08010146CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CONTRAC'LORIN.EUItMATIQN
BUILDING ADDRESS:
PERMIT NO.
10123 N WOLFE RD #1093
TBD – TO BE DETERMINED
08010146
0.'S NAME:
PERMIT ISSUE DATE
CUPERTINO SQUARE LLC
02/22/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHTIECTAINGINEER:
BUILDING PERMIT INFO
T.I– LEARNING CENTER –NEW
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
„I N'scrl tion
I hmcby affim that I am licensed under previsions of Chapter 9 (commencing
- - ^ - -^ ^ ^- ^ ^'-- ^ - - ^- ^^ P
with Section 7010) of Division 7 of the Business and Pmfeasiom Colo, W my license is
in full forte W effect.
License Class Lie. N
Date Contractor
ARCHITECTS DECLARATION
1 urdenand my Plans S)WI W Cud as public records
Licensed Pmfeuional
OWNER - BUILDER DECLARATION
1 hereby M. Not 1 am exempt from the Canuactors License Law for the
fallowing moon. (Section 7031.5. Business and Professions Code: Any city Of County
which acquire a Permit to construct. after. minnow. demaliab, or repair any groclum
'
prior to its issuance, Man requires the applicant for each Permit to file a signed mmmcnt
that W is licensed pursuant o the provisions of Ne Convector's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Seaton 7") of Division 3 of the eusinm and Profminm Code) or
that he is aumpt therefrom ad the huis for W allogcd exemption. Any Anledon of
Section 7031.5 by .cy applicam Tor a permit subjeou the applicant in a civil penalty of
APN Number
Occupancy e
P Y TYP
not more than nw hundred dollars (55007.
❑ I, ummofthepmperty ,mmywploymwithwgmud bmiecompomdm,
will do the wont and Neswcwu ts naimeMed ormaered fersale (See. 7064, Business
Required Inspections
and Pmfrasiav Cade: The Contractors I.I. Law dm not apply in a owner of
property who Wilescrimpoom tivao7M1 and who dm.uchwork htouelfm through his
ow employee, provided that such improvements ere not mean dal Or offered far sale If.
howtm, the Wilding or Impoowmal is sold within one year a completion. the owner -
huilder, will haw the WNem of proving that k did rot Wild or improve far purpose of
01 , as .. of dg prepeny, am excluively con mares MN Iicevrd mnuaaam he
wtuoaa the project (Sec. 7044. Business ark Professions Cade) Ton Conuacmrs U.
cove Law dm not apply to an matter of property who Wilds or imprm thereon , and,
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wW contracts for mca mKcm with a conuacmr(.) licensed purseam in the Com odes
License law.
❑[goesemp n gee ,B&PCf thtsm
Z
Dam
WORK •R'S OMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the fallowing dnelantiov:
❑ T haw and will maintain a Cersigcateof Comer toulf-InsureforWorkersCompen-
adon. as provided for by Section 5'100 of the Labm Code, far mo performgte of dg
work for which this permit is loved.
❑ 1 haw W will maintain Worker's Compenmlan Inataa. u required by Section
3700 of the labor Code, for the perfarmance ofthe were for which this permit Is laved.
'
My Worker. Comp ormthm host guz artier W Policy number ae:
Csoricr. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
,
(rich section need at W complemd if the permit Is f crone hundred dollars ($100)
nr Imo)
I Certify Not in the perfo the r Ifor hich this permit Is is und, 1 all not
employ any person In any ore bled tothe Wps r o an
Laws of California. Dam
Applleant
NOTICE TO APPLICANT. If. after making this Certificate of ExcurilLiOn. y u gumbi
become eabjen to 0. Workers Comps nudon previsions of the Utter Cade, you muse
faMwiN comply with such previtiams or this permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
I hareby,M. that there sea construction leading agency fm dm perform. of
the work for which this Permit m finned (Sec, 3W7. Cho. C)
fenders Narne
Undoes Address;
I certify that 1 haw read this application W state than the aWw information is
Carom I agree t0 Comply with all city and creamy cargo-ace ami mate I., relad.g an
Wilding armruction, and hereby Marie reprmentadm of this City an enter upon the
above- memvned property far ivpectian purpuee
(We) agree to saw, indemnify and keep harmless the City of Cupertino agal.t
-
liabilities. Judgments. Coast and expe.on which may in any my sec.e against aid City
in Cannot... of the grati g of this Permit.
APPLICA NDE D ND WILL COMPLY WITH ALL ON -POINT
Issued by: Date Z_2 mod`
SOUR LA O
Re -roofs
Type of Roof
si { mu se re pplic _
HAZARDOUS MATERIALS DISCLOSURE Dam
Will the applicant art future Wilding oavpat gore or Media d1ruchms material
Rood by the Cupertino Mums 1 Code. Chapter 9.13. and the Health and Safety
Section 255324n
❑Yon No
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
g
Will the applicator futum build' 8 amupam see cqulpmat or dcHm Mich
,I
emit air an=in.. as ood by the Bay Arta Air QualBy Management
all new materials for inspection.
DiaWa7
ct?
❑ Yon on
I have mad he huunduv materials requirements under Chapter 6.95 of the Califor-
-ia Health k Safety Code, Settle. 755D5.25533 and 75534.1 un6, the II 1,u ilding
dm not curmm y ov a taa s l u m spovihllity m notify ace uP of the
mquimmcnstJw tW t mr i„t. emr,cmdrteatc,5 ay�t D�
Signature of Applicant Date
All roof coverings ro be Class "B" or better
owner sir. a eaa
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