00060128CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS', I'IfRMI I' Nu.
10201 TORRE AV 00060128
OWNEN_�NAME:
r'TISHMAN SPEYER
w O 7p ARCHITI!Cr/P.NGINGER:
LICENSI!UCONTRAC'IOICS DECI.AKNIION
04 O 1 hachy notion be, 1 nm hennaed ands, lawman, ol'Ch,i 9 (commencing
with Section 701XB of DlvWon 3 oftbe B.diecsund l'rofusionn ONe.und my license
Y J is in full force and effect.
p,License Clavi Lid.
O y U Date Contract
w 3 ea y AItCl 11'[I!Cr' S DECLARATION
.F. ° I unda'smnd my p sus .hull ba u,,d m auddi, ,mord,
5'.
Tic
p ,O Licensed 1'ndc,innal
e OWNER-BUILDHR DECLARATION
,71 I hereby affirm that 1 am exempt from the Contractor's Licenw Law for the
Z following reason. (Section 7031.5, Business and Professions Code: Any city or county
,S C which requires a pem ii to conserve, alter, improve demolish, or repair any orucuum
pier, lie ieen:awe, also minims muapplicmn lin.uch permit n the n sigacd stmeman
S that he is wenod pomace h. moprov'isu ns of tad Cit crai Licenw, Law (Chupmr9
(commencing with Sat 7100) of Division 3 of the Rosins, and 11 l'essions Code)
or that he is exempt therefrom and the basin for the alleged exemption. Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant) a civil penalty
of not marc than five hundred dollar, (S50(d
D I, us owner of the property, or my cmpmyees lido wages ns theinole contpensmion,
will do the work, and the structure is not intended or Florist ler side (Sec. 71144,
Bovari and Pmm,,inns Cold, the Contractor's hies., Law does not apply ,,ton
owner Of property Who builds or improves thereon, and who does such work himself
or through his own employees. provided that such improvements am not intended or
offered for sole. If, however, the building or improvement is sold within one year at
completion, the cosser-huilder rill have the burden Of proving that he did not build err
tnprnve far purpnao at snle.l.
01, m Owner al'the property nn, exclusively contracting with licensed contmchms,
omtmet the pnjeet (Sec. 7044• Business and Professions Calc:) The Contractor x
License hnxdoes not apply m an owner of pmlerty who builds or improves thereon.
and who connotes otets for such projects with a comercums) licensed punuam to the
Contraam'e Licome Law.
D In exempt male, See . It& P C liar this mason
Dwnn' D:nd +v
WORKER'S COMPENSATION DEC1.ARA'1'ION
737MI hereby affirm under penalty of perjury one of the fallowing declarations:
1 have mod will nainmin a Certificate of Cement , sell -insure ln Worker's
on,aeu,;n T. as pr... dttl For by Section 39(X) of the Labr Code, far the
rformance or the work fr wich on, p ennit Is issued.
1 have and will maintain Workcr's Compensation Insurance, as required by Sectio of the Labor CNe. far the p<•rlormaw, of the work far which this permit is
sued. My Worker's Com,,anwlion Insurance carrier and Policy number are:amier: Pal icy NO
CER' I-If1CA1'ION Op IiXEMP'I'ION FROM WOKKERS'
COMPENSATION INSURANCE
(This wetian need not W v nplded if the permit is fa one hundred dollar
IS 100)or lens.) -
1 send, that in the P lona, nee ol'the ver:dr Inr which this )snit Is Issued, I
x1 11 urn employ any our In' y manna, sit n_s to be mb,i— I to the Worker,
Compcnxmion LC:Jifn >: /b �D-�•d@
Applicant- —^
NOTICE q'O
AIA -IA -17.1 . toner km thin Cenifcate of Exemption. you zhoulJ
become whjat tome Workci s Compenm ton provisions of rhe Labor Cade, you must
Q C hmbwith comply with such pmvisions Or this pmant shall be dcaned revoked.
HCl1NS'I'Nl1C'I'ION LIiNDINf AGENCY
a > 1 hereby affirm But Ihere is n cunshorn en lending agency Lor the perfomeanee
of the work lin which this permit is issued (See. 3097, Ci, C.)
L Q Lender's Name
= Z Lender', Address _
U Q I certify that I have mitt] this application and stale that the abnw int'ormution is
fss F.ta rre,l. I name m annply with all city and county ord'manws mod seem laws relating
Q U to building cmunuctlan. and hereby anabolic nprecanm'nes of dus city to enter up on
the alawe<nammned properly fur inspection purposes.
E— Iy (we)agree to sass. indemnify and keep harmless the City of Cnpenino against
y liabilities, judgment, costs and expenses which may in any way advice against said
U Z City in consequence of the greasing of this )ruin.
APPLICANT U ERSTAN AND WILL COMPLY Wall ALL NON -POINT
` SOURCF!RCO TIONS. Alf / rr s ob
V Signaurc olA Iictim, im.,r \ O W Duro
HAlARDOUS MAT 7RI 1 1DISCLOSURE
Will the applicant in future Wilding occupant store or handle huraNnwx material
;is dehnnl by the Cupenino Municipal Cade,. Chapter 9.12, and the Ileullh and Safety
Code. Section 25532(x)'! " o
0 Yes 1^11Ar
Will the uppllcam Or mem building occupant use equipneut or devices which
emir himrdous our contaminant n defined by the Huy Area air Quality Management
-almtia?
\• ❑yes No
\I have read the bu:uslous materials raeoiremcnt under Chapter 6.95 of the
Calhorniu Ilaid k Safety(: ... I.S1,loor,25505,25533 x,125534. 1 unt].... nal nun
if rhobuildingdocsxi currently M1uvaameant,that's ieI rmancsibllity a nuke mu
�ttccupant nl rbc rcyuiry uv which must b< neer prior to i.vsuunde of a Crnifculc nl'
`:oau,aandyn
w—( L.- LO,On
ON SUH DATH
06/20/2000
It111L'e!•p�RU�YRINL�3LxMJ
Job Description
TEMP PERM — EXPIRES 7/20/00
Val
I Required Inspections
304 — ROUGH ELECTRICAL
Issued by: Date
Re -roofs
Type of Roof
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection. Applicant understands and will comply with
all non -point source regulations.
Signature of Applicant
Date
All roof coverings to be Class "13" or better