08010145CITY OF CUPERTINO+d
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
10123 N WOLFE RD #1095
TBD — TO BE DETERMINED
08010145
A'S NAME:
FERMIT ISSUE DATE
CUPERTINO SQUARE LLC
02/22/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHflER/ENGINEER:
BUILDING PERMIT INFO
INTERIOR T.I MANAGEMENT
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
-
1 horeby affirm Nu 1 am licensed under provisions of Chapter 9 (commcncing
esCnn�]On
-•- -• --• - --• -, �- -•T- -•m �• --- +yav
with Section 701d of Division 3 of No Bumneu and Pmfe,siam Cade, and my license is
in full fore and effect.
License Class Lie. g
Dam Contractor
ARCHITECT'S DECLARATION
I understand my Pia shall he used as public records
Licensed Fmrcaskmal
OWNER-BUILDER DECLARATION
1 hereby a ?m that I am eumpt from the Commences License law for the
following reason. (Sxtion 713 1.5, Business and Professions Code: Any city or county
which requires • permit in conwuct, alter. Mpmw, demolish. Or repair any structure
prior to its issuance, also require, the applicant forsuch permit in rile a signed wemcni
this he is licensed paramount to the provisions of the Conuacmra License Law (Chap=9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7001) of Division 3 of the Business and Professions Cade) or
that he ts exempt therefrom and the huts for the alleged cumptiom Any vi.I. en of
APN Number
Occu anC
p y ']pit
Section 7031.5 by any applicant fm a permit subjects the, applicant m a civil pmalty of
rot come Nan five hundred dollar ISM
❑ 1, a awncs of the property, car my wPlaym with wgea be4 tale eompens
r
will dos Newark and the he Coots mrs License ova w de d set a(see. n th, Business
Imes
and Cedr: The Cormumr, Law dos ore apply lf in owner of
Required Inspections
property Improves red who him,elfm Nmugh ht.
praperO who builds
i annot intendedmplatin.( I(.
h Improvements are not
ewnver.
dim Wilding prsuchimpmwmats
within one Sear of completion. tlse
, We
Orden
Wilder purpose or
builder w have urc When of proving Nat he did not build car improve for pugore of
ill haw of roving that
sale
ty-y u owner of bun pmpertY• am exclusively connecting with licensed contractors m
-'
noaaron the pmfeca (Sec. 7044. Business and Proportions Cade:) The Commences Lt.
tense law does not apply to an owner of person who build, m improvea Nemon, and,
who contracts for such projects with a ednhanur(s) licensed pursuant to du Contractors
L lc,. law. ///��1 ��-
❑ l m eumpt�4rgyr Se . Nis am
/ / I Date
Date
WORKEWSCOMPEft,aTIONDECIARATION I If
I hemby affrm under penalty er perjury ore of tic (allowing decluWoa:
❑ 1 toward! will mainain • Cmifialeor Consent m self Wore fmworkera Camper -
cation, as provided for by Section 3700 of the labor Cade, four the performance of the
work for which this permit is Items.
❑ 1 have and will mdrount Workers Compensation Insurance, as required by Section
3100 of the tabor Code. for the performance of the wart for which this permit is lured.
My Workers Compensabon Insurance, carrier and Policy number an:
Cartier. Policy No.:
CERTIFICATE OF E)( MP ION FROM WORKERS'
COMPENSATION INSURANCE
(Miammum seed not W completed i(the pemitis(orone hundred fella s ($100)
or Ins)
1 cerdfy that in the plain m of r o which this Permit u its so. l 11 not
'
employ mYpenon loan u mbjoctmthe Wa
Laws or Califamia. Dam
Applicant
It DZZ,14
NOTICE TO APPLICANT.-If. aMr making Nis C.nificau, of Eum lion, yd. N
become subject an the Worker. Compemtion provisions of the Labor Code, you most
forthwith comply wit such provisions or this Permit shall W deemed ranked.
CONSTRUCTION NDIN G AGENCY
1 hereby air.. then Iy c Gm lending agency for N erfu of
the work for which it IYa c . 09'1, Civ. C.)
Lenders Name
L ende's Addw
1 cenifY that I haw, read this appticvim and sum tied the above In(mmatiun Is
correc4 I agree to comply with N city and county, ordinances and mm laws totaling to
-
Wilding cossuuNon. and hereby a.,hurt. repreunudvu of thin city m corer upon the
abow- mentiored pmpeny for inspection purposes.
(WO agree he caw, indemnify and keep hornless the City of Cupertino agaiaa
liabilidea, Judgments, casts and apnoea which may in any way accrue against said City
I. conrcgmnce of dm granting of this permit. 1
APPLICANT. A WILL COMPLY WITH AL N01P�Dl�
Issued by: Date
TIO
tIO
SOURCEk�
Re -roofs
/�f1 /Jjh /Iv- {.ERSfAN
� /UIS
Sttnuun r p ucan ontracmr Data
1
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will tho applicant m future building MCUPMLRem urhandle husrdou material
fined by the Cupertino Murdci partode, Chapter 9.11, and tiro Health and Safety
Section 355714)7
❑Yes EN.
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, agree to remove
Will Nc applicant or future building occupant use otimpmml of &,I. which
crab hvndnu air contaminsnts gdcfined by the Bay Area Air Quality Management
.I
all new materials for inspection.
Diauical
Oyu No
I have road the becandous mamriatsnquinmcnts under Cluper6.95 afbe Ca for.
nia HnithAS9cIyDede,Senimts 505 ,15533am115530.1unirsrandthuifthc Wi ing
Liars rot c d ha n4 n it u mY IuPewhilitY m mUry ft [[upon f the
ntiont n tarot rmuuRCancenreamar reel
Signature of Applicant Date
All roof coverings to be Class "B" or better
owns a as a've
,g rat Da a