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CITY OF CUPERTINO
40',C 0 RJNF RMATIONS4
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT N0.
20370 TORRE AV
' 'NER'S NAME:
PERMITMUEDATE
CTC FUNDING LLC
03/31/2006
PHONE:
SANITARY NO. CONTROL NO,
ARCHITECT[EbIGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACT'OR'S DECLARATION
'
b
I affirm Nat I an IiCemM under provisions of Chapter 9 (commencing
ascription
i
n?0effecDivision Sof NC Business and Professions Codc. and myliccnx is
with ion?
TENANT M - ACE CHANGE FROM OFFICE
in full forty and _Rett i ,
llforc
Date Cunuxctor 1 "[
pQ�V �g�
'O SH0WR01a1HI v 2006
ARCHITECTS DECLARATION
V
1 understand my plans shall be used as; public records
Licensed Pmfcuiona]
OatHER-BUILDER DECLARATION
BUILDING
I hcrchy .(Seco that 11. exempt from the Cnntmcmr'f Liccnu Law for the
following mason.(ant(Section RI] L; Baxlnnss and oli Code: MY city or county
the
Which requires a permit re cnmtrvm, alcor, impmw, demolish, or repair any awctmc
improve.
prior W its issuance. also requires the applicant for such permit to 01c a signed statement
that he is wit pursuant flic the LlwloClaw(Chapur9
Sq. Ft. Floor Area
Valu I
7to
(Comm encingwith Sedinna ")of Doionsof
ncing of Division) of _Business Professions CSN_) or
and alleged exemption. Any violation of
that io u exempt IMaefrom and 0u hula for the alleged cumpnt
to
Semon ID any applicant rs a permit subjects me applicant a civil penalty of
�737�t,�t.e y�
TY"i
Occupancy Type
not more than Ree Wndred dollars (ssooj.
. five
3 O'7e£ l7 V 0 0
❑ 1, u owner of the pmMay, or my employees with wages u Noir sole wmpenudon,
win Pr thework, .nae: no on isnot intendedm tow dos not a(Sec.to a4, owner
end Protrusions Code: The ConuecWrk License law dose not apply lf an owner of
Required Inspections
enywho uchimprovand who through his
man aressuchwmkhimxlror
own employcu, provided mal such improvements are not intended moRered rmule If,
yesca. providedOat
however the building or improvement is sold within one year or comp(_ Ne owe
builder will hbu
hew the rden of proving Nbe for al did not Wild or improve far purpose of
of
salt.).
❑ 1, as owner of On property, am exclusively contracting with licensed Contractors W
construct the project (Sec. 70", Business and Professions Cade:) The Conuacwr's Li.
cense Law dose not apply to sat owner of propcny who Wilda ori arrows Hereon, and
who contracts for such projects with a contructor(n) liwnxd pursuanuo the Contncmra
License Law.
❑ l am exempt under Sec. B k P C for this notion
r Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury oro of the following declatations:
❑ Ihaw4WwllmeinuinaCcrriiwmof Cnu_n,Wxlf-imumfm Wor esCompcn-
sation, u provided for by Section POB of the labor Code. for the pcofm nano, of He
work for which this permit is issued.
I have and will maintain Workers Compensation Insurance, as Rquited by Section
3700 of He labor Cade. for the performance of the wink for which this permit is issued.
My AreCompenudon lasumnen canter and Policy number an:
Cartier. Policy No.:
CERTIFICATE OF E% MON FROM WIOtv
COMPENSATION INSURANCE
(Thlesection need not be completed if the permit Is portion hundred dollars (SI00)
less)
1 sonify Out in the performance of the work for which this permit is lesions. I shall not
employ any person in any manner. as to become subject to Om WmkerS Compcnudon
Laws of Califomis. Dau
Applicant
NOTICE TO APPLICANT: If, after making this Cenifcare of Exemption, you should
become subject to the WoAcri Compensation provisions of she Labor Code, you moral
roMwith comply with each provisions or this permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm mal them is a Conswction lending agency lot W performance of
He work for which this permit la issued (Sec. 3(197, Civ, CJ
Under's Name
Undcr's Address
I Certify mat 1 have mad this appnention and sun that the above information is
cuncct. 1 ague to comply with all city and county oNinaners and state laws relating to
building Conswction, and hereby attoome representatives of this city to enter upon the
shove -mentioned property for inspection
(We) agree to saw, indemnify and loop hannnss On City of Cupertino agaiml
whichpurProes.
ITabillsicsjudgmc a lases which may in enY way eccrvc a8ainst said City
me onxquerWe Ne grutng of this molt.
APP NT ERS? NDS A WILL COMPLY WITH ALL NON -POINT
Issued by: Date
S RC UL T
Re -roofs
Type of Roof
atu fA YC tract DaW
H AR U ATERIALS DISCLOSURE
Will dm appli to, lure building occupant 11, or handle hrardom mannal
u defined by On Cu nMan" pal Code. Chapter 9.12. and the Health and Safety
e. Scctnn zss3z
❑Yin No
All roofs shall be inspected prior to any roofing material being installed.
W01 the applicant more building ticcupam sex eyvipmcm or devisor which
If a roof is installed without first obtainingan inspection, I agree to remove
P $
in
_mil haraNnus air conuminuu cfincd by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes
I have mad He smaunaHaquimments under LTapur A.95orIWCalifor-
niaHcalth &uSafcty Code. Sect SW5.255]J Cod 25534.1 understand my if du Wilding
does curtcm1, haw a recant w it u my ouromeMlity, in entry Uc occupant or He
re re Kat IWme aorto. nsoccer.c.lican fOccpan,
Signature of Applicant Date
All roof coverings to be Class "B" or better
er nrixcd nDate