06090026 CITY OF CUPERTINO
BUILDING DIVISION PERMIT i�CCO,NTRACT�ORJNFORMATION .
BUILDING ADDRESS: PANKOW SPECIAL PROJECTS 11PERA1RNO'06090026
10150 N WOLFE RD
OWNER'S NAME: PERMIT ISSUE DATE
- VALLCO INTERNATIONAL 2101 WEBSTER ST STE 1500 0 OS 2006
E: SANrfARY NO. CONTROL NO.
(510) 893-8337
ARCHItECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
o pF LICENSED CONTRACTOR'S DECLARATION
So "mm I bereby that I am licensed uMer proviuve,of Cleaper 9(commencing Job Description
<y infoilforceadcffao
Division]ofthe Business and ProfessioCdSe
Code, TEMP. PERMIT FOR JC PENNY' S PARKING STRUCTURE
�qi License Class Lle.a
Dam TEMPORARY PERMIT EXPIRES 10/05/06
ARCHITECT'S
DECL DECLARATION
i�a 1 undersand my plans shall he used u public rowrJs
iyU
o n Licensed Profcssisnal
g OWNER-BUILDER DECLARATION
<C I hereby affirm 1 exempt from thConvector's License Law for the
s.
❑O following mos .(Sectionon 71131.1.5,Business and Professions Calc:My city or county
which requiea a permit to cures;the Jur,impress,demolW,ri repair any Rreture
prior to itsissuance,pt...t to requires;the applicant for such permit tofiksigned suumcm
ss< that mencc.nwit purwam 70001 provisions of them Buacesnicer Lew(Charter Code)or Sq.Ft.Floor Area Valuation Q
iF0 (commencing with Section 70001 of Division Jn(the Business and ProGssions Cmk)m
Jus he is exempt therefrom and the basis for the alleged exception.Any violadon or
Section 7031.5 by any applicant for a permit subjccua the applicanuo a civil penalty Of �pe`p}pN 7038 . 00
Nniber Occupancy Type
nil more Nan five hundred dollars(1500). 316 2 0 0 3 8 . 0 0
❑1.u ower of the poprny,or my wploym with wage u Jc'v isle campcnutian,
will do the workaM theswctum is not ineded oronered forsak(Sa.9064.Business Required Inspections
and Prefessions CC&:The Corrects's License Law does rot apply m owne an motor of q p
Property who builds or impreves Nereon.and who dassuchwork himulfor Nraugh his
own employees.provided Jul such improvements art sot intended oroRemd for sale If, \
however.Ne building or improvement is Said within one year of completion.the Owner-
builder will have the burden of proving that he did not build or improve for purpose of /J
sok.).
❑1.as ower of the property,,B sine s and contracting with:)The C Contractors i- 0
coulNm the project(Secapply
to an Business and property
wh imu Wild,or i Teev s thopens nd 's
ccue law dots not apply to an ower of property who sodp or improv Conara.and V
who contacts for such projects with a cansrator(s)liceued pursuant Io use Conlrutors
Cleave law.
❑1 am uempt undo Sec. .B h P C far Nis mason
Owner Dau
WORKER'S COMPENSATION DECUBATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑1 have end will maintain a Craifinu of Comem M ulLiuure far, WorkeraConn,m-
Senion,u provided for by Section 3700 of the Labor Code,for the performance or the
work far which this permit is issued.
❑1 love and will maintain Worker's Compensation Insurance.as requimd by Section
3700 of the Labs Code,for the performance of the work for which Nu permit is issued
My Worker's Compensatisn huurance casim and Policy number are
Conics. Policy No.:
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(TWs Section need not be complemd lithe permit is intone hundred dollars(SIM)
or less.)
I certify that in to performance of Je work for which this Permit is issued.I shall not
employ any orson in my m urncru as to become subject o the Workers Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,ager making this Certificate of Emmpsisn,you should
become object m the Wmk.h Compensation provisions of the Labor Cod.,you most
.JO forthwith comply with such provisions no this permit shall be deemed revoked.
Z' CONSrRUCfION LENDINGAGENCY
[—i I hereby which thi that Inc.is a Wood
Construction lending agency for Ne perfu,mence of
a the work for which Nu permit u issued(Sec.3097,Civ.C.)
0. Q Landers Name
D z Lender's Address
U O 1 certify that 1 have read this application and sou that the above information is
L6, f^ connect.l agree to comply with all city and county ordinances and state laws elating to
0U building construction.and hemby authorise representatives of this city to enter u,unthe
d above-mentioned ptopc st for inspection erms purpwhich may
(We)agree to save,indemnify and keep harmless Ne City Of Cupenino against
F' C,IZ liabilitiesjudgments ,gamin oft hissuwhich may in any way accnu agaius cid City
U Z. APPL CANTCOr Live UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature of ApplicaH RDate Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or forum building acupapt r 9.1 m handle handsu material
as defied io the Cupertino Municipal Cade.Chapter 9.12,and the Health and Safety
caJc.Scds.211111a)7
❑Yrs ON. All roofs shall be inspected prior to any roofing material being installed.
Will me applicant or future building Occupant Sea equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emir hazardous air conumirems as defined by the Bay Area Air Quality Management all new materials for inspection.
Diurics7
❑Yes ❑No
1 have read the haordnus maermis requiemcnts under Chapter 6.95 ofthe Califsr-
m.Health&Safety Code,Sections 25505.15533 and 25534.1 understand that if the building
does not Carmody have a tamun,that it IS my responsibility an notify dm Occupant Of the
mquimmcau which mutt ka met on,to issnaee of.cobrcate of Davpocy Signature of Applicant Date
Owner or aut ari ed agent Dam All roof coverings to be Class "B"or better