04030237 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMI*
BUILDING ADDRESS: DEBCOR INC PERMIT NO.4030237
PERMIT ISBUE DATE
ER'S NAME:
SANITARY q&tOL NO.
PHONE:
BUILDING PERMIT INFO
ARCH1TECr/ENGINEEK: - BLDG ELECT PLUMB MECH
0 0 0 0
no, LICENSED CONTRACTOR'S DECLARATION Job Descri tion
F 1 herby affirm Nat I an licensed under previsions of Chapter 9(commencing
- p
nub Section 70(1o)ofDivisloa 3o1fNC Business and Professions Carlo,end my license is
s i.fail f...adeffect.
a License Class Lic.g DEMO 525 SQ. FT.
Z^a DataContractor
'aJW ARCHITECTS DECLARATION
77 I undersand my plans shall be used an public mentis
OyU
Licensed Professional
OWNER-BUILDER DECLARATION
1 hcrcby.(Sure that 11. chcmpt from Na fesmons Cc License Law for the
i00 which
guiresa usaftt 7117LABus;ter, and ere.de ion Ca lc:Any city or county
X$ which requires a permit m down,Blur,impmw,dcmnliah,or repair any suuaum
FZ i prim to its issi amea.arses requires the appiiunl for such permiuo Ole a signed smumem
< But he is licensed pursuant to the provisions of the Comwcmts License Law(Chapter9 Sq.Ft.Floor Area Valu hon
�$ $ommencing with Section 7W)of Division 3 M the Business and Profcasions Code)or _
that he In exempt aminfrom and the boas far the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant m a civil penalty of 3 Mj9AP0*er0 O Occupancy Type
Out mom than Bva hundred dollar(M).
❑1,as owner of the preperys or my employees with wages an their sole compensallon,
will do the work and Neacommic is nothianded croffeNd forsam(Sec.7044,Business R0 ❑ 0$ eCtlOnS
and Profundum Code:The Connector's License Law docs not apply to an owner of Requ'
property who builds or i m proves Luccon,and who dos such work himself or through his
awn cmployeuilding or i the impruch ovement
in not y intended moReud for Owner.
Wilda,c Na have
the or improvement ie hold within mu you of mproe to,the men or
Sed.j. will have Ju burden of proving Net he did not build or improv for puryase of /
tale.). /
es owner of project
property,am exclusivelysinand
contracting with:)The
contractors N
omwd Ju an not (Sec.70dd,Business and Profusions Code:)The Conmmr'h U. O�
came law cora not apply in an owner of property who builds or improve themom and
whofar such projects with a conlncNr(s)licensed pursuant m the Connacute
Liunse se Law.aw.
_ ❑lam eze pY Sec .8&PC for this Nunn
a
ORKER'S OMPENSATION DEC A N -
1 hereby affiw under penalty of perjury ane of the following declarations:
❑I haw and will maintain a Cemlficau of Conant to self-insure forwo lacescompen-
sation,as provided for by Section 3700 of IN,Labor Code.for the performance of the
work for which this permit is issued.
❑I haw and will maintain Worker's Compensation Insurance,as required by Section
37W of Ne Labor Code,for the performance of the work for which this permit is issued. „
My Worker's Compensation Insurance carrier and Policy number are:
Cartier. PolicyNo.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissection mod not bo completed iftht permit is foram hundmddullace(SIM)
or less.)
1 certify that In the performance of the work for which this permit is issued,l shall not
employ any penin in any manner so u In become object o the Workers'Compensation
haws of California.Dam
Applicant
NOTICE TO APPLICANT:IL attar making this CcniRcau of ExcmPtlnn,you should
become subject Ire Ne WmIm,'s Compensation provubus of the Iahnr Code,you must
OfaMwiN comply with such previsions o Nis permit shall In dcemed mwod.
„zr► CONSTRUCTION LENDING AGENCY
thereby affirm But dare isacommunion lending agency for performance of
ai� the work fur which Box permit Is issued(Sec.3097.Civ.C.)
