08070067 CITY OF CUPERTINO '%', e�3+^' " '"'''
BUILDING DIVISION PERMIT 9^ (`,ONTRAGTORII 'O.�tMAT"ION "'
BUI TNG ADRKESS: PERMIT NO.
.0773 N WOLFE RD BSM, INC BUILDING 08070067
'S NAME: Lill PERMIT ISSUE DATE
J KTMCO REALTY CORP 2490 ARNOLD INDUSTRIAL WAY 07/10/2008
\ 1"ONE:
(925) 688-1234 SA ARY NO. CONTROL NO.
ARCHTTEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
wap LICENSED CONTRACTOR'S DECLARATION IOU Description
1 hereby affirm than 1 am licanted under Provisions of Chapter 9(commencing p
with Section 7090)ofDiv(dun 5 of des Business and Professions Code.and my license is COMM'L TI CONST APPRX 50 ' DRYWL PARTS TO RPLC
a in full force en 8'10303
>v'y� License Claesg� Lle.1 PREV
Dow ComWrnc . E tce_
eeg7W
ARCHITECTS DECLARATION DEMOED OFCS; SWTCH LTNG@ OFCS. ADD 2 DPLX RCPTCLS
YWU IundcrsunJmyplanaAM]beused as public records @EA OFC; NO RE-RF&NO STRCTRL
g G t; Licensed Professional
5 OWNER-BUILDER DECLARATION
I herchY affirm that I am eampt from the Contractors License law for the
p o following reason.(Section 701 IS.B.M.and Professor.Cade:My city or county
which requires.
quira permit to mnswct,after,improve,demolish,or repair any cwcturt
prior to its issuance.Man requires the applicant for such permit he file asigned swrmenl
< uutxislicensed common to ft rovivo.ofdcConuacuMslimmusLaw(Chapter 9 Sq.FL Floor Area Valuation
.�Q (commencing with Section 7000)dDiviuon 5 ofthe Businessland Professions Code)or $12500
e w_ that he is exempt tMrefrmn and the bask fm the,alleged caempueo.Any violation of
Secures 7071.5 by airy apVlkant for a Permit subjects the applicant to a civil penalty of �p N Number Occas ane e
as mos,than live hundred dollars($5001. 31645017 .'V-1 P y�p
I,as owner of the property,or my employees with wages as Miele sole cmnpe.adon,
will de,Ne work,and lk smrotune k not intended or offered forgk(Sec.7044,Businesses
and Pmfesumns Code:The Contractors Idoom law does nut apply to an owner of Required Inspections
property he builds or improwa menton,and whodescssuchwork himself or through his
own employers,provided that such improvements As,rot intended or offered tarsale If.
however.the building or improvement Is sold within one year of completion.the owner.
builder will have the burden of proving that he did rot Wild or improve for purpose of
talc.).
❑1.as rswmr of No property.am exclusively..housing with licemed mnba.to
construct the project(Sec.7004.Business and Professions Code:)The Cmtnctors Li- .
cents Law does not apply to an owner of property who butlds or improves Nemo,and,
who contracts for such pmjem with a contractor(s)licensed pursuant to dne Contractors
License Law.
I aempt
ameundersee ,Bk PCforNisro
nesn
Date
/ WORKERS COMPENSATION DECLARATION
�- I hereby offset under penally of perjury rot often following dedmisio.:
hawandrillmaintainaCenificatoof Csune( Wurkela Compere
men, pro sforu50 of thes,LA.Codc.forthe per(ormmc of dt
work for which ho peset is spael
tee and will maintain Workers Compensation humorous.an retained by Section
700of the Labor Code,fm the performance ofine weals forwhich this permit It issued, '
My We s Compensation Wernsnace partite and Policy number ate:
Catsler. - Jam__PolicyNo.. SOI
CE FICATE" EXEMPTION FROM WORKERS v
COMPENSATION INSURANCE
(Thksecuon need trot bucornplmed if een permit is pursue hundred dWlars($100)
or levo)
1 certify Net in the arflormanro of the work for which this permit is issued.I shall nes
employ any person in any manner as as to become subject to me Workere Compensation
Larva of California.Date
Applkma
NOTICE TO APPLICANT:If,after making this Certificate of Eaemption,you should
become aubject to the Wortera Compensation provisions of too labor Code,you new
.J O foMwiih comply with such provisions or Nle permit mail he deemed revoked.
z In CONS'fRUCnON LENDING AGENCY
!Yi Ne wok forwhichby�Nuwl Nene k a mnstromim lending agency for the performance of
Qpermit is ec.issued(S 5097.Civ.C)
lenders Name
M, T<nde sAddress
U Q I certify mat 1 haw mad Nle application ab mate dor the above informaune It
I,Fcomet I;,roc
to comply with all city and county on .and awe Lars relating to
D U building conumclion.was hereby aulhodse mpmsmtatiws or this city Is corer upon use
W ahow-menuoncd ts,co" for inapeeti a purpn on
"gy (We)agree th ave,indemnify and kap harmless the City of Cupertino against
fn liabiliuq,Judgmcnta.c.taandofthis w" maY in atrywayamuc agai.lssid City
U z in con of the grvnUng of this u.
^ AP (CANT NDER ANDS WILL ALL NON-POINT Issued by: Date
B RCE R LATIO
�
vie rtof ApplicaDate
Re-roofs
HAZAFZDOUS
MATERIALS DISCLOSURE Type of Roof
Will y t applicant or forum bual Co occupant store orand th hagNous material
Brod by the Cupeninrs Municipal Codc,Chapter 9.13.and the Health and Safety
.Sc zss5z(.n
❑y. ❑No
All roofs shall be inspected prior to any roofing material being installed.
Yes
Will Use applicant or future building occupant use equipment or devices Mich If a roof is installed without first obtaining an inspection,I agree to remove
emit harsudnus air canumi.nu as defined by the Bay Area Air Amity Mmugcmenl all new materials for inspection.
Diatrict7
❑yes ONo
I haw read the hagNau materfaisnegvventeau under Ciupas6.95ofthe Califor.
nk Neal mYCade, end 25554.1undmundmmifdebulding
does l Y w• t dor It" my 'bilary to amity da,"c"Pant of dt
foot n trm m"�mto tit ' / /OS Signature of Applicant Date
Owner orarthorirdagent Dam All roof coverings to be Class'%W'or better