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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT.
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BUILDING ADDRESS:
PERMIT NO.
1.0393 TORRE AVE STE L
TBD – TO BE DETERMINED
08070062
R'S NAME:
PERhm ISSUE DATE _
FRED SCHUERTOY MD
07/10/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECfIENGINEER:
BUILDING PERMM INFO
'BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Description
I hereby affirm that I am limned under Previsions of Chapter 9 (commencing
with Section 701111).(Division 3 urine Business and! Profeuivat Cype an Yiimrsseis
NEW CBNTS FLRNG,PLMBNG(SNKS) ELCTRCL
in mu Come oral eflecl
1[ `r
License Class Lie. .S//
OUTLETS&LIGHTNG
Date ft HIM CTSDECLA A ION
ALLPHASE CONTRACTORS, INC. DBA ALL PHASE BUILDERS
1 uMcrsuml my Plans>hall be uxd u public recoNs g.�f/i 'L!
Licensed Prefewmail
OWNER -BUILDER DECLARATION
1 hereby aRrm that 1 am exempt from tie Contractor's License law for tbe
following reason. (Sectied ]M". Business and Profcssons Cods: Any city or County
which cal a pmmft to cmnwum, alter. imlrtme. demolish, or repair my structure
prior to its issuance, alm requires the applicant forsuch Permit in file a signed statement
be is noosed to the or den Consumer's larch Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(bat pursuant proviaimu
(commenting with Samoa 70D0) of Division ] of the Business and Prolesmarts Code) or
$60000
dun be is exempt t erefmm aM the basis far We alleged exemption, Any Notation of
'
-
Occupancy Type
Section 7071.5 by airy, applicant fears permit subjects the applicant to a civil penally ofumber
not mart dun five hundred dollars ($5W),
3 6 9 4 0 01' 9 .
0 Luowrc ofdsproperty, many wPloyces with w{esudevsolecmnpensadon.
Required Inspections
ad dotiework and the waw 7044, Bwineu
dens act a(Sec.
and Rtyvolm ns Cade: The Conuacce, License law does owner of
he Cmuuer'sLim apply a
ar himselfarthreugh his
enYwho Wlldaorid who ,t
thovesch improve aresewh
owns oroRu fm tale B,
own employees, provlded tart such improvements seanenu tae not
however, the arointended
4 sold within one year of mmpv for dee
i ,
tbuilding u
en of Pa is
ore of
builder wail base ties burden of proving that be did vel Wild m Improve far Purpose of
have
isle.).
❑ 1, u owner of the property. w excluaiwly conwuing wide licensed mousers to
mmwcl the project (Sec. 7044. Business and Pmres9ons Code:) The Cedraclsr's U.
.
cam law does not apply to an owner of property who Wilds or improves Merton, and
who contracts for such projects with a comnnor(s) licensed punwnt to the Contractor's
Licence Law.
Iunemnapimider See .Ba PCforthismuon
Data
WORKER'S COMPENSATION DECLARATION
I hucby affirm under penally of pedury orc of the following declarations,
❑ 1haw AMwillmaintainaceNbcamofconsentaself-imamrorwar escomNn-
rte by Section 3]00 of the lobar Code. for the perfonnamu of dee
Workfor
wIXk far' whKh tali pemlll Y Iliums.
❑ 1 have and will maintain Walker's Compensation insuMm, as required by Section
37 .f Ne labor Co. fns the Perrarmanca.film work for which this permit is issued.
My War Compens tion has curia and Policy number are:
O
Curio. Policy No.PLO lbs Q2. 1.3
CE lwl -rE OF EXEMFIION FROM WORKERS'
COMPENSATION INSURANCE
(Nu soared need shot be aompleted if Ne Permit U forane hundred authors (5100)
or les)
I certify that in arc performucc .f Ibe work for which this Permit is issued. I shall not
e:npl.y my person in any marvel so u at bmomc subject to the WarkerY Compensation
laws of California Dec
Applicam
-
NOTICE TO APPLICANT. IL after making this Certificate of Exemption, you should
become subject in the Workch Compensation provisions at the Lahor Code, you muss
'
ranbaith comply with such provisions or the permit mull he ticemcd revoked.
CONSTRUCTION LENDING AGENCY
I heuby affirm that thcrt is a construction lending agency for the perfermame of
the work for which this Permit is usual (Sec. 3097, Civ, Q
Lender's Name
haler'. Address
1 certify that I have mad this application and state d u Use .bow informstied is
mrccs I Agra m comply with ml city and county odinarcea send stats tan elating a
Wilding mnstrmlion, aml Wreby authorise mprewm,m es of this city a now upon the
above-mentiaMd property run Inspection purposes
(Ws,) agree to save, indemnify and kap harmless the City of Cup sting against
liabilities, Jad menu, cow and expenses which may le any shy accrsse agame(said City
ince In{ofthe Temic
APP NT DERST IT
CADERSTANDS AND WILL COMPLY WITH ALL NON -POINT
—7>._ /O, G"P
Issued by: Date
SO RCE REG CATIONS.
Re -roofs
Signuu of IianUConuactar Data
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Lwn1 the applicant or fuam building occupant sem orhandle hassrdous materia
Road by the Cupertino Municipal Code. Chapter 9.13. orb the Health and Safety
ar
. Seed 15532(,)7,
[:1y.
All roofs shall be inspected prior to any roofing material being installed.
Will dee a I -am ter foam Wilda acehr and sow
Pp p cquipmenlordcvima which
If a roof is installed without first obtainingan inspection, I agree to remove
P
emir hasudow air cedtaminsmts u d by the Bay Area Air Quality Mansgcmem
all new materials for inspection.
Dimictt
❑ Yes u
I have read the hxardeds materials hryniremenu undcrchaper6.95.1'ace Glirm.
iia Hral"S yCade, Saar. 25505.73533 am125534. 1 undermural thaifthe Wilding
dans and "WEndy save a tenant that it is my responsibility in notify the omupant or the
requiremc tswhic mot be met pct ruin( m ofacertifeau.facupx
Sig nature of Applicant Date
All roof coverings to be Class 'J}" or better
Owner orm . sd agent D,te