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CITY OF CUPERTINO
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BUILDING DIVISION - PERMIT-
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BUILDING ADDRESS:
SOUTH BAY CONSTRUCTION CO
004120118 '
10251 TORRE AVE 220
OWNER'S NAME:
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PERMITISUBDATE - -
DR. SOARES
511 DIVISION STREET
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SANITARY NO. CONTROL NO.
(408)379-0400
ARCHITECUFNGINEER: --
BUILDING PERMRINFO
BLDG ELECT PLUMB MECH'
LICENSED CONTRACTOR'S DECLARATION .-
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1 hereby affirm Net 1 Am limmed under provision of Chapter 9 (comNcndny
wlih c0 WAA))of DMAkm3of Ne Busfenion C de.and Ic..Is,
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REVISION --IN HOUSE USE ONLY
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NO„NEW: PERMIT- ISSUED./ ORIG. #04090234 --
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OWNER -BUILDER DECLARATION
1 hereby mare that I am exempt from the Comracrors License Law for Ne
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following Masan. (Sudor 701.5. Business and ProfeWon Code: Any city or musty
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which requires a permit to celmmut alter. improve, drmmish, or repair Amy structure
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Priorxits iouenca.Abu roquise Ne appliesotfmwch pemritro0leaaigm Alow—un
ismnsedPerammI.mepdmaianoftheConme iJm�A (Chapter 9
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Sq. Ft. Floor Area -
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Valuation
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Nm he artxw
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(manmencing with Section 70DO) of Division 3 of the Business and Pmfcmimm Codo) or
at he le exempt therefrom ue basis for the Alleged nomption. Any violation of
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APN Number ..
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Seetion 7031.5 by any appilcam for a permit subjects the applmam to a civil penby of
Act mora than Piro hundred dollen (150)1.
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❑ 1, As ommoof the property, m my employm with "tun their sele aompewlion.
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Required Inspections -
will do Ne woo, and thestructele is not handed proffered formic (Sec. 7044, Business.
code: The ConcroYs Liana Lew does Actx apply an owner or
and Profusion m
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properlYwhowildsorimprmvtilmmn, andwho dmsuchworkhondfor thereto his
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ownemploym,provided dusuch impmvemanuaM notimeMd"offered f"sax. If.
however, Ne Wilding or improvement is mid within one year ofcompletion, Ne owner.
Wilder will have the burden of proving that he did not Wild or improve for purpose of-
sauJ.
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❑ 1, as owner of the Property am exclusively contracting with Il mmol Contractor an
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convect IN, project (Sec. 7064. Buthon and Profession Code) The Cts"ImAoh U.
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cone Law dm not apply to an owner of property who Wilds or improve the con. and,
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pursuant Ne Contnnora
who contracts each projects with wlaconuacror(q lianxd Punmro
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ense LoLaw.u
License
❑lam uempt undo Ste .BB PC far Wsreasen'
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WORKER'S COMPENSATION DECLARATION .,,,-.=,,,, �:.-a-.
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I bereby AM. under Acca tY of perjury ou of the following declensmu:-
haw end wEl maintain It CWfiam of Cement x sel5luum for Waiters Compere
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rhthifor which Nis permit Is Issued.
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haw and will maintain Worker! Compensation Inarana. as requlRd by Section
of Ne labor Cade, far Ne peformanm ofNe work for which Nu peemit u loud.o
CampensW"Ittiaa)nmcarteran oil umber are:
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CE IFICATE EJM OM WORKERS'
COMPENSATIONI SURANCE
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coria section need n"Wcomplexd time permit is Treses handed daBN(SIEB)-
orIC6L)
I certify Not in use performance of the work for which this permit is Issued. I shall not
employ any person In any mannerW Y m become subject to tW WorkeKCompenadon
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Uses ofCWfomit Data
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NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should
become subject to the Worker's Compensation previsions of Ne Labor Code, you mum
OfoMwith
comply with such provision or this permits hall W domed revoked.
LENDING AGENCY
r^yiCONSTRUCTION
. I horehy.111. that there is a consmeson lending agenry for the perfiermaue of
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tite ..,it for which Una permit is Wood (See. 3097, CN.. C.)
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Lender's Name
LendersAddrnas
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1 m ufy that 1 hew rid this applicedon and sum that the aWro Information i.
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"Am"L 1 qMe to comply with all city and county ordinance and sou lows Mistiest to
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building construction, and hereby authodn reprexnulives of this city to enter upon the
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Ahmo-mmummed property for Inspection purptseL
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(We) agree to save, indemnify and keep harmxas the City of Cupertino against
liabilities, Judgments, coats and expense which may in any way acerm again said City
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consequence Ne {anti !this permit.
T UNDER S AND WILL COMPLY WITH ALL N P
Issued by:344Date
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Re -roofs
Applmnt Cont w DueHAZARDOUS MATERIALS DISCLOSURE
1ype.of Roof
rofApplmntCon�w
Nc applicant or for. building occupem atoll or handle haumoas material
y se CupeNno ideal Cade. Chalur 9.13.and the Hcaith and Safcryn
25532(.)7
All roofs shall be inspected prior to any roofing material being installed.
❑Nothe
a roof is installed without first obtaining an inspection, I agree to remove
epplinanl r r x building oeeuP.nl sax equipmeml ar device whianIf
nn air mmaminan As dcnned by the Bay AMA Air Quality Management
all new materials for Inspection.
Dimrict7
Oyes ❑
Ihavemad Nehoardnusme dab Mquircmenu under Chapter. G95of Ne Califur.
este IthkSafety CcA1C1 ion SSIISj5577 And 25334.1 underal Nui:.-bu ing
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curtcntiy Wroa etI smY MsponUhllitYxnosl'y Ne LYUPan (Ne
u cre ham. 'pxitsumeconcotncaeo10' paneY
Signature of Applicant Date
All roof coverings to be Class " B” or better
Owner ar seNorizcd egcm Date