06110023 CITY OF CUPERTINO
BUILDING DIVISION PERMIT C�N' RAGTO;RIN 'ORMATIQN
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: Twsn PERMIT ISSUE DATE
7ARCHrrECTfENG[NEER:
UNTER PROPERTIES 170 KNOWLES DRIVE, STE 120 12/22/2006
'
SANITARY NO. CONTROLNO.
(408) 379-5500
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
pp LICENSED CONTRACTOR'S DECLARATION Job Description
w C hereby afro WI 1 am licensed under pmvsiom of Chapter 9(commencing« tionTrttu)mDivi anJafweBuainessandPrnfeuinmCdc.,andmyliccrteia CONSTRUCTION OF NEW DEMISING METAL STUDWALLS
rce and effect. 3 36 CJ
iqiq Liccnsccl - Lic.x L NO GYP BOARD, SEPERATING FUTURE TENANT SPACE,
77
'�W Date a D ARCHITECTSSDEXLAsT10N x 11 NEW MECH. UNITS, 2 1600AMP METERS, 9 200AMP Ga iv��n.�
i 1 undersand my plans shall he used u public records
i a v MTR
`w rte„ LittnscJ Professional
OWNER-exempt R DECLARATION
I I hcrehy.(Trtn that 1 1. exempt from the Craime, ou License Law for the
p o following meson.(Section 7lo I.S Business and Professions Cam:Any city or county
.m( which requires;a panni,tu aorta rho alter.impmsu;dcmmW,or a sig any swctum
;Fi pnarwits issvnceuarmamquires 01oviac of for Contrach ctor's
Loe.Lsw(ed suwmcn,
:Zrimuthciacingwitpurwam7 the,")provisionsofWCanuacwrin ProfesawlCTaptcr9 Sq.Ft. Floor Area Valuation
i I-a that Weaving with therefrom
and the
basis f J of the Bud"•.s and on.Any vi Code)at $60000
a r5$ that io u esempl therefrom and the baso for Ibe alleged exemption.Any violation of
Section 703 LS five
any hereat ant for a permit subjects the applicant to a civil penalty of Number Occupancy Type
cert mare man res hmnamd dollars(15007. 36940002 � P Y YP
0 1,v owner of the Property,or my employees with wages as their svlc compensation,
will do the am&and meswctam Or not intended aoffeed for ulc(Sec.7W.Business Required Inspections
and Pmffesdanu Code:The Canuanon Ligase law dues ronst apply w an..of q P
properly who builds or improves Oa.a,and whodoessuchwarkbirrself or Waugh his
Own employes,provided that such improvements em not intended wa@aed Torula If
hawevv,the building or improvement is sold within arc year of completion.the ower.
builder will have the burden of proving mat he did not build or improve for pulpae of
calk).
❑1,as owner of the propcny,am exclusively commcting with licensed ma=.to
construct the project(Sec.7004,Business and Professions Cade:)The Con ns:or's Li.
cave Law does at apply w an owner of Iampeny who builds Of imprasv dmtmn,and.
who contracts for such projects with a comnerm(s)licuned pmuam w the Contractors
License Law.
❑1 am esempl under Sea. .B h P C far this mason
Data
WORKER'S COMPENSATION DECLARATION
I hereby alnna under penalty of perjury ane of the following declandiov:
❑1 ba.c m,d will mainuin a Certifimm of Covent m wlf insure forworkces Compen.
satian,v provided for by Section 3700 of the Labor Code,nor 01e performance of the
work for which this Permit is issued.
❑1 have and will nommahn Workers Compensation I...as myu red by Section
]700 of the Labor Cade,for me performance of Oa work far which this panni,is issued
My Workers Compensation Laurance artier that Peliry mother am:
Carmen Ga✓�^'duf-J (kw�r�PrayNo.:_43(2'L2—IZ
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
IThiesccuon need notbecompleted if the penal,is(a,one hundred dollars(SIM)
or leu)
1 certify that in the performance of me work for which 0113 Permit is issued.I shall no,
employ my person in any manner.u is became subject w dm Workus'Compensation
Laws of Califamia.Data
Applicant
NOTICE TO APPLICANT:If,after making this CcNfin¢of Esemp,ion,you should
became subject w the Workers Compensation provisions of the labor Code,yam meso
.,O fonhw,0 comply with such provisions or this permit shall be deemed rovnkcd.
Z'� CONSTRUCTION LENDING AGENCY
F+�' IbemhyaRrm that them is a covwetinn lcndingagemy for Ute perrmarm.of
1_4 the work fur which On permit u wood(Sec.3097,Civ,C.)
W�Q Landers Name
Z Lenders Addmas
U Q I cenify that I hale had this application a,ul saw des the above information is
I, F correct.l agree to comply with all city and county aNinances and sum laws relating to
0 building coniWaionr and hcmby auth nom mpeacna,ives of Nis city to cater upon the
0.i abovementioned property for inspection purpases.
(We)agree to save,indemnify and keep harmless the City of Cupcnino againm
tFi N liadhil.,jmdgmcnts,
costs expo"•^•which they in any way accrue against said City
C)z in on 0of the granting of Our
permit.
^" AP IC UNDERSTANDS AND WJ�COMPLY WITH ALL NON-POINT Issued by: Date �" �Z�
5 URCE GULATIONS. /�
_ r 't, �! L'1 lu'7 Re-roofs
Sign al ApplixantyContractaran,
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will W applicant or raw.building ompant stom or handle havrdous material
as defined by the Cupertino Municipal Code.Chapter 9.11,and me Health and Safety
ale.Seeuon 15531(x)?
❑Yes 9 Nm All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future wading Occupant use equipment or denies which If a roof is installed without first obtaining an inspection,I agree to remove
emit haaaNnv air canuminan v darned by the Bay Ama Air Quality Mmagcmcm all new materials for inspection.
District?
❑Yu u
I have mad the hem d,ws materials mquitements under Chapter 6.95 afore Califor-
naHcalth&SafeLycode.Satirns,2W5 33 aw11553.1 adcrs,and thati(thc Wilding
d urtcmly have a mum,ddssd��117 t it y mapamih,li)"o rpdry des upon,of des
yes ants which must bcydyQdor uvmc ofa Team of Occu ane
� �; �d7 Signature of Applicant Date
owner urauthori,edagent Date- All roof coverings to be Class"B"or better