04080037CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
SOUTH BAY CONSTRUCTION CO fRrNO04080037
10271 TORRE AVE TIT.VT) 9.
OWNER'S NAME:
PERMIT ISSUE DATE
CTC FUNDING LLC
511 D VI
Eo
- SANITARY NO. CONTROL NO.
(408)379-0400
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDGELECT' PLOMB MECH
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LICENSED CONTRACT'OR'S DECLARATION
Job Description
P
1 herebyaffirmMa1ffirm that 1 am licensed under provisions of Chapter 9 (commencing
).f Divi.km3of Ne Busin n and Profnsium Cod).andmylicenscis
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A��ue.«
REVISION --ROOF TRUSSES
License
Dam canmemr
NO NEW PERMIT ISSUED/ ORIG. #03080087
��ii ARCHITECCS DECWAT N
1 oltbrstand my plans shall W used u public records
-
Licensed Professionol�
OWNER -BUILDER DECLARATION
License Law 0W
I hereby ¢Tran that 11. exempt from Ne Cssiom
Co co
following mason. ]1n1.5, Busiaw and ons Code: Any city s county
a
demolish.Fie anytecure
permit t improve. e
whish mgnlmsapWmlt rel consumer, after. ImpmM,hm
iii a sig statement
Fetor to IIS cen ed p ..also requires Bar the vision o for sucCon pmmil toFileLicense Law apten
(cothe is Pumuao 7000) of the
Sq. Ft. Floor Area
�i a�a n p -
mecccvcd
eBusinessnd Prorlsw(C Code)
9090) of Division 3 of the v Code) or
(commencing with of Division
exempt
hectiro
alleged on. Any
Nat he is exempt therefrom and the bssu for the alleged exemption. Any viola0on of
that he is
APN Number
Oeeupane e
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Finally of
not more Nan five hundred dollars ($500).
36940017.00
❑ 1, as owner of 070 property, Or my employe" with wages as theirsoic compensation,
Required Inspections
will do the wok. and the stmmum is notimmnded oroR)red forsale (Sec. 7044, Business
and Professioru Cade: The Croquettes License Law dam not apply In an owner of
_
Property who buildsorimprowa Hereon, and who doessuch work himself oritrough his
own employees, provided mel such improvements am not intended oroRered forsele. If.
however. He building or improvement is sold within on you of completion. the owner
builder will hive the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner or the property, am exclusively contracting with located contractors to
construct the project (Sec. 7044, Business and Professions Cede:) The Contacmri Li.
cense Law docs not apply to an owner of property who Wilda or improves thereon, and,
who contacts for such projects with a contactortt) licensed pursuant to the Contractor's
License Law.
❑ 1 a e exempt under Sec. . B & P C for this reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby of nom under penalty of perjury one of me following declarations:
have and will maintain a Cer ifeste of Consent to ml6insum for Worker's Cumpen-
70n, ss provided for by SeNo t 3791 of me Labor Code, for the pnrfomnsnc of the
work for which His permit is issued.
❑ 1 have and will maintain Workees Compensation Insurance, as required by Section
3700 of He Labor Code. for the performance of me wok for which this permit is issued.
My Worker'Ts JC�o�.m.p.e�n�satio1n Insurance �carrier and Policy number y:
Carrier. l Cle�lFs-�r Policy No.i �0
193%L_
ERTIFICATE OF EXEMPTION FRO WORKERS'
COMPENSATION INgURANCE
(This section need not W completed if lW Tomtit is foro m hundred dollars (SIM)
or oss.)
I certify that in the perromance of the work far which this permit is issued. I shall not
employ any person in any manner so as in become subject to the Workers' ComFensation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If, alien coking this Conditionof of Exemption, you should
became subject tt the Worker's Cocpunsa previsions of me labor Celle, you mon
forthwith comply wire such provisions or his permit shall W deemed mvokctl.
Comply is
'
CONSTRUCTION LENDING AGENCY
1 Wseby .Iron Hat mem I,. construction lending agency for me perfurcmce of
the work fur which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
lender's Address
1 certify that I have mad this application and sum, that the above information is
coma 1 agree to comply with all city and county ordinare s and soon laws miming to
building construction, and hereby outhonm reprosenooiwa or this city to enter upon me
ahove-mentioned property for inspection puryrus.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way seem= against said City
in consequence of the granting of this permit
APPLICA,NT UNDERSTAyD$ AND WILL COMPLY WITH ALL NON -POINT
SOUrE L tJIs1N5j' ` /�
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Issued by: Date
Re-roofs
Signature afApPlicanUCant car Dam
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof f
Will Um applicamor future building occupant store or handle hnarmas material
in defined by the Cupertino Municipal Code. Chapter 9.12, and IN Health and Safety
Code. Section 25532(a),
All roofs shall be inspected prior to any roofing material being installed.
❑ Yu
If a roof is installed without first obtaining an inspection, I agree to remove
Will me applicant or forum building Occupant um equipment or devices which
_x/andous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
strict,
❑Yea 7f'Wu
ve rs materials mquircmcros under Chap¢r6.95 roma Caliper.
I hamad the havaNu
nia Hoddi & Sefa,Cme. Sections 25505,25533 and 25534.1 understand thaifthe Wilding
docs not currently haw a On at it is my r)sponaihility to notify IN Occupam of the
requirements rL m tW IF to issuance Ofacenincate rGetnp Ly.
Signature of Applicant Date
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ror�h
All roof coverings to be Class "B" or better
Own