07020070 CITY OF CUPERTINO
BUILDING DIVISION PERMT t sIJL�ILC � JC Vy �Z�N-
BUILDING ADDRESS: PERMIT NO.
20300 STEVENS CREEK BLVD #400 CONSTRUCTIVE BUILDING SVC, 07020070
OWNER'S NAME: PERMIT L%UE DATE
SYMANTEC 3937 39TH AVE 02/22/2007
PHONE:
SANITARY NO. CONTROL NO.
(510) 531-1175
ARCHTiECT/EIJG1NE77t:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Z LICENSED CONTRACTOR'S DECLARATION
� lob Description
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
u with Section7000)or 3efthe Business and Professions Code.and myI*enscis CONSTRUCTING NEW PARTITIONS AND DEMO GYP BOARD
o. in full fora and �� /
License Class Lie-" -7�� SOFFIT
w Date Contractor
ARCHITECTS DECLARATION
1 undaxtand my plans shall be used as public records
c�
Licensed Professional
y
OWNER-BUILDER DECLARATION
g 1 hereby affirm that I am exempt from the Contractors License Law for the
00 following reason.(Section 7031.5.Business and Professions Code:Any city or county .
which requires a permit to construct,alter,improve.demolish,or repair any structure
y prior to its issuance,also requires the applicant for such permit to file a signed statement
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Professions Codc)or $2 5 0 0 0 0
c that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit sdbjects the applicant to a Civil penalty of �,E N Number Occupancy Type
not more than five hundred dollars(M)_ 36901019
."l71
[j 1,as owner of the property,or my employees with wages as thew sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor License Law Lice Law does not apply to an owner of 9
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.lf.
however,the building or improvement is sold within one year o(completion,the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li-
ccase Law does mot apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractors)licensed pursuant to the Contractor's
Licenae Law-
1 am exempt under Sec .B&P C for this mown
Owner - Date . . . _
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: .. -
VT I have and will maintain a Certificate of Consent to self-insure for Workers Compen-
'on,as provided for by Section 3700 of the Labor Code,for the performance of the
rk for which this permit is issued-
❑1 have and will maintain Worker's Compensation Insurance,as required by Section - -
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My WoS ompensa'oa In a - and Policy n bTerX
Cartier. Policy No.: I
CERTIFICATE OF EX PT10N FROM WORKERS
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(S 100)
or less.)
1 certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Worked Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,art=making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
z forthwith comply with such provisions or(his permit shall be deemed revoked.
O
I CONSTRUCTION LENDING AGENCY
�--� I hereby arfum that there is a construction lending agency for the performance of
the work for which this permit is issued(Sec-3097,Cv.C.)
I Q Lender's Name
'z Lenders Address
I
1 certify that 1 have read this application and state that the above information is
correct.1 agree to comply with all city and county ordinances and state laws relating to
Ubuilding eonsuvetion,and hereby authorize representatives or this City to enter upon the �1
LII ahove-menliuncd p pert or inspection purposes.
c Gt. (We ,i emm y and keep harmless the City of Cupertino against
c V) liabili- Iud expensm which may in any way tccrw against said City
z in o ti of this permit ;/ ,
A
DISCLOSURE Type of Roof
W the applicant or future building occupant store or handle hazardous material
as dcfi y the Cupertino Municipal Code,Chapter 9.12,and the Health and Safely
Code. ion 25532(a)? ,�.�� All roofs shall be inspected prior to any roofing material being installed.
Yes ono
pP g perm equipment o devices which
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use
emit hazardous air contaminants as dermcd by the Bay Area Au Quality Management all new materials for inspection.
District?
❑Yes
1 have materials requirements underChtpter6.95 of the Califor-
n
ofa Certificate orOccupancy. Signature of Applicant Date
Owner a uth 'zed agent Date All roof coverings to be Class "B" or better