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CITY OF CUPERTINO♦'
BUILDING DIVISION P R T
CONTR11;,1A1�1CTOR Nk'( RMATI,ONv
,
BOILDINGADDIRESS: -
SOUTH BAY CONSTRUCTION CO
fNLATN003080088
10251 T
NER'S NAME:
PERMIT ISSUE DATE
CTC FUNDING, LLC
511 DIVISION
04/14/2004
TRUNE:
SANITARY NO. CONTROL NO.
(408)379-0400
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 E 0 0
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am ANTRA under provisions of Chapter 9 (commencing
Job Descri t�if
p
with Section 7gHp of Division 3 of Ne Business and Professions Cade. and my license is
r
in fall force andermm,
NEW 2 STORY BLDG (18607 SQ )
Locnse Class Lit.N
Dotc Contractor
-F . -
OFFICES
ARCHITECTS DECLARATION
nets ZOh/.
1 crsmtJm Ians shall nosed as public records
VGGLtNa L YYi
L ro s io al —
Oat NER-BUILDER DECLARATION
OW
_ ,@%vl�,
1 hereby olfirm 1 oro exempt from the OLiccnu Law for the
BUILD
following reason. (Section 7031.5, Business and Professions Code: Any city nr county
{Q{Y�J�/_-
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issumce, also requires the applicant for such permit to foe a signed statement
that heialicensed brruaotInthe provisions nthe Cnmredm'sLi...Lew (Chapmr9
- Sq. Ft. Floor Area
N"945587
(con cing with Section 700()of Division 3 of the Busincssrnd Professions Code)m
,at he i5 exempt Ncicfrom and the basis far Ne alleged exemption. Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant o a civil penalty of
APN Number
Occupancy Type
p y yp
not more than Fvehundred doRars($500).
36940017.00
El 1, is owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
Required Inspections
and Professions Code: The Contractor's License Law docs nor apply to an owner of
propeny, who builds or imprnvm thereon, and who does such work himself or through his
Own employees, provided that such improvements are not intended or offered for sale. If,
however, the buildi ng or improvement is sold within one year of completion. the owner
-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
'Laser of Ne propeny, am exclusively contracting with licensed convaclors to
CORSIMCL the project(Sea 70VI, Business and Professions Code:) The Counselor', Li
.
cense law dues not apply to an owner of property who Wilds or improves themon, and
who contracts for such projects with a connacmr(s) licensed pursuant to the Contractor's
Lice se Law.
CD1 am exempt under Sec. B & P C for this reason
crX I AY/%�D w_�sC�'1� Date
W RKER'S COMPENSATION DECLAB&ypN
I hereby M. under penally or perjury one of the owing dcclarstinns:
❑ 1 have and will maintain a Certificate of Commn to self-insum for Workcr'sCompcn-
today, az provided for by Section 37W of the Labor Code. for fie performance or the
work for which Nis permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by station
37M or the labor Code, for fee performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number aa:
Cannot: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed if the permit is forone hundred dollars (II W7
or less.)
I card fy that in the Nrformancc of the work for which this permit is iamed. I shall not
employ any person in any manner so as or become subject to the Workers' Compensation
Laws of California. Data
Applicant
NOTICE TO APPLICANT: IL after making this Ccnilicam of Exemption, you should
become subject to the Worker's Com pcnsation provisions of the Labor Cale, you must
forthwith comply with such provisions or this peroul shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
-
I heathy of irre that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3(57, Civ. C.)
Lenders Name
-
Lcnder'sAddram
1 certify thal 1 have read this application and sum that the above information is
coned. I agree to comply with all city and county ordinances and state laws relining to
building con irmation, and hereby amhorire representatives of this city to enter upon the
for inspection keep ca.
shove-TWy) agred ee
(We7 agmen to save, indemnify and kith harmless the City Cupertino against
costs and may In anyway OLCNC Again${fieldfifly
ro
inconsequnc of the ofexpanses
Aconsequence of the granting of this permit.
permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
issued by: Date
S URCE L TIONS.
Re -roofs
Type Of Roof
\ -
I-14' 0r 4}y
�gnalure fvt�ican✓Conuaelor Dhr
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle herardous material
as derided by the Cupenina Municipal Cuda, Chapter 9.12, and the Health and Safety
code, Section 25532(a)?
❑Yes JIKNo
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
Will the applicant or future building occupant use equipment or devices which
emit harrom us air conmmirants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
Dyes '64.
1 have read the mosidous materials requirements under Chapter 6.95 of the Calif.,
may Health & Safety Code, Scabrous 25515,15533 and 25534,1 understand thin if the Wilding
does not currently have a Ienm4 Nal it is my responsihility, to nod ly the occupant or the
requbemen, which moat be mel bmmisaance or a Cenlficam or occupancy.
Signature of Applicant Date
-4—(,/(-
All roof coverings to be Class "B" or better
ea agar,
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