant for such permit to file a signedsts=am
Contractor's Licemo UU,(Cminer9
Sq. Ft. Floor Area
Valuation
that be is licensed pursuant to the provismm of the
(commencing with Section 70DO) of Division 3 of the Business; and Professm. Cade) or
that be is exempt therefrom and to basis for tiro alleged memption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a Permit subjects me applicant to a civil penalty of
not more Dun rim hundred dallem MOD).
❑ I, a nano of tier property. or my wplay.. wit wages as theirmlecompemstlon,
Required Inspections
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will an amwork. and tertsunue b not intended oroffe.d far sale (Sm. 7044, Bulinus
and pmfeadom Code: The Conuactoana rs LiLaw does not apply W an awner of
propeny who builds or Impmwa therme, and who does such work himsel f or through his
own emplayem, pmvlEed that such improvements art not intended oroliced forme TL
boaems, me building or improvement is mid within One year of completon, to owrmr-
builder will have ter burden of pmAng that he did not Wild or improve for purpose of
Sam.).
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❑ 1, as owner of the Property, am =elusively contracting with licensed mmumtors to
construct the pmject (Sec. 7044. Business and Professions Cade:) The centra mees LI -
come law does at apply to an owner of property who builds or improms demon, and
who contacts far such p.jects was a contnnor(s) licensed pursuant to the Crnt setoM1
License law.
❑ 1. exempt under See . B B P C for this roman
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hemby of on under penalty of perjury ane of the following declarations:
I ham and will maintain aCenifhceto of Consent to self -imam for Workers Cempen-
.
=lion, m pmvided for by Section 3700 of the labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Worker$ Compensation Insurance, a required by Section
'
37M of am Labor Code, for me performance of the work for which this With blamed.
My Wmr Compenntim lmu M.oraad Poli mb`er
my
o.
Comer.. ���—�I3f o I No.-
ERTIFICA7E OF EXEMPTION FR WORKERS'
COMPENSATION INSURANCE
(Thh mctiam mad at be cumplctod ads, permit is (bumm hundred dollars (SIO(a
role=)
1 unify till in to pe rformmm of the work fur which this permit is lamed, l shall not
employ any person in my mantarm as ea become subject to tiro Workon' Compenesib m
Laws of Califomia. Dam
Applicant
NOTICE TO APPLICANT. If. after making this Onlifhcam of Exemption, you should
become subject m to Workers Co picen n provisions of tc labor Coda you mmt
comply with such provisions or this Permit shall We decreed mvakcd.
Ofortwlt
CONSTRUCTION LENDING AGENCY
1 hereby alarm ter mem in....earn lending agency far me performance of
am work for which tis permit is bound (Sec 3M, Civ, C.)
QLenders Name
Lender's Add^.•
I crtify that I ham read this application and sato that to above information is
HCarmel. I agree to comply with all city and county ominanms and stns laws mining to
V building construction, and herebytutorive mprescntdves of this city to enmrupnn dm
W above-menduned P GPeny for impEmmn Purpams
(We) agree to ave, indemnify and keep harmless to City of Cupertino against
liabilities,judgmenu, corn and exponent which may in my way amen against mid City
in consequence of the granting of this paem8.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS.
Re -roofs
Type Roof
Signature of Appli=ot/Conuaclor Dow
HAZARDOUS MATERIALS DISCLOSURE
of
. Will the applicant or future building oompanl Stam or handle hasmous material
as defind by to Cupertino Municipal Code, Chapter 9. 12. and me Health and Safety
Cade, Section 255324)7
All roofs shall be inspected prior to any roofing material being installed.
Y. ❑No
If a roof is installed without first obtaining an inspection, I agree to remove
Will to applicant or future Wilding ompant use equipment or devices which
emit henmom eI, canurrirtsnu a dc0rmd by to Bay Area Air Quality Management
all new materials for inspection.
Dimict7
❑Yes ❑No
.m .,.amriais : immenuunder Chapmr6.95ofineCalifor-
am .