W Q Lenders Name -
z Lender's Address
O Q I certify that 1 haw read this application and sum that the above Informalon is
ry F cancel.I agree m comply with all city and county ordinances and sou laws muting to
0YJ altowngconsuuctiomend herbyectionmrepmsenutives of this city menur upon the
W above-(We)4 ed property for inspection purposes.
tjy4
(We)agree 1.s outs indemnifyexpenses
es keep hay in an the City of me against
s ageing
U pd'q incioom,bjnsm of the
grarEaad eh pe3RhwhiCn may In any way BCCNe agBlahl said City
C„)'1 ineonsequcnec of DERST Nof Nis permit.
r1• APPLIC NDERSTAN AND WILL COMPLY WITH, NON-POINT Issued by: Dale
OU C � ULATION . %
� u �i Re-roofs
;u,
nature ApplicoVCanRDODataHAZA0.0005 MATERIALS DISCLOSURE Type of Roof
Wiil Neapplicant art fume building occupant erre or and Ba hazardos d Safet l
defined by Nc Cupertino Municipal Codc.Chapur 9.11.end Ne HeaIN antl 5afaryde,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yea qA'�Will the applicant or future building occupant use equipment or devices whichIf a roof is installed without first obtaining an inspection,I agree to remove
rit hazardous air contaminants an defined by the Bay Arca Air Quality Management all new materials for Inspections
District?
❑Yes 0No
1 have mad tic harardo.n.255 ials rquimm255 under Chapur A.11(the Califor-
diaHcalthffiSafcryCodc,Sccdons25505,2S5JJ anJ25534.1 undcrsNnd Net ifmc M1uilJing
Jas not c ntly hair a tenant Nat it is my responsibility m nodly th<occupant of tic
res u;rc n zpni mast bore t o 1.asoma.or a Cmmricau of Deem, cX Signature of Applicant Date
7G -0
rano 'red anent Data All roof coverings to be Class "B"or better
Data
DEBCOR Inc.
Developers•General Contractors F: onclawmmrM Paddrw. aay.ts+os
Lic.#816446
OFFICE Ca
soonsDevalley,6CA 6669 os� Page of
Dh -446-1913 Fax:831-438-5234
File:
Call from:p
Call I.
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mw ng with:p
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13 s8 �« APkvto
e IN A.CCORDANr'E WITH THE CITY Oh
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. CITY OF CUPERTINVS
DEMO v 03 0 z-?
. CUPERTINO PERMIT APPLICATION FORM
APN# .3� / � Date:
Building Address: (o
135-�— S • S�� z�/tirG
Owner's Name: Phone#:
3���eo2 �vC I0t- yy6- /"I/3
Contractor: License#:
(�W FtC2
Contact: > Phone#:
ECIC X20 �q-n/s�'r �(ofi-�63�- �5 3U
Applicant/C tractor:
• � �f°FF�92a /T�nCS� /
Building Permit Info:
Bldg Elect Plumb Mech
Job Description: u
Residential: Commercial:
Sq.Ft. Floor Area: 5_ 2 S&F– T $/Sq.Ft.:
Architect/Engineer: Valuation:
• Type of Construction: W 0o D Occupancy Group: / Gv
Q ic. if
A lle Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BSEISMICRE Seismic Residential BUILIDNG
n
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUIL.IDNG
CITY OF CUPERTINO �^ '^ `k ' xe 3
BUILDING DIVISION PERMITOReI. T'QRTI�RMr4'T.TO�',;.:
BUILDING ADDRESS: DEBCOR INC PERMIT NOO4O3O237 '
NEWS NAME: PERMIT ISSUE DATE
DEBCOR INC
12
ONE: SANITARY W 1 OL NO:
ARCHITECr/ENGTNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u O o LICENSED CONTRACTOR'S DECLARATION Job Description
T Mackay arum that 1 am licensed under provisions of Chapter 9 memmmming - p
a]j with Section 700111.1'Division Sof the Business eM Pmfessmas Code,and my license is
in full fame andcrecL DEMO 525 SQ. FT.
512 Z License a., Lie.M
Z Date Connector
us Mail be
DECLARATION
Y ty7 I undenunJ my plans shall he used as public records /
30M Licensed Professional
Q OWNER-BUILDER DECLARATION /
3 CS 1 hereby affirm that I am exempt from the Contractor's License Law for the
0 o following mason.(Section 70313,Business and Profession Cole:Any city at county
$ which mquims a permit to convect,alter.Improve,demolish.Or repair any anagram
poor to its issuance.also requires the applicant forsuch permil to file a signed getemenl
HZQ That he is licensed pursuant to the provisions M the Contractors License Law(Chapkr9 Sq. Ft. Floor Area Va II00
$ (commencing wine Section 7")of Division 3 ofthe Bushossand Professions Code)or
that he is exempt mcrefrom and the halls for she alleged exemption.Any violation of �as,pia�.9v�,��v.{.
