04060216 CITY OF CUPERTINO " k`g
BUILDING DIVISION PERMIT CONTRACTORINFORMATION
BUILDINGADDRESS: TICO CONSTRUCTION CO PERMITNO04060216
10700 TANTAU AVE
OWNER'S NAME: PERMIT ISSUE DATE
TANTAU BUILDINGS ASSOC. LL 1585 TERMINAL AVE nf;/9.4 /2no4
E: SANITARY NO. CONTROL NO.
(408) 499-0266
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
4 0 z LICENSED CONTRACTOR'S DECLARATION lbDescri hon
W I barely affirm too ro
at i am leered under provisions of Chapter 9(commencing IJ
Z w'th See 7")of Division 3 oflW Risimcss .fauoons Cede.and my license is
i"`' ean0_"` S.SyL TI--ROOM PARTITION (.4 INT. OFFICES)
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flqOa¢ Cunlsauor
�ARCHITECTSgECLAIQN
a.YBndCRun6m,Lplenay2ll be Lacd4a public records
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Licensed P oalb
^ OWNER-BUILDER DECLARATION
3<z I hereby affirm that I am exempt from the Contractors License Law for rbc
p 0 following mason.(Section 7M 1.5,Business and Professions Code:Any city or County $1i n2CS
$ which acquires a Permit to crommuct,alter,improve,demolish,or mpolr any structure
,Z< priori its issumen.also require the applicator for such permit to file a signed suorenl
€Q that he is licensed pursuant torMprovisions ofthe Communes License Law(Chapter 9 Sq.Ft. Floor Area Valuation
$ (commencing with Section 7000)ofDivision J of lW Business and Professions Code)or
that he is commit,therefrom and the Wo for the alleged eaemption.Any violation of
Section 7071.5 by any applicant for a permll subjects the applicuuo a civil penalty of
net moss than Bve hundred dollen(5500). .3 VdVfPa 0 Occupancy Type
❑I,uownu of the poparty,mmy emplmyces with wegouNeo sole compensation,
will d.the work an°Ne awcture is not intended oroffued forsale(Sec.704W,Bunimes p_
and Professions Code:The C.nlsacWr,Li.law does nor apply W an owmr of Required Insp 6fla
property who builds.,Improves themon.mil who due sauchworkhimselforNmughhis d
own employees.provided Nat Such improvements ase not Intended or offered for sale.It, `�"
however.the Wilding or improvement is sold within one year of completion.the owner
builder will have Ne burden of proving Nat he did not Wild o,Improve for purpose of
salt.). V A
co L as.wm,of the property,am exclusivelysand Prolamin,with:)Th.C contractors W ? 9
conswn the projett(Sec.]044,Business end Professions Cade:)The Contractors Li- ®�®�® ?00�
come Law does W owner not apply an or property who Wilds or improves Hereon.and V
who contracts for such projects with aeon semr(q licensed porsuul W Ile Contraction ®�
License Lew.
❑Imo acmpt undo See. .B is P C for this rcuon
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby of som under penally of perjury ons of the following decimations:
I hale and will maintain a CerObcate of Consent W self-usum for Worker
Nu s Compcn-
son, provided for by Section 7]00 of the labor Calc,for the patrolmen.of tite
work for which this permit is issued.
❑I have and will maintain Workers Compensation Women,as mquired by Secdon
3700 of the Labor Code,for Ne pertom inec of the work for which this permit is issued. -
My Workers CompensatiotnnIInsurance a�r�vlt�enit Policy number am:
IFS icy Nd=P"JI3—IUyS�'—O�
.7
CERTIFICATFOP EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Mussenion need not becompleted If the permit Is formic hundred dollars(91010
or los.)
1 certify that in the perfomunce of the work for which this Permit is issmd,I shall not
employ any person in any manner an as to become subject to the Wokeri Compensation
Laws mf California.Date
Applicant
NOTICE TO APPLICANT:If,.Our making this CertlOCate of Exemption,you should
became subject W the Worker's Campcnuu"n provisions of the Lehr Code,you most
Z O foMwith Comply with such provisions or his permitshall W deemed mvokcd.
CONSTRUCTION LENDING AGENCY
I lumhyaRmn Nmthem iaacesuuctin lendingstom,fnrlhe psuformer"of
Nc work fur which this permit is issued(Sec.7097.Cih,C.)
ILl Q lenders Name
]z
Lender's Address
U Q I certify that I have read this application and state that that As inf amNmn is '
U.F "neck l agree to comply with all city and county.nlinances and some laws mining to
O U building convection,and hereby authadee nqueaenutivu of this city 10 enter upon due
W alive-mcntionW property for iopeedmn purymra
G (We)agme W on ndcmnify trop harmlm the Ciry of Cupertino against
h limiliths.udgmen��sa�..Eosin anti expect ich may in any way setae against mid City
U z in consequence of ,{{taming of this it.
a.1 APPLICANTS No T p�.AN' WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE EOf; /'Y� •Ur
JJ ✓ Re-roofs
igna oofApplicHA RDOUSMATERIALS DISCLOSURE DateTypeof Roof
Will the applicant or future Wilding occupanumte erhandic hrallous material
a dclined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
cmle,Section 35573(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑resat
Will the applicant or future Wading Occupant use equipment or devices whims If a roof is installed without first obtaining an inspection,I agree to remove
I
t hsardnns all Musurommushis,defined by dte Bay Ama Air Quality Management all new materials for inspection.
Dliarkt7
Dy.
1 have read the hi ardous materials requirements underCh ocr 6.95 Cribs Califor-
nia nI uomm c.Sections te MMY nromuh3\ne amity
thmifthe Wilding -
Jou nor cuneus Late m 55 rcspmnsi5M.I un badly dm otifout or the
mqulrcmcnks 1 n missuuceoraCcrdficateyPtlrjggpgmry. Signature of Applicant Date
oar o,amhorimd ugeT� bb�ll' All roof coverings to be Class "B"or better