04080053CITY OF CUPERTINO
BUILDING DIVISION PERMITcorr�RaTozz
BUILDING ADDRESS: _ -
SOUTH BAY CONSTRUCTION CO
fRffTNO04080053
10251 TORRE AVEBLU 1
OWNER'S NAME:
PERMIT ISSUE DATE
CTC FUNDING LLC
511 DIVISION SIP77T
OR/27/2004
NE:
SANITARY NO. CONTROL NO.
(408)379-0400
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 he y nm thatI am littn.d under previsions of Chapter 9 (commencing
withSeed n f Division 3 of the Business and Proposed.., Code, and my ]lease. is
ince. mree tlerceet. -14
o;e°"I° conlr.crTFsm�s
REVISION--ROOF TRUSS
NO NEW PERMIT ISSUED/ ORIG. #03080088
ARCHI'IECTS1:=RATION
Fernand my plans shall W used ablie records
Licensed Professional
OWNER-BUILDER DECLARATION
I boachy .(Sinn to, 11. exempt (mm the Contractor's License Law far LW
O
-baa
following mo. n. o ] ons Code: Any city county
meas and Proimprove,
V f
a
de fie awemte
t L elms improve, do
Permit .nam t,
which requires a permit
ran loom th ermit t a tie ed
Beathmits issuance, ansan: to dbe thevision of for suchpermit tofilensigned haine,nt
thathe wit pursuant .the oft Conuacand en. Loons
Sq. Ft. Floor Area
[IDN$90
of Divionsn(
Coda) or
(commencing with Section Division3 ofthe .ntl Proportionsnslation of
mencing
'
egeBusiness
I Nat he u exempt therefrom and dm basis for Ne alleged eumption. Any viohtion of
ands
APN Number
Occupancy Type
Smile. 7031.5 by airy applicant fore permit subjects the applinnl an a civil Penally of
not more Nan five hundred dollars (SM.
.
36940017.00
❑ 1, u owner of the property, or my employee, with wages as their sole compensation.
Required Inspections
will d0 the work, and NC sWemm Is not Intended unfitted total. (Sec. 7W, Business
and Predications Code: The Contmcwr's License Law does not apply to an owner of
property who Wilda orimproves thereon, and whodessuchwark himselforthrough his
own employees, provided that such Improvements am notint nded oroffered forsale. If,
however, the building or Improvement is sold within atm year of completion, the owner.
builder will have the burden of proving that he did not build or improve for purpose of
-
sale.).
❑ 1, as owner of the property. em exclusively contracting with licensed contractors to
eonswet the project (Sec. 70a, Business and Professions Cade:) The Contmemr'a Lt.
cove taw does not apply to an owner of property who Wilds or improves Beaton, and.
who contracts for such projecs with a conexclor(s) licensed pursuant to Be Consonant's
Lice.. La"
❑ 1 ire exempt under Sec. . B & P C for this rca.n
Owner Data
WORKER'S COMPENSATION DECLARATION
hereby afifrm under Penalty of perjury one of the following declarations:
-
eve and will maimain a Cenifrcmw of Consent to m]f-ieaure for Worker's Compen.
WnI
, ns provided for by Section 3700 of one Ube, Code, for the pert.... of the
work for which this permit is issued.
El I have and will maintain Worker's Compensation Insurance, Or acquired by Section
'
3700 of the labor Cade, for flat Performance of the work far which this Boren]is issued.
M it's Cpe..,*.onlna...ec...,.nd N),gn'umheramm
T
C(tat'}: i� It�tl.Cist� Poli a.l3 1z h' f� Iy
CERTIFICATE OF UFM 0 OM WORKERS'
COMPENSATION INSURANCE
(This section excel nm W e.mplemd if the pemtit I, terse hundred dollars ($IN)
lase.)
1 ccnify Net in the perfommnce of No work for which this permit is issued, I shat] not
employ any per.n in any manner an as to Wcomc subject in the Workers'' Comix nation
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject in the Worker's Compensation previsions of the Ichor Code, you must
forthwith comply with such provisions or this permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby the, them is a (Seal.n tending agency for the perfurmance.f
whmitre
rte for which Nu permit is issued (Sec. 3097, Co. C.)
Ne bound
de
Lenders Name
I, lenders Address
1 ccnify that 1 have mad this application and show that the above information is
correct. I agra N comply with all city and coumy ordinances and este laws miming in
building construction, and hereby and orim representatives of this city in enter upon Ne
above-menllancd properly for Inspection purposes.
(We) agree 1.... indemnify and keep harmless the City of Cup,num against
j liabilhiesjutlgmenu, cuss a ad expenses which may In any way neem, against aid City
e2'1�_
in cimseamnce of Ne gmming of this permh.
APPLI NT U1NDERST f S AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOU FGU g3TI01 /
—�// q
Re-roofs
Type of Roof
si at ppbcxmuCrandievor
HAZARDOUS MATERIALS DISCL05 E Data
Will the applicant or future building occupat stere orhandlc hazardous material
as defaced by the Cupertino Municipal Code. Chapter 9.13, and one Health and Safety
Catic, Section 25532(.)?
❑secs l�rvu
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 um equipment or devices which
hazardous air conuminans as defined by Nc Bay Area Air Quality Management
all new materials for inspection.
rice?
❑Yes P
I have mad de, hvaNtms materials requirements under Chapter 6.95 of thc Califor-
.is Health & W.tyCode, Sections 25505, 25533 and 25534.1 undcuund that if the building
dos net curtc88 hoax a ren t is my responsibility u Badly the oacupat of the
mquimmcntswht .iyb tpd ianmmeofaceroll, ,a GQ
Signature of Applicant Date
All roof coverings to be Class "B" or better
own orauth cdagat Date