08060010 (2) CTTY OF CUPERTINO ± pa Q €
G'PT
BUILDING DIVISION PERMIT CONTReiC�TORII�bRMATION "
BUIL DING ADDRESS: PERMIT NO.
7.0510 STEVENS CREEK BLVD TBD - TO BE DETERMINED 08060010
f.R'S NAME: PERMIT ISSUE DATE
EVERTRUST BANK 07/11/2008
N
E: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
DEMO EXTNG TLR CNTR, FLRNG, BLDG ELECT
I� MECH
0
X00 LICENSED CONTRACTOR'S DECLARATION ' ,.,•„-,Inb Descri ions
1 hereby arm thJ 1 stn licensed under provisions of Captor 9(commencing ^-•^^-- - -,__...,., •_• p
Mwith Section 70(18)of Division 3 of Bu Business xeM Pro@ssimrs Cade,srul my Ikenm is
imfull force and effect. - _ �G/2Sg�'
jnZ Lice=Can Lle.L
7 Dau Cmlruwr
E 7W7W ARCHITECTS DECLARATION
W U 1 uMcssuml my pairs sail be tried u Public recoNa
6
I i]rat Licensed Professional
3 OWNER-BUILDER DECLARATION
s� E 1 berehy aRrm Nal 1 am exempt from the Contractors License law for the
y c following mown.(Sunset 70713,Business and Profusion Cade:Any city or may
which require a Permit in convmn,Jur,improve,don o ata.or toper any uncture
Zi prior as its issuance.also requires the applicant for such Permit in rile a signed suument
< Nal W is licensed forward to Bu pmriions of the ConuacurS Limner Law(Capur9 Sq.Ft.Floor Area Valuation
Y�$ (commencing with Section 7000)of Division 3 of ted Business and Pro@ssdom Code)or
— that he is exempt tarefmm and the burs for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil pealty of APN Number Occupancy T
not mart than five huMred 5001• P Y dollars(5YPe
❑Luowes of Bkpeopmty,amy liny&swithnageuBuvmkcompensation,
will Pr workle whom and the stronum u net s Livens a Law
clo net apply
]Oso,owner
of
and property
ons Cade:The CenummY.Lown law don not apply il an rough of Required Inspections
.a enywa .provired don ess such
who dmsaucltenekhimulfor through hu
awn employes,provided i that such improvements are net intended m o@sed for Sala aL
hsider in aveMinLraimpmrpmmtg midwriterosuyevofmmpkdoaduawar-
tak.Lr win are to buNen of proving tat k did rot baled m improve(m purpose of
ssk.7
El
1,u owror of Ne popeny.w uelusively cmuaming with Binned conuanms m
construct the pmjem(Sec.7044,Business and Profession Code:)The ConummYs U.
comm law doe out apply m an owner of property,wa Wilds or improves themes,and,
who conuacts for such pnjem with a comewsor(s)licensed pursuant to was Canuamuls
Lieenew law.
Ivneacmptsndv See ,BAPCfmthiamamw
Dam-
WORKERS
auWORKEI'S COMPENSATION DECLARATION
I bereby afriro under penalty of perjury rand,of ter following declammons:
.due.
prunum for
necond 37M of GONmlk Code.
eform Compen-
moan,upro h thi ripe by Beeson 3]00 of Bu Labor Cade.fm the peAormanm m(We
wink for which Nu permit is issued '
1 have and will munuin WertcYs Compmrseuon Inmransc,as,mqu'ued by Sectio
Mori Ne labor,Code.far the peRarmanee of the work for which Nis permit is issued. '
My Wartefa Compensation Iman nnm carrier and Policy number ver:
Cartier. '4ad'a_ �tlAs(�[ Policy No.:�S^`L.J S{ft"Z
CERi1F0 OFEX P70N FROM WORKERS'
COMPENSATION INSURANCE
Tilos mem need rot kcanpkud irtk permit a foram,hundred do0an(SIM)
cur les)
I certify that in the performance of Ne work for which this permit u Lsa mi.I shall not
employ any permn in any summer so u to become subject a Bu Were^^'Compensation
Laws of Calif..].Dau
Applicant
NOTICE TO APPLICANT:If,after match,this Cenifuu of Eaempown.you J,Ww
become subject to tau Work s Cmmpenaoon provision of Ina facer Cod,,you must
.,O forthwith comply with such provision or Nu permit shall W dremrul revoked.
'Z CONSTRUCTION LENDING AGENCY
F I lmreby allkm the there laacomarumnn lending agency for the perfamvmc of
B
C> the work for whichus permit k ee.3897,Civissued(S .C.)
I8 Q Lcnd r Name
=z Irnder's Add....
U C) I calory the 1 have esad this application and sou the Bre above information is
is, correct.I agree to comply with JI city and county mdinwmes end sou Ian relying m
Wilding construction,and hereby smhmime repnsenutives of this city to enter upon Bu
a Wvametioned propcny fm inspection purposes.
F y (We,)agree to save,indemnify and Imp I.I.the City of Cupertino a'nr,'
z liiii litiu judgments,ceuW expmt>a which may in any nay amus agunst old Cary
()z ro PLIC NT of the granting of the D WILL
y Date
"-'
SOURCE
UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT ISSUed b
SOURCE RE_G/ULATIONS.
smL R vice��/'�k A-71 10 Re-roofs
we
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
rb:WiB Bu appliens or future Wilding aavpansstorc or aMk haardoe mse a /
by the Cupcnino Municipal Code.Chapter 9.12 and the Nestor and Safety
.Section 25571(x)? '
❑Ye ANo All roofs shall be inspected prior to any roofing material being installed.
Will the rt'liem or future Wilding occupam use equipmem m devices which If a roof is installed without first obtaining an inspection,I agree to remove
c
a
hmudoes atr conumirunu u deftrcd by Ne Bay Area Air Quality Management all new materials for inspection.
QYe IgNo
I have,read Ne hateaNau madec alsrequim unu underCapar6.95 ofthe Califor-
ulth&Sdcty Code,Secdmu25NB,25533"M5M.aundcrvandthvifthe Wilding
not cmsently hoc a sm.L that it u my responsibility u w,fy ,a on.,of the '
immcntswhich be mJpiormissmod000faCenifkatoofocmtwmy. Signature of Applicant Date
✓��a
Owner or amhanved agent Dow
All roof coverings to be Class'/"or better