06030111CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
NOVO CONSTRUCTION
PERMIT NO. 06030111
20450 STEVENS CREEK BLVD
OWNER'S NAME:
PERMIT ISSUE DATE
CUPERTINO CITY CENTER
1042 HAMILTON COURT
05/04/2006
PHONE:
SANITARY NO. CONTROL NO.
(650)701-1500
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
With Section 7000) of Division 3 of Use Business and Professions Code, and my license is
in full force and effect. 3 79/G_).__)1
TENANT IMPROVEMENT -OFFICE SPACE
License CI Lic. p
Date/_`Y OCContracor NOOo r-t,..,isl,��-
SANITARY VIDEO DONE 4/24/06 GEORGE SANTOS
CTS DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from Use Contractors License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to consumer, alter, improve, demolish, or repair any structure
prior to its issuance, also requites the applicant for such permit to file a signed statement
he is licensed to Contactors License Law (Chapter 9
Sq. Ft. Floor Area
Val i®iQ 0 0 0
that pursuant the provisions of the
(commencing with Section 7(100) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and Use basis for the alleged exemption. Any violation of
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Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofer
not more than five hundred dollars (5500).
3 10T 0 0
❑ 1, as owner of the property, or my employees with wages as Use's sole compensation,
Required teed Ins ee[ions
will do the work. and the structure Is not Intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law docs not apply to an owner of
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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. IL
however, the building or improvement is sold within one year of completion. Use 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 contacting with licensed contractors to
construct the project (Sec. 704. 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 Use Contractors
'
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 perjury 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:
'`Pplcy % 7
t-{tl�r.o� C•'
Came .:No.: .=ZOrYC
CERTIFICAV OF EXEMPTION FROM WORKERS'
C MPENSATION INSURANCE
r
(This section need not be completed if the permit Is for one hundred dollars ($100)
or less.)
I 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 Workers Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should
become subject to Use Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
y CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
'
Lenders Name
LendorsAddress
7
D I certify that I have read this application and state that the above information is
-' correct. l agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
for inspection
above-mentioned property purposes.
(We) agree to save, indemnify and kap harmless the City of Cupertino against
/p"1 liabilities, judgmens, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.(�
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SO RE LA ONS._
Re -roofs
Type of Roof
c6
Si7ure of Applicant onuactor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hayardous material
defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Cede. Section 25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant sere equipment or devices which
emit havardous air contaminants as dcrtncd by the Bay Area Air Quality Management
all new materials for inspection.
District? �
❑ Yes 91
I have read the hvardous materials requirements under Chapter 6.95 of the Califor-
nia Hcalth & SafctyCodc, Sections 25505,25533 and 25534.1 understand that if the building
docs t currently have tenant, that it is my responsibility to notify the occupant of the
rc inonns,�s�lUCn mus be met prior to issuance of a Ccniftcate Oupancy.
Tll�\` -3 /y' "�
Signature of Applicant Date
All roof coverings to be Class "B" or better
ncr
or authoriyrd aecm Date