08080234CITY OF CUPERTINO
1100 TION'
BUILDING DIVISION PERT
%CQWRA.CTOR
e
Bu
b CREEK BLVD
TBD — TO BE DETERMINED
PERMIT
PERMIT NO.
08080234 ,
R'S NAME:
PERMIT ISSUE DATE
EVERSHINE GROUP
10/13/2008
PHONE:
SANTIARY NO. CONTROL NO.
ARCHTTER7ENGINEER:
BUILDING PERMTINFO
-BLDG
ELECT PLUMB MECN
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job DCSCfIptlOn
ereby athat 1 licensed under provisions of Chapter 9 (mmmmming
1 hf14m am
with Section 7010) of Division 3 of the Business and Proliummes code, and my licensee
COMM'L TI NEW FACADE FEATURE@CRNR(E)SHOPCNTR
in full forte end effect
License Class Ue.+
INCLDNG COLMN TO MATCH(E)DOUBLE COLMN&FINSH ROOF
Dac_ Counselor
ARCHITECTS DECLARATION
TO MATCH SHOPCNTR &INCLD DECORATIVE WOOD
1 understood my plana shall be used as puhlic recorN
-
Lieemed Professional
OW NER-BUILDER DECLARATION
1 botchy eft,. Not I an exempt from the Contractor, License Law far the
following mason. (Saban 7131.5, Business end Professions Code: Any city or county
which requires a permit to csmson" alter, improve, demolish, or repair my structure
prior an its issuance. also requires the applicant forsuch permit to fle a signed statement
Cmuacmes liecmc Low (Chapter 9
Sq. Ft. Floor Area
Valuation
that he is licensed Pursuant m the pnvisiorsof the
Professors Code)
$50000
(commencing wits Section 7000) of Division 3 of f Business ad or
that he is exempt therefrom and Its, basis for the alleged exemption. Any violation of
36906009C.ri'1RK"
O
Occupancy P y Type
Section 7031.5 by any applicant for a permit mbjccu the applicant In a civil pwlly ofbar
not mare than five hundred dollars (15M).
❑ I,asawner of Us pmpeny.mmY moployeea wits wagesuNeb sole campvuaoon,
Required Inspections
(car 7044,Budf
dotsevms
fined Law do
W Pmfewav Calc Th Cmtramrs Liana law uses oro apply if m awder
and Costs The1 apply
q P
is
p ssuchwank himalfm Wough his
mimpualach
improve ants anw1aclo
macdcrlYwWuuprods
thasaneh improvements an not od.f d "Offered tOcsale. I.
'
Wilding improvement V mid within of cmove or, the owner -
ewds, Ne Wilding
however.
Out Wild
W ilder will low the Whim of proving out W did rot Muld a improve rOc putpoa of
u
• .L as owner or the property. an coduaively contracting with Ecamed contractors to
com tact the project (Sec. 7044, Budd and Professions code:) Tia coduacmrs LL
cove law doss not apply as an ownm of property who WiWs or impmvrs themen. rod.
who canVicta far Such projects with amuscle*) licensed pmaeanl to the COmmarmr4
licence law.
1 oro camdpl undo . B & P C fy esus reason
nee .,�� Dare l0l t.3 fob
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarauam:
❑ Iheve4ndwillmainsina Ce fimmofCavcnuoulf-Wumfor Wor sComNn-
uGon, u Provided foe by Section 3700 of the Labor Code. for the performance of use
were for which this permit is is,Ocd.
❑ I have and will maintain Worker, Compensation Insurm¢, as tmuired by Second
37W of the latur Code, for the Performance oftse wart for which this permit is issued.
'
My Workers Compeduoon h mm me carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissectlon need not he completed ifft permit is fermne hundred dollars (SIM)
or lona)
I carry Nat in the performance of ac work for which this porrut is issued, l shill nut
employ any'permn in my madmr.ta 1 arrl Subject to the WorkersCompassmot
.
law, of Cairomis. Date O
.
App* G• _
NOTICE TO APPui NP. IL a0er making Nis Cmuftcam of Eaemption, you 5haum
became subject to use Workers Compendium provisions of Ne UW Codc, you most
r forthwith comply with such provisions m Nu Permit shall be do mnt mvelad.
i
ON LENDING AGENCY
CONS..,.
construction loading agenry (m Nc performame of
1 hereby aRrm Nat there ts a constm
. 30
' the work for which this permit V issuW (Sec. 3(19'1, Civ. C.)
Isnder, None
I<ndeh Address
'
1 cmtify Nat I haw tcsd Nu application and Stam that th above information is
correct. I agfes m comply with all city and county aNimunces and state 1. rela40g to
Wilding construction, and hereby mthorim representatives of Nu city as enter upon Ne
mevc-menlianed properly, ran ivpccdoo purpoaa
(We) agree to save, indemnify and keep hamless Ne City of Cupertino against
I Iimilit.m,Judgments, casts and expenses which may in my way mente against aid City
in eonsequmee or the gmnung of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE GUL NS.
h3)o
Re -roofs
�' (o d'
��
SiggifftWiff ArpliestarContrator Dae
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will six applicant or future Wilding occupant NOR m handle Incautious material
dclred by the Cupenim Municipal Code. Chapter 9.11, and Ne Health and Safely
m. sued. 25532(a)?
All roofs shall be inspected prior to any roofing material being installed. '
❑Yes I&NO
If a roof is installed without first obtaining an inspection, I agree to remove
Will Nc applicant or future Wilding Occupant use equipment or devices which
emit Musts. air cmumivnu u defined by the Bay Arca Air Quality Mmagemedl
all new materials for inspection.
District]
❑Yes )6No
I haw read the ha ardnu maariabrequirtmenu under Chapms6.95 of the Califmr.
hia Health & SarmyCode, Sections 25505, 25533mu255N.1 untiiaaW Nuif tie Wilding
does not currently hate a sound. that It is my responsibility in notify otic occupant of us,
regdirt'�muuxmetpiartck...
/tilt
Signature of Applicant - Date
J� 13
All roof coverings [o be Class'%¢." or better
Dare.
W, rarmdmmr<aagent