06030030 (2) CITY OF CUPERTINO �- °
BUILDING DIVISION PERMITCONTRACTOR�INFORMATION
BUILDING ADDRESS: PERMIT N0 0 6 0 3 0 0 3 0
20425 STEVENS CRK BLV
W NER'S NAME: PERMIT LSUE DATE
CAPGEMINI INC 03/07/2006
NE: SANrTARY NO. CONTROL NO.
ARCHITF,CTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMBMECH
:op LICENSED CONTRACTOR'S DECLARATION
U W I hereby affirm Nei I am licensed under provisions of Chapmr 9(commencing JO
with Session 10(11)of Division 3ofare Busircua"oresswm orae.and my license is QAC COMPRESSOR REPL
n n. in full force and e q (rj
Licenx I .L Lic.In
n5,6 Dao; C.rimcsor
ARCNIIECI'S DECLARATION ,/Ara ['
w U 1 understand my plans shall M used as public records P1FIK 1OOu
6
g y Licensed Professional
3 OWNER-BUILDER DECLARATION
COO1 hereby alErm on I em exempt sinfrom CealrntsCo License Law fur the
o O following mason.(Sadun]fD 1.5,Business and Rafeadum Calc:Any oily or county
5$ which requires a permit to construct,alter,improve,demolish.or repair any strucmrt DIN9f $12000
inner ba its issuance.also roquires the applicant for such permit o Glc a signed stamment
E chatMislicensedpursuantmlMprovisionsofNcCatamunt'sticxnxlsw(ChaNcr9 Sq.Ft. Floor Area Valuation
yF (commencing with Section 71(107 of Division 3 of she Business and Professions Code)or
i $ that he ts exempt therefrom and the basis for the alleged evempdm.Any violation of
Section 1031.5 by airy applicant for a permit subjects the applicant in a civil penalty of
not mom than five hundred dollan(SSr10), r Occupancy Type
0 I,m ownor of the property,ar my employees with wagesas their sole compensation,
will do the wok,and thesmcture is not intended or offered forsale(Sec.1044.Business
and Pm(essioru Cods:The Contractor's License Law does acs apply to an owner of Required Inspections
property who but IN or im proves thereon,and who docs such work himself or through his
own employees,provided that such improvements art not intended ora@red for sale.IL
however,the building or improvement is sold within one year of completion,no ownsn
builder will have the bunter,of pmving that M did not build or improve for purpose of
sale.).
0 I.as owner of the property,am exclusively contracting with licensed Contraction to
consumer the Project(Sec.1044,Business and Professions Code:)The Conmmor's Li.
cone law does not apply in an owner of property who builds or improves Merton,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Convenor's
License Law.
❑lamexemn.mccr Sec. ,B&PCfm,bd, axn
or Date
WORKER'S COMPENSATION DECLARATION
1 hereby rfnrm under penalty of perjury one of Ne following declarations:
0 1 ham and will maintain a Ccoificax of Comenuoself-insure for Werka esCompcn-
ration,as provided for by Section 3100 of the Labor Cod,for the performance of the
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of be Labor Code,for the performance of the wart for which this permit is issued.
My Worker's Ca oMmuntion Insurance camier and Policy number m:
Caffi-11 t(t$v`stie"t R/w/� Polity Na.:WZ
CERTIFlCATEOF EMPIONFROM WORKERS'
COMPENSATION INSURANCE
(Thu trounced net be completed Kthe .it is formm hundred dollan($100)
or Icas.)
1 certify that in the performance of the work for which this permit Is issued.I shall not
employ any person in any ream erre as to become subject in the Workers'Com,,Mdon
laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cenificam of Exemption,you should
become subject m the Worker's Compenasion pmvisieas of the IaMr Code,you muse
.JO forthwith Comply with such prnvisims or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
Ihereby affirm that them is a Construction lending agency to,the performance of
Ila the wok fur which this permit is issued(See.3099,Civ.C.1
CA Landers Name
z lender's Address
tJ C) I comfy that 1 have mad this application and state Net the above fir.on.su n u
LL correct.l agree m comply with all city and county on incases and stain laws missing to
Ubuilding construmion,and hereby authorise representatives of this city to enter upon the
above-mentioned property for inspection purposes.
G (We)agree I.save,indcmn�s"CCy. cin hamlet IM Ciry or Cupcnino against
N liabilities,judg cnts,co ntrpcn hich may in ony way acemc against said Cisy
V z inconsequent gramin rspermit.
APP ND Obi DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 3- 7-o C
CE RE aU hT(ON!
Re-roofs
Signatumo ApplicadX0111nnor I pre _
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fumm building cccu cant nam or hendk hvallous mammal
as defined by the Cupenino Municipal Code,Chapter 9.12,and the Health and Safety
Code,0Ycn25532(a7?� .� All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or fusum building occupnl use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emh hazardous air contaminants as defined by nice Bay Area Air Quality Management all new materials for inspection.
District?
0Yes �o
I ham mad the been tin ate rials requirements unJcrChapter 6.95ofthe Califor-
niaHulth&S cdmu 505.25533and Z5534.Iunderslandthatifdc building
does me ly have oto that it is my rcapomuniny to notily Ne occupan fthe
iremcrux h met pd rmlssuancearaCentriic..ClU O Signature of Applicant Date
Owner ora Wnacdagent p m All roof coverings to be Class "B"or better