01080107a
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS
PERMIT NO.
20300 TORRE AV
CONSTRUCTIVE BUILDING SV_-,
INCO1080107
OWNER'S NAME:
APPLICATION SUB DATE
CUPERTINO CITY CENTER ASSOCI
T 3937 39TH AVE
08/21/2001
PHONE:
SANITARY NO. CONTROL NO.
(510)531-1175
Z ARCHITLCT/ENGINEER:
BUILDING PERMIT INFO
c
BLDG ELECT PLUMB MECH
i LICENSED CONTRACTOR'S DECLARATION
Job Description
I herchy affirm m that 1 ma Ileenud under pn)%i.xnn, of Chapter 9 (commencing
with Section 7")(if D ins.. 3.1 be Bmsmea, a. l I xyq`C de. 4m econs,
rmmeataea
TEMP PERMIT.
LC s Lie, x
DDitecense
(EXPIRE ON 09/21/01)
um Commmor
v A CHITECT
led a> al add 1 unJemunJ my plain shall he nhli r
CLicensed Prufnsi... I
um, OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
G following mason. (Section ]031.5. Business and Professions Cade: Any city or county
e which requires a permit to construct, alter, improve, demolish. or repair any structure
- - -. - - - - - -. - ._ __ _
7.5
e,..primI 'I'. mance also m9 the ppl' an for such permits be 'gad hommunl+
( ,,� Sq. FL,FIOOr Aces q y
a Ration
i
- at he I niedP naanfl the d ici s of the Contractors Ito (Chapter
(hSq.-
7000)fD ion 3 Business ProfessionsCode)
(commencing with Seton of the and
or that he Is exempt themfmm and the basis for the allfgell aampaimil, Any violation
it s3 ,•"_. ;M7,. >t
of Section 7031.3 by any applicant for v Permit subjects the applicant to a civil penalty
A umber
- Occupancy Type
Inf hot more than five hundred dmlmt,(a5Bo),
❑ L vs owner of the propmy, or my employee with wages as their sole comprnsadon._
-
`'" f •'
will do the work: and be suuc um is not intended or offered for sale (Sec. ]BW:
"Business
and Professions Code: The Contractor's License Law does not apply to an
Required Inspections'".
caner of pmprny Who builds or improves the tim. send who does such weak himself
1
of through sol own employee. provided that such vementrmenln are not intended or
of
r comple for sok. If, however, the building m improvement of moa n sold within noes Wild
lder will have Ne burden of proving thin he did not hind or
completion, the owe,
of sat
improve for purynse of ale.).
❑Laso*her of (he pro cn� nadmaivelycontructssionsodc,) licensed contractors to
"_--
memct the project (Sec. Business and Professions GdoD Tac ctor's
I. improves tit
License Low does not apply to vn owner ofpmpcny who builds or improves themon.
." sad.who convects for, such projects with a. contractors) Iiaased pursoant m the
_ .. __-. ... ... ... _.... _ .. .. _ _
C mnemr's License Law.
❑ I am exempt under Sec. ,B&PC fmthis reason
,r I
l rtl•` I
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury mm or the following declarations:
❑ 1 have and will maintain a'Cerifeate of Gmsen(to sel4insum for Worker,
Cmmpsation, as provided for by Section 37W of the Labor Code, for the
'performance of the work fm which this Permit is ismai..
Vvc and will maintain Worker'a Compensation Insurance, as requir) eby Section
3 1 0l the Labor'Codc, for the p ilmoname, of the work for which this pctmirix
sits d. M tr//��.. C pe t I ,ince curt cr and I Y M
- -
caro lU ii4N r r
s i �.. r; "1 yq '}L ..
CERTIFICATION OF %EMPTIO F O WOR ERS
J. xt
..
COMPE SATION INSURANCE„
_, _ ...—
," _.
(Thisttctim..,oil noihc coardail ifthc pcnnit is for one hundred dollen
S(M0 nr Icss.l •,
;
' ccof the work foi which this permit is iswcd.l
I card" them the petro
's1uI1
nY•,.�G..%r,:.IT:
not employ saypermif in any manner so'as m become subject m the Workers
'un Lows, 'f CaliforniaDine.
ACo- iwm
dr nr Exemption, rum snmmp
NOI'ICC TO APPLICANT. If, arta making ;hismvi
• .. .
ns of"
become sublcn m the Workers ComMnution p the Lahr Code, you must
'
forthwithcomply wadi such provisions mpermit shall be JeemN invoked.
__. ... --
- .. .. .- . _, .
CONSTRUCTION LENDING AGENCY .. ;' • .1
,
that thcrc t it ii. lending agency fur the pcifo�manm
f
' ' r
intsed iS
Lathe woName which this permit is i.aued'ISec. 3ll9]; Civ. C.I
workwhich
Lendcr'x Name ".. -,... •. ...... ._.
Landers Address"
I comfy inti I have mad this application and state Inas the above information's
correct. I .gree m comply with all city and county ordinances and some ews rclium,
j to building c . Inaction rid hereby maturarrac representatims of this city t nor upon
y2 the dsom-areationed property for sid%,actionpurposes.,
y (IN's) ago m sv demmfy d keep h mless the C ty f C p o ag nst
A lash 11 pal d exile as y in any y gains) said
ti City- . g t"g nth' pc t
' Sf RC L OMYLYWITH A NON -POINT'
Issued by: Date 2J
Re -roofs
si esu emamctoa Date .r :.
HAYARDOUS MATERIALS DISCLOSURE
., c appli'am or morebuilding'mccupim srme or handle hmaNnm motorial
Type of Roof,
,.
a n the Cupertino Municipal Code, Chapter 9.12. axil the Health and Safety
' ' ,,. ,•
C 5 uo 2553 (alp r dpi•
'OY -",••,;�'. -+d a.
, .,'
_ All roofs .shall.beinspected. prior, to,any. roofing. material being installed..
.1'wulthenpplicamnafnambuildingoecmpnlmace,ipmeatmdeiee.which
�m
If a roof is install ed'with'outfirst obtaining an inspection; l''agree.tofremove
emlM1uM."m artcons sdf"dby theBay Area A Quality Management
District^
all new materials for inspection. Applicant understands and will comply with
�':°' �,
all non -point source regulations. -
r.
,.1 •,),, ,� •
I have mad the h' mi materials mquvemen¢ under Chapter 6.95 of the
mie ad a,.1 understand (hat'
Soar Code, Srniolcna-
if
- _- -
ng Jn l�yml cute I t IItis my
the of mY rc pain
of o'cty
which Prior ficue of
ecu m a l (t t h it neat I p I 'i, c nifda/m mf'
.a. �,
'- °` p° ? �,011
Signature of Applicant Date
_.
All roof coverings to be Class "B" or better'
I n age Due f—
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± OFFICE