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06070012 CITE'OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: SCA CONSTRUCTION INC PERMIT NO()6 070012 10100 N TANTAU AVE OWNER'S NAME: PERMIT ISSUE DATE SAND HILL PROPERTIES 1769 PARK AVE STE 200 07/05/2006 )NE: SANITARY NO. CONTROL NO. (408) 293-9050 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O p LICENSED CONTRACTOR'S DECLARATION O O U(- 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description Z i with Section 7000)of Division 3 of the Business and Professions Code,and my license is < in full force e(fe and c � DEMO C DMMERCIAL SPACE j Z License CI Lie.fi 03 11 ,/ t ❑ Datc Contractor e.A S ARCHITECTS DECLARATION U I understand my plans shall be used as public records a y O y Licensed Professional e y� OWNER-BUILDER DECLARATION < 1 hereby affirm that 1 am exempt from the Contractor's License Law for the OO following reason.(Section 7031.5,Business and Professions Code:Any city or county (� <m V which requires a permit to construct,alter,improve,demolish,or repair any structure V 000 Z 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 (DValua 'on t–$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). Occupancy Type 1,as owner of the property,or my employees with wages as their 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's Licerise Law does not apply to an owner of 9 P 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.If, however,the building or improvement is sold within one year of completion,die 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 Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law, ❑1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of peijutry one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work 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 Worker's Compensation Insurance carrier and Policy number are: _ Carrier. i�ir� �d i Policy No.: CERTIFICA OF EXEMPTION FROM WO COMPENSATION INSURANCE (this section need not be completed if the permit is for one hundred dollars($100) or less.) 1 certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z' CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of (Yi the work for which this permit is issued(Sec.3097,Civ.C.) WC1� A Lender's Name Z Lender's Address U C) I certify that 1 have read this application and stale that the above information is Vy ► correct.I agree to comply with all city and county ordinances and state laws rclating to OU building construction,and hereby authoriie representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. A.�� S� 6 Re-roofs StVIfflI­m­6TAppItcant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs s fall be inspected prior to any roofing material being installed. p Yes %w Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Arca Air Quality Management allnew m�terials for inspection. District? ❑Yes pyo— I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant.that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certificateof occu ancy. Signature(f Applicant Date —�� me Owner or authorized agent Date All roof coverings to be Class"B"or better