08040177 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CO€N" T4RAms 0
I NO.
TANTAU SOUTH BAY CONSTRUCTION CO Venial 0 8040177
FRS NAME: PERMIT ISSUE DAM
APPLE 170 KNOWLES DR 05/27/2008
MONE: (408) 379-5500 SANITARY NO. CONTROL NO.
ARCHTTI=/ENGINSER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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0 LICENSED CONTRACTORS DECLARATION
to I Wintry affirm Mat I amlicamsed under provisinark,of Chapter 9(commencing Job Description
U5 with Sedon70Mof0ivWon3afftBusircv ficerioniCade.ander,fic-ackis REVISION ADD SECURITY FENCE IN GARAGE AND
l
DniLic.mif ad Chun RE-STRIPE PARKING AREA MODIFY ELEVATOR VESTIBULE
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I- ARCHr[IeCTS=LARATIONc-( ORIGINAL PERMIT # 07120018
Ind I understand my plans shall W used as public normis
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OWNER-BUILDER DECLARATION
I licoub,ififirm Mat I.m exion"from Me Cmaractor'.uken.Law far ft
. se 0 C following mason.(Section 703 1.5.Business and Proficnesiom;Code:Any City or county
1.9 which no,fres.permit readout.Aw,improve,demolish,m repair any stersectme
2 prior to its issuance,also acquires the applicant fiarstich Permit 1.filcitsi,madmocracrit
H, thou W is licensed iruirsamor,in the pracomccocif Me Corturacuor's Lice.Law(Chapter 9 Sq.Ft. Floor Area Valuation
1- (commencing with Section 70M)of Division 3 of Business and Professions C $40000
n Code)or
5 that M 4 animals fficed.and the basis far Me idincul catereption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to A Civil penalty of
.1..Man five hisondrid dollass f5500). 31618 0 2 5 qMMber Occupancy Type
0 1,as owner of the property,or my employees with wages as their micectimpenuadon,
will do th.wor1c,and the shourtme u not Mtended oraffercul forskit,(Sec.7044.Business
and Por,ficssionts Critic The camassioes License Law does an,apply in an owner of Required Inspections
property who Wilda or imannums thvmn. dikesouch werrhimuselforshoo.gh his
own employees,provided Oat such improvements am not intended oraffened for sale.U.
however.Me Wilding or improvement is sold within one year of completion,Ine comer
builds,will asive thic burden of proving Mat Ise did num Wild in improve(or purpose of
sake.).
0 1.as manner of Me Propny,.m rachadmi,contracting with Ilam¢d contrabounis he
comarect the project(Sec.7044,Business and Prafiessimis Chabit)The Contractors U.
ecruse Law doca not apply to an cromer of proper,who Wilds or improves thimen,and.
who contracts for such projects with a condractor(s)licensed inarearn in Me,Contionsear`3
License law.
0 lareascroplunderSee _,B&PcfauMisnWmn
an Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury am of On following declarations:
0 1 have and will maintain a CeifificateofCoadent to self insure fan Worker's Compete
count,as provided for by section 3700 of Me LaWr Code.for the performance of Me
war,for which Mat permit is issued.
0 1 ham and will maintain Workers Onopsockdom Ini.raquiread by Scefiren
37000 the Lalmr Code,far Me lanfiromenseccifthe worric for which this permit I.issued
My Workers Cirropersoodom lass.carrier and Policy number.:
Carrier. W Policy Na.: C_2-cv�0 L( 0
61011&w OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Croo secdcas oundl anobe completed if the permit is forom,hundred 011m(SIM)
or it.)
I ocoulf)v Mat in the Performance of the work for which this Permit is Wood.I"I aso
employ any pension in any mationerso as to became subject in Me Workas Conliamosiflem
Laws of California.Date
Applicant
NOTICE TO APPLICANT.It,after making this Certificate of Eacmpmom,you should
become subject us the Workers Compeconsium imenanikirms of Me Ulow Cache you am
z forthwith comply with such Provisions or this permit shall W docancid revoked.
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E 7) CONSTRUCTION LENDING AGENCY
I�aabY affirre Miss Moe 6a examustruction lendi.g.lient,,far Me, rr...f
Me work for which Oil Permit is issued(See.3097.Civ.C.)
CL E
Lender's Name
::) z Lender's Address;
U 0 1 really,Mai I have read this application sonat sae M,Me above information is
Comm I afirst,in comply with all city and county ordinances ad state laws rclaust,to
Wilding construction.and Mosby atiMonme repareanneadims of this city 10 enter upon Me
a1voc-irentioned property for inspection purposes.
(We)alince to save,indemnify and keep lumbleak;Me City of Cupertino against
,A lattal'usajuOrroutiat.m.
in cc of '.
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o"M
ti APPLI NT U RS7ZI'll A�l LL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR F REG MTION!
Re-roofs
�
HDOUS MATERIALS DISCWSURE Date Type of Roof
Will the applicant in for=Wilding occapaint awe or hand,,habournabous no,scrad
as defined by Me Cupertino Municipal Cork.Chapter 9,12.and Me Health and Safety
Sced..255324y'
Dy. No All roofs shall be inspected prior to any roofing material being installed.
KOIf a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building oexupon,use,equipment or devices witch
cDisrilttribacandaus air conausainums as dcdefenddefendby the Bay Area Air Quality Management all new materials for inspection.
ct?
0y.
I have mat be hu'.L L mOmmouras under Chapter 6.95 oftha Wilding
ria Statorm nM.25533 and�5�.1 undenciand Bad if Me Wilding
does tlr- isoationt Mat is an Mi. if,Me resonant or ft
Zu'real in, .1 47 /C9
renne whichamoLkOuLlan.' is; once now.1 U, 7(C16 §TT ratilre,of Applicant Date
Owak,aawthmimd.gaml Dow All roof coverings to be Class'W'or better