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CITY OF CUPERTINOa
INEOATION�"'.:
BUILDING DIVISION PERMIT
sCONTRACTflR
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BUILDING A44DRESS:
PERMIT NO.
ft 207U5 VALLEY GREEN DR
SOUTH BAY CONSTRUCTION CO
08090096
NEWS NAME:
PERMIT ISSUE DAM
BERG & ASSOCIATES
170 KNOWLES DR
09/16/2008
PHONE:
SANITARY NO. CONTROL NO.
(408)379-5500
ARCHTfECTYENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
Chapter 9
lob Description
1 hmcby affirm that 1 sen licensed under provisions of (commencing
wild Somwo7g10)orDivision 3 of thc Bust. setd Profcstians Code. and my license is
TEMP PERMIT - COMM' L TI REPAIR FIRE DAMAGE, ORIG
k full forte and ettm.
Lie a ( Lk.: 'A k2
#08090077; PERMIT GOOD THRU 10/16/2008
Dam Can g
DECLARATION
ARCHRDECLARATION
1 understand my plans Nall W used m public romNr
-
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby &pisco that I am exempt from the Contractors license Law for tW
following moon. (Section 7MI.5, Business and Profesons Code: Any city of county
which requires • permit to emomrsm. slm . improve, demolish, of repaf my metum
prior m its iaivaMe. also requlmt the applleml forsuch permit W file a Signed amWnern
W is liecowd to the of the Conmxetora Ucome Law (Chapor9
Sq. Ft. Floor Area$60000
Valuation
that pursuant provisions
•
6 0 0 0 0
(commencing with Section 7(00) of Division J of the Business sent Profcssioa Codc) m
y
that he as exempt thereftam and the basis for tW alleged esunlrd . Any viPlauan of
NumberType
Section 7031.3 by my applicant for a permit subjects the applicant to a civil penally ofOccupancy
butmow Jun five hundred dollars(3500).
32610046.
❑ I.uowrcraftlupmpmyamymplayertswiNw uJtebwkmmNmdon,
Required Inspections
will do thework. and thestroctuw Is rot intended or offered forsale (Sec. 7014. Business
and Prefessiom Cade The Cantracmes Leduc Law does oat appy to an owner of
property who builds a improves thereon, and who docs such work himself or through his
own employees, provided that such improvemmU are not intended oroRemA for sale If,
howewm the building or improvement is mid within arc year of caopletion, the owocr.
builder will love the harrow of proving that W did not Wild or improve for purpose of
sale.).
1, as owrm of the Property, am coclutively contracting with licensed conhacmu to
routruct the pmje s (Sec. 706x, Business and Poefeulons Cade:) The ConOacmrs U.
.
cv"- Law does em apply man owns ofpropertywW Wiles ori romr. tthereon.and,
who contracts For such Projects with acerusa or(a) licaread pursuant to live Contrastara
License Law,
mIameawp ser aSee ,B&PClorthismmon
was Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ow of ate following declamations:
0 I bam and will maintain a Certificate of Com=et to self -insure fm Wofkers Compen.
Wine, as provided for by Section 37M of the Labor Code. for tW performance of the
Work for which this p=rmit is issued.
❑ 1 have and will maintain Workers CompemNan Inmrance. as meshed by Sec ion
37(0of th, labor Cade, for tW perfmmanca of Je wok fee which this permit is Was&
My Workers Compensation Imarame carrier and Polity number are:
Carrier. 04IhIPSTI(- Policy No.: C24'JR 0`I$32L—
I
MFICATE OF EKEMPITON FROM WORKERS'
COMPENSATION INSURANCE
Inds sectton teed set W canplcted BIrc permit is fame hmt0ed down (SIOD)
or less)
Ice it that in tW perfemtama a tW work fa which this permit is issued. l Nall set
wp oy any pence to my manner an a as become subject to Ilte Wortann Compensation
`
Laws of California. Dare
Applicant
NOTICE TO APPLICANT: IL after making this Cenifrcate of Exemption. you should
become subject to the Woher's Compensation provisions of IW Labor Cade you mon
forthwith comply with such provision alts Permit" W domed mvaked.
CONSTRUCTION LENDING AGENCY
I Wmby alarm that Jtem is s contmtotim lending agasy, for the prsfarmamre of
the work for which this Permit Is issued (Sm. 3097, Civ, C.)
Lenders Name
Lenders Address
1 certify that I have mad this application W sum this the aWw information is
canes I agree m comply wilt all city and county ordinances and slow laws tesfing m
Wilding construction. and hereby authorize representativet of this city to enter upon tW
above-mentioned property for Inspection purvt...
(We) a to ate, indemnify and kap, harmless f City of Cupertino against
liebilitiea,J g nu, tato mdeapcuea which may in any waymcmo aga s mid City
in co W
Ir./�APPLI ILL COMPLY WITH ALL N N -POINT
f111
SOUR
Issued by: Date v
Re -roofs
SiPnuuze of ApplicanUContrxelor Daw
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
the applicant or future Wilding aecupmt Som w handle ItusNate materia
OWill
dcfrned by the Cupertino Municipal Cade. Chapter 9. 12. and f Health and Safety
)?
oda. zss25532(a)?Cy. �No
❑Tea
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant sew equipment a device; Mich
If a roof is installed without first obtaining an inspection, I agree to remove
emit huardom of contaminants as defined by tW Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Ym
Thaw read the huSccd=awriasmquircnwwunJcr Chapter G93ofJw Glding
/ ✓� // //� %
dthatifthe building
ns HeslthhSafeyhave. Sectin,00
/\
it
Jou one n have a mnanl Jin it s my tetpansihilily m trotifY Je ac Pmt of the
I/� 81
mgam nuwh munWmetpa anemeifcateofaea
Signature of Applicant Date
oft4- —S LI r��� i 10oz
All roof coverings to be Class'" or better
owns—S m Daw