Section 7031.5 by any applicant for a permh Edictal Ne applicant M a civil penalty of 3�V F w U0tger0 0 Occupancy Type
oat ream then five hundred dollars($500).
- ❑1,as newer of the property,or my employees wish wages as their sele comptuation, -
will dothe,work.and the stromYm is not intended Or offered(a,sale(Sec.7W,Bu9nLat Required Inspections
and Professions Cade:The Connector's LicenE e n$Law dace not apply to an owner of - q p
propenywho buildsorimpgoms dmrcon,and whodoessuch warkhimselfarthrough his .. -
own employers.provided that such impmvemenu am not intended or offered formic.If.
however,the building or improvement is sold within one your of completion,the owner.
builder will new the burden of proving Nat he did not build or Improve for purpose of
sale.).
a owner of she property,am exclusively connecting with licensed contractors to
onswet the project(Sec 7044,Basin.and Professions Code:)The Contractors U. '
cense law does not apply to an owner of property who builds or improves memon,ad
who convects foe such projects with a contractor(s)licensed pursuant to the Contractors
License 54;
ew.
❑lam usep�F Sec. .B k P C far this recon
a aha o
ORKEft'S OMPENSATION DELL A� N
r 1 hereby afiml under penalty of perjury ask of the following declamations,[haw and will maintain aCcrificate offonsenuo self-Inure for WorkersCompen-
aeprovided(or by SOction 37P"�� ie Labor Codc,far Ne per(oamaike of the
woarkkfor
which this permit it issuetl.ij-
❑I he
and will maintain Workers Compensation Insurance,as required by Section
3700 of Ne Tabor Code.for the performance of she work for which this permit Is issued.
My Workers Compurnation Instance,carrier and Polity number are:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu auction used not bu completed if the penal is for anc hundred dollar(SIM)
or less)
1 certify that in the performance of me work for which this permit is issued,l shall not
employ any person in any manarso sec w become subject to the Workers Compensation
I.of C.1ifornia.Dead
Applicant
NOTICE TO APPLICANT.IL after making this Certificate or Exemption.you should
become subject to the Worker's Compensation provisions of me Labor Code,you mug
.J Q forthwith comply win such provisions o this permit shall he deemed revoked.
za CONSTRUCTION LENDING AGENCY
(ti l hereby affirm that them is a convection lending agency or the performance of
lYi w>-t th.wad fur which this paresis Is issued(Sec.3097,Civ.C.)
Le �.
W�Q nders Name
Le
�z Lentlels Address
U I certify that 1 have mad this application and gate that the above information is
1'L F Contact.I agree to comply with all city and county ordinances and sum laws mixing to
V Wilding ration ktion,and hereby audiencempreunurs livof this city toenlmupnn the
W shave-
men0oned Property for inspection purposes �r
gy (We)agree to Eve,indemnify and keep harmless the City of Cupertino against
r y liabilities,judgments,costs and expenses which may in anyway&wane against said City /rT.
L)7 in crone rcence of me gunung of hm pemtiL V
A PPLIC NDERSfAN AND WILL COMPLY WIT NON-POINT Issued by: Date
OU ULATION . U
�� L Re-roofs
S nature Applican✓Conlnclor Cfam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle haeallous material
as defined by the Cupertino Municipal Code.Chapter 9.12.and du Health and Safety
e,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
-OYcs uyidr-
Wiil the applicant or future building Occupant me equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
a."hearings air contaminants as dc0ned by the Bay Amu Air Quality Management all new materials for Inspection.
DwIm7 1
❑Yes ,O No
I have mad me hazardous materials requirements underChapter 6.95 of the Celifor.
ria Health A,Safety Code,Sections 25595,25533 and 25534.1 understand that if the building
docs t 0 my responsibility to noisy the Occur",of site
no nim n mug be I o toisausneeof a Ce`r ( nal, Signature of Applicant Date
w m or aumoriuJ agent 'V Due All roof coverings to be Class "B"or better