08080042 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONFTRAiCT',O�R ', �NJATI
BUILDING DRESS: PERMIT NO.
0tr�0 N TANTAU AVE DEVCON CONSTRUCTION INC 08080042
W NER'S NAME: FERMrr ISSUE DATE
'!'ANTAU DEVELOPMENT LLC 690 GIBRALTAR DR 09/03/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 942-8200
ARCHf1ECryENGINEFR:
BUILDING PERMIT INFO
BLDG ELECT ' PLUMB MECH
D O O O
PCZ LICENSED CONTRACTOR'S DECLARATION
,� Job Descri tion
i�Ua I hereby•(firm then 1 atm Iteucd under and
prof ua of Dupree 9(commencing P
n<n
with Section]gllq ofDivulon 3.fthe BasinmssWProfessival Code.and mylicense u DEFERRED RVSN ENTRY GLS CRTN WL SHPDRWNGS
in full force and ecL
�pz Lianae , 2 Lm.0 ICn ORG#08020156
Co.
__ .
7W ARQ'lSc I'S DECLARATION
1 understand my plana shell he mond as public recoNa
JyU
y0 to Licensed professional
OWNER-BUILDER DECLARATION
, f I hereby slim that 1 am mompa from the Contractors ucamse law for the
O o following much.(Sccti 7031.5.Busimss and Pmfessiou Calc:Any city or county
S_� which nmbes,a pmmit m conswaL runs.improve,dcmolW,or unfair any structure
Zy prior m its issuance.also mquuu the applicamforsuch permit or file a signed auacment
that he I.licensed puboat to 0th provision of the Columbus's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
(cammeneing with Sermon]000)of Division 3 of the Business and Pmfesstnal Code)er $100
$ last he U exempt un erSom and dun b•su for She allegexemption.ed epti .Any A.I.don of
i
Sdon 7031.5 by my applicant run.permit subjects She applicant m•civil penalty or
�,mom manRKhandled dollars(SM. 31609029 °�Number Occupancy Type
G 1,u mucor of 0a pmpury,el mY wplmyeu wiN wgu u dme'vSole campensstion,
will do the wort and She ewmure uwt marded oroRemd tartan,(Sec.]011,Buz.
and Pmresdons Code:The CemuanmYs Liceua Law dons ret appy to an owner of Required Inspections
property ran build,el impraaes dveon.and wbo dots such work himsel f el through his
awn employers,provided that such improvements arc not inanded oro0emd for ale If.
haweser.the building whopmvement is Sold within arc year of completion.the owtwr-
Wilder ,will lave the burden of pmving mat he did ret build or bmpmte for purpose of
rale.).
0 1,u owner of She property,am ascivalwly contracting with licensed conucws IS,
consumer Uma pmjem(Sec.7014.Business and professional Cade:)The Characters U.
coon Law does not apply he an caner of property who Wilds or improves theater.Lid.
who contracts for such process with a conram.r(s)licensed pursuant to me Colossuses
Liceve law.
0 lamuemprunderSee ,BhpCfortWtmmon
Due
WORKER'S COMPENSATION DECLARATION
I hemby affirm under frsuuy,of perjury,roe of the following deWuulomts
0 1 ham and"I malntsin a Certificate of Consent to sear-haum fur Workaes Compcn- '
radon.as provided far by Section 7700 of the Labor Code.fel da performance of the
work for which this permit is issued.
❑1 have Lib will mamas.Workouts Compensation Irumana,u mmmod!by Section
5700 ofthe labor Code.for the pmformance ofthe work for which this permit is issued. '
My Workees Compensation Ides.carrier rM poilry number ale:
Card_ __G1 � policy No.11.
CERTIFIG 07E FE%F MON FROM WO5'
COMPENSATION INSURANCE
(Thu section mal ret he Smoldered ifft permit Is Forane hundred dollars($100)
Mlers.)
I cenify Nat to It performance of me work fan which Shia permit is issued.)shall trot
employ any person in any mamma won b berme subject to the Workers'Compensation
Laws of California Dam
Applicant
NOTICE TO APPLICANT:If.after making this Oce iftcao of Exemption,you should
become object as the Workces Cmhparmase pr enemas of the Label Code you muss
.J O foMwdo comply with such pmvu mut or this permit ehrll be demand revoked,
z Vy CONSTRUCTION LENDING AGENCY
(—m Ihemhy wMam that there is couwcfinn lending.genry for the performanceuf
CG > dm wart to,which this permit is issued(Sec.3097,Ch,C.)
fA A L.ndc',Name
z Lendaes Addrev '
V Q 1 centify that 1 haw read this application sod sum that the shove information is
[s.f' correct.I agree to comply with all city and cowry ominances and rete laws relating m
0 C.) bov
Wilding construction.send hereby auhmm repunonnutives of Shu city m an=upon the
above-mentioned property for superman purposes
(We)agree to Sam.indemnify and keep harmless the City of Cupertino against
(r) liabtlifinsjvdgmencs 'arW expense,which may in any way amuse against said City
V z in nse9uance of the j dog of this permit.
`-' A AMU D NDS ANO WILL CO LY ITH ALL NON-POINT Issued by:%2�60 Dale 9 7 vj
14
SOUR EGU A ON .
Re-roofs
Sign .a A Lcand o serer Dan,HAZ DOUS MA ALS DISCLOSURE Type of Roof
Will the ,1!1 Wilding occulammomarhandae haaAoua m•u:rial
as defined by the cupola..Municipal Code Ch,pm,9.11,and the Hmmm and Safety
Section MIN.)? All roofs shall be inspected prior to any roofing material being installed.
0y.
Will the apflkant or foram wilding occupant ase equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hvardnu air comamialnts a doftncd by me Bay A.Ail Quality Management all new materials for inspection.
District?
I haw mrd Shu1aa =m=6ri requimm Bundc,CWptns6.95ofShuUifor-
nuHeal"SalenyGadeSec6 25505.25577and25534.1u AcnuM ifdm wilding
does cure' haw it u my reapom dl" 'I,time occupant ser the
mquimm hem ret 'm mss Cent run fOeapaney.
Signature of Applicant Date
0.c'Mmt . ycd.gam am All roof coverings to be Class'%Q."or better