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07010049 CITY OF CUPERTINO BUILDING DIVISION PERMIT i INF. BUILDING ADDRESS: PERMIT NO. 10260 BUBB RD TBD — PO BE DETERMINED 07010049 OWNER'S NAME: PERMIT ISSUE DATE DURECT CORPORATION JNE: SANITARY NO. CONTROL NO. ARCH]IECT/ENGINEER: BUILDING PERMIT INFO SELECTIVE DEMOLITION, BLDG ELECT PLUMB MECH © O D O i p LICENSED CONTRACTOR'S DECLARATION loMbescription v E- I hereby affirm that I am licensed under provisions of Chapter 9(commencing :Z u, with Section 70(M of Division 3 of Ute Business and Professions and my license is a. in full force and effect. 41 z LicenseLf ass Lie. �� pate Contractor ARCHITECTS DECLARATION 7 C< 1 understand my plans shall be used as public records )yU u H Licensed Professional y OWNER- BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the CCOO following reason.(Section 7031.5,Business and Professions Code:Any city or county <1.Pi which requires a permit to construct,alter,improve,demolish,or repair any structure Z y eprior to its issuance,also requiresthe applicant for such permit to file a signed statement Ft.Floor Area Valuation :s G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. a t– (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation or Section 7031.5 by arry applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars($500). 0 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 License 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.U. however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Cock::)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. 0 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: Or 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. 0 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 Workers Compo aeon lns nee ca 'and Policy number are: Cartier �Policy No.: �4121- RTIFICATE OF EXEMPTION FRONMORKhRS' COMPENSATION INSURANCE (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 the Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z' ' CONSTRUCTION LENDING AGENCY (..d►�+ I hereby affirm that there is a construction lending agency for the performance of pC> the work for which this permit is issued(Sec.3097,Civ.C.) Wfs.A Lenders Name Z Lender's Address U 0 1 certify that 1 have read this application and state that the above information is LT.►d correct.I agree to comply with all city and county ordinances and state laws relating to CU building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (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. Date APPLICANTUNDERS WIL PLY WITH ALL NON-P INT Issued b,': SOU REGU Re-roofs S' u.( HAZARDOUS MATERIALS DISCLOSURE reType of Roof Wiapplicant 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 shall be inspected prior to any roofing material being installed. 0 Yes If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 0Yes u I have read the hazardous materials requirements under Chaptcr 6.95 of the Califor- nia Health&Safety Cafe,Sections 25505,25533 and 25534.I understand that if the building does not currently ha that it•s ity to notify the occupant of the reyui cntswh'ch a pn In an r nifrcateof duan Signatur;of Applicant Date n r or aKIT._d agent QW, All roof coverings to be Class "B"or better