07060268 CITY OF CUPERTINO
BUILDING DIVISION PERMIT Z�1F ?R1V�ATION•
PERMIT NO.
BUILDIN6 ADDjiESS:.UBB RD TBD — TO BE DETERMINED 07060268
l t.1 G b ll t� PERMIT ISSUE DATE
:R'S NAME:
DURECT CORPORATION 09/21/2007
SANITARY NO. CONTROL NO.
PHONE:
BUILDING PERMIT INFO
ARCHIlECT1ENGINEER: BLDG ELECT PLUMB MECH
ed a LICENSED CONTRACTOR'S DECLARATION Job Description
VC I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z(�� with Section7000)afDiviion3oCtheBusinessandProfessionsCode�ajndmylicenscis T. I. —LA13 SPACE INCLUDES T—BAR, ELECTRICAL,
in full force andcff _Z �1�8 LIGHT,E:�HAUST.
t n? Lic. 102 .73 X
License Class # J�
F pare Contractor
1000 = L02, 730
ARCHITECTS DECLARATION
i a< 1 understand my plans shall be used as public records
)yU
U, Licensed Pessional
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
pO following reason.(Section 7031.5,Business and Professions Cale:Any city or county
which rcquiros a permit to construct,alter,improve,demolish,or repair any structure
Prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
?a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 >q.Ft.Floor Area $120000
Z h=" (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
L .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of PNNumber Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 5 7 2 0 0 2 L
not more than five hundred dollars(5500).
❑I,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 rat apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
are own employees,provided that such improvements anot intended or offered for sale.If.
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.).
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.
n I am exempt under Sec B&P C for this reason
aer Date - - -
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain a Certificate of Consent to self-insure for Workees compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I 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 Work
�er+1s Compensation Insurance carrier and Policy number are:
Carrie, 7 /t'� /
Policy No.: 9:1 1
CERTIFICATE OF EXEMPTION FROM WORKERS'
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 Workeri 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 O CONSTRUCTION LENDING AGENCY
(~�rA I hereby affirm that there is a construction lending agency for tete performance of
IY,> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
4+ Lender's Address
U 0 1 certify that 1 have read this application and state that the above information is
Lt. correct.I agree to comply with all city and county ordinances and state laws relating to
rJ U building construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
W
(We)agree to save,indemnify and keep harmless the City of Cupertino against
rA liabilities,judgments,toss and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
APPLICANT UNDERSTANDS AN ILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE RE p-7 `Z:�7
Re-roofs
signal fApplicant/C Dare T of RoofH ARD S MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
,s defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
.odc,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 use equipment or devices which
emit harardnus air contaminants as defined by the Bay Area Air Quality Management all new r.laterials for inspection.
District? O
❑Yes u
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety C 25505,25533 and 25534.1 understand drat if the building
docs not curtently h a Lena tha1,47 5t it is respor si 'ity to nouCy the occupant of the Date
requirement whi stbe tprior once crtificatcof.Oc upann Signature:of Applicant
Gv _ All roof coverings to be Class"B" or better
Owner or authorized ager Date