04120116L --
CITY OFCUPERTINO .'
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BUILDING DIVISION -PERMLT
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BUILDING ADDRESS:
SOUTH BAY CONSTRUCTION CO
MITN1b4120116
10251 TORRE AVE if 228
OWNER'S NAME:
PERMIT LEVE DATE
HUNTER PROPERTIES
511 DIVISION STREET
'�9904
E
SANITARY NO. CONTROL NO.
(408)379-0400
ARC HITECUENOINEER: �'• ,.
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BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job D(scn UOn
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1 hatch aM. that i am lLmnud under pmvisipu of Cbapwr 9 (mmmemmng
wish Srt o' NnofDivblon3ofJm Bud. fcssiav Code. and myliceue is
*fond
nmufo -'/ 9
Licca Clms Lk. M"
Dare cantr6ldr
REVISION --IN HOUSE USE ONLY
NO -NEW PERMIT :ISSUED/ ORIG. #04080181 -- - -
R IECTI. A
Lic n Professional
OWNER -BUILDER DECLARATION
Lhcmhy &M m Net I am exempt from the Contrploes License law for the
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following mason. (Section 703 L5, Business and Pmressions Code: My city or cauntY
which requires a permit in cameral, alar, improve, demolish, m amely any structure
poor to its issuance, also requires the applicant for such Permit m file a signed statement
JuthebRronsedParauan, to use Provisions of the Contractor's Umtata Law (Chapter 9
Sq. Ft. Floor Area
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Valuatior$43
(Commencing with Sudan 700(1) of Division of Na Business and Professions Code) or
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Jut W IS eumpt therefrom and the bub for the ailcgcd castigation. Any violation of
APN Number..
Occupancy Type -..
Sudan 7031.5 by My applicant for a pursh Subjects the applicant to a civil Penalty of
not ream than Five hundred dollen ($500).
36940017.00
01,uewner orJw pmpeny,mmy vmployeu wire w.{eauuetrmleaampewoon.
Re uired Inspections "'--- .-"j, -
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will do the work, and thestructure is noununled oroneml fovau(Sec. 7041, Business_
and Flaf ..1. Can: The Canusstues Liaise Law dma nal apply t9 ao matter of
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pmpenywhoWilds orimpmvesJureon, and whodeessohwurk Mmaelfor thmu{h his
owncmploym,prdvldedJWrvchimpr menumnotinundedmoRcudforaalait.
however, Ili impmveme within see Wear orimpro a fix, th
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Purposeof
bail will have Ne burden of proving Ilial he ala not Wild m improve fur puryose of
harve thetris ., than
sskJ. '
❑ 1, as owner of the property am uclusively contracting with licensed contractors to
_- • .- .,, ,- .. - ,(� -
construct the project (Sec. 7044. Business and Pkofesdons Cade:) The Countesses U.
_ /
cave law data not apply m an owner of property who Wilds or improve Demon. and,
-_._ .. ^- a `L—Jwho
conwets fmsuch projects with a contractors) licensed parsusnt in use Conuutor1
License law. s.
❑ I sus uempt under Sec. ,B&P C for Nis muon
\�\
[)caner Data
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WORKER'S COMPENSATION OECI.ARATaON.�,;-„;.:—_.__
I
I hereby affirm under penalty of peduty ane of the following declarations:
I haveand will maintain a Certificate or Cavern toulf-imam fa WorkeesCampen-
aaaan, u pmvidcd for by SecOon 37W of Jre Labor Code, for Ju Performance of the
. .
work for which this permit is issued. ---- -
❑ 1 have and will maintain Worker's Compensation Insunna; u required by Section
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3700 of Ne latter Can. far Ju perfarmana oftho wok fmwhich this pemtit b Wiled.
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My'
olicy/,1CarrierNo.:
i/V
�FICATF
FROM WORKERSURANCE
(This rection need pr heeomplued iflW Permit is fmane hundred do0an(SIM)
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or hum)
I comity that in to performance of the work far which this permit is issued, l shall not
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employ any person In my manuar W is in became subject in JC Wolken' CampnsWUan
""of California. Dau
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Applicant
NOTICE TO APPLICANT: If. after making this CeniBate of Eump ion, you should
Wrome subject in the Worker's Compensation provisions of the Later Con, you mot
faMwiub comply with Such provisions at this Permit Moll be assumed revoked.
CONSTRUCTION LENDING AGENCY
1 Wreby aRirm Wt Nen is a eamvcdnn lending agency for the Performance of
the work for which this permit is WuW (Sec. 31N7, Civ. C.)
Us&,'s Name
Lender's Addles
I aNfy that I have mad this pplleadon old suss tuns, she above Infonnadun IS
.
correct 1 agree in comply with all city and county ordinances and state laws reladng to
building construction, and hereby authodu representatives of Nis city in enter upon the
above-mentioned property for inspection purpous.
(We) agree to ave, indemnify and keep harmless the City of Cupertino against
IlabilWn,judgmcnu.W3u and apeues which may in any way. gains, Cold City
A PLr ANTcUNDERMnn S AIND WILL COMPLY WITH ALL N -P NT
Issued by: Date
SO REG LA
Re -roofs
Type of Roof
dtAPPI AZAR�OUS MATERIALS DISCLOSURE ta
Will Jus applicant or future Wilding occuput sure or handle buudou material
u defined by the Cupenino Municipal Code. Chapter 9.12• and the Hmlth and Safety
ode, Sadan:ss32(a)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yca ❑No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant tree equipment m dwiaes wbich
it haysdnus air ronuminuts as defined by the Bay Area Air Quality Management
all new materials for inspection.
Divim7
❑Yes ON.
I have mad the hinreq.im.nmurukrChapw6,95.(ftCaliur-
5533 mJ25534A.Mrsrardthatifthe Wilding
N&SafctyCa�01,ssaaovu.r
dace urunJ usymspxuitiili,yuptify eau ant fJure
maocnlficueofOca r'
-n';70
ON
Signature of Applicant Date
All roof coverings to be Class "B” or better
r sur emlmoyed a em ate