06020109BUILDING
PERMIT
I hcmby AM. that I am Ikemed under Provisions of ChaPmr 9 (commencing
with Section 7(00) of Division 5 Of the Business and Pmfnssiom Cade. And my Ikon¢ it
in full forte and affect.
Licenec Class LIC. As
DamContncmr55
ARCHITECTS DECLARATION
I ulrdevund my plans shall W used u puhOc rtenr Hm1NA HNA'
d C071—�V
Licensed Professional
OWNER -BUILDER DECLARATION
I botchy Mano .(Siem on 1exempts an the leases Co LiAny c ty a for the
following mason. permit
t 71)31.5. Business end sae, de um Code: Any city or county
which requires • e, sho re emotional,Thealum Improve, h Permit t,11 repair any Nmcture
prior m its ivumco, elsentrequiresthe the applicant forsuch Permit m ce se Laved statement
Nm W is Ikcnwit puervanl to the Of Division
of the he SummA and
law (Chapter r
that An is
wonthectlon and of Division? of the Budnwandon. Anynvi Gain)ter
Nn io u eaempl ihemfmm and the aper it the alleged eumant W Any violation of
not me than by my applicant for a permit subjects the Applicant m a civil penalty of
not mort Nm five hundmd dollen (g5W).
0 1, a own" Property. or my employees wIN mgm v Mle aampensadon,
will da Nc woh.a in' "notlnlendcd wth 7 ode (Sec.70d4,Buti•...
.,,d 0.nM1.dnn. 1 m n rmm�arm4 Lk...v ml mole la an own" of
builder will have the budmy
sale.).
0. u Manor of the Property. a
com orml IN pmjees (Sec 7044,
cense law dM" not apply m an I
who comments fm such pmjeca v
Us. law.
0 I am A.Men ural" Sec _
yearofcompletion.theovous,
altar improve for purpose of
B k PC for this maw.
Dam
91 WORKERS COMPENSATION DECLARATION
1 hereby M. under penally of perjury mm of Ne fallowing declasalims
O lhtw..,l Mllmainuina a nsanua MY-teamforWorkersCompen-
.don, as provided for by sec the labm CMM, far Ne performance of the
work for which this permit' mord.
Thaw and will maintain Workers Compensation Inrvnnce, As required by section
57M of Ne Mbar Code. for the performmce of the work fm which Ihu permit is blued.
My Workers CoAmpenvlim Inrvmmm gamier and Policy number
tastier. Il C 1. i1-- Palley Na.:
CERTIFICATE OF EXEMPTION FROM WOR ERS'
COMPENSATION INSURANCE
(This well =ymr
eted if the permit U far hundmd dalhn (gltk)
or less.)
1 certify Nat In thwork for ch nth permit is issued. I shall not
employanymnamm bcpd6rvbject to dm Wmions'Comperumdan
become subject As the War a Compensation pmviuNe Labor Cents. you mutt
.JO forthwith comply wont provisions orNis Pcrmil t1lW med revoked.
Z.~N.. CONSTRUCTION LENDING AGENCY
E -t I hereby affirm NU Vert le aconslrvNon lending agency for NC Performance of
a � the woh for which this permit is issued (sec. 2f1Yf, Civ. C.)
W'0 Lender Name
= z Lenders Add.
U Q 1 certify that I haw mad this APPlicauon and sure that Nc shove infomou's" Is
W F" comem I agree to comply with all city and county ordinances and Main laws miming As
0 V Wilding construction, and hereby autborrra Oprewnutives of this city to cnmT upon die
aWvomentioned property for issecuun purpowM.
(We) agree m saw, ind... I fy and keep harmless the City of Cupertino against
w ta] liabilities. judgments. costs and expenses which may In my way ammo against Mid City
U Z in consequence of the granting of this Permit
APPLICANT UNDERSTANDS ANB WILL COMPLY WITH ALL NON -POINT
iDOUS MATERIALS DISCLOSURE
futumbuilding mcupantm ucerllandlc haraNpmmateriel
Municipal Code. Chapmr 9.12. and the Health and Safety
Dyer )NNo
Will dm applicant orf.tlaw-kuildlaFauayuM•uM equipment or devices which
nsNnus air contaminants v dellned by Na Bay Area Air Quality Management
R
®Yee ON. (ret 6(TNLrRNl-va ON( -Y
nu Health&Safety Cos,Secdom25505,25557md255y4.lundenand NmiUhu Wilding
does not curren0y haw a tone, Net k is my mspomihllity m notify the nxupant or the
mquimmcnu which mu s bM met prior m issuance of a Cc tifsaue of Occupancy.
PANKOW BUILDERS L7CKO``""06020109
1lwYgtl
PERMIT ISSUE DATE
Job Description
NORTH PARKING STRUCTURE FOR MACY'S @ VALLCO
TEMP PERMIT #06070060
3
Issued by:
Re -roofs
Type of Roof
037.00
Required Inspections
Date g—( f - _ v Z
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better