08100050CITY OF CUPERTINO
BUILDING DIVISION PERMIT
.COI'!CTRAC77�7"ORI,1V-'f?RMr1T, b
BUILDING ADDRESS:
PERMIT NO.
10441 BANDLEY DR
DEVCON CONSTRUCTION INC
08100050
NEWS NAME:
PERMIT ISSUE DATE .
METZLER N AMERICA PARTNERS C/0
'690 GIBRALTAR DR
10/09/2008
PHOI..T 7.
SANITARY NO. CONTROL NO.
ARCHI'IECTIENGINEER:
BUILDING PERMIT INFO
DEMO EXISTING WALL, CEILING
�aLDc ELEcr PLUM9 MEcx
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
son
I 1 am Hnad under provisions of Chapter 9 (mmmcnsing
1 bmeby afrtm Wx
with section 7M) of Division 3 of the Business and Professions Code. and my license Is
in fullfarce and effectjig G
u«nae Clasa Lk. a
Date a O Convector
ARCHITE(-TSDECLARA ION
1 understand my puns shall he used as public mxards
Licensed Profcuional
OWNER -BUILDER DECLARATION
I Waby aRrm that I am esempt from the Contrsotora License Law for the
following oncron. (Section 7051.5, Business and Profasaions Code: Any city or county
which requires • pmmit to commour, ober improve, d... ish, or repoir any structure
print to its issuance. also mgmires the applicant forsuch permit in rile a signed staament
Ft. Floor Area
Valuation
that x is licensed pursuant to the provisions of the Contractor's Liana Law(Chaptm9
Sq.
(commencing with Section 7000) of Division 3 of Ne Business and Professions Cade) or
that he Is car mpt thmefrom and the basis for W alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjecs the applicant to a civil penalty of
not moa than five hundred dollars (SSW).
❑ 1, a owner of the pmperty, or my employees with wags as their sole comperuadon,
Required Inspections
will do the work. and the swcture is not intended or offered for ass (Sec. 7016, Business
and Professions Cada: The Convenor's License Law doe, nat apply to an mane, of
progeny he buildaorimperves thereon. and whodoessueh work himselfor Waugh his
awn employees, provided that such improvements art not Intended mufferd forsale IT,
however, W Wilding m improvement Is sold within ons year of completion. the Owner.
boiler will Move the burden of proving that he did on, Wild or improve for purpose of
sale.).
1. as owner of she prolsray. am exclusively contracting with licensed conuacmrs Of
consumer use project (Sec. 7046. Business and Professions Cade:) Tie Contractors V-
censa law does not apply ban owner of property who Wilds or improvca dreteon, and,
who canufacs for such pmjem with a canuacmn(s) licensed pursuant in W l.onuactora
Lice. law.
❑lam ocmpt under See .B&PCfmthsressoo
w Dam
WORKERS COMPENSATION DECLARATION
10
1 hereby affirm miler pensiq of perjury, cave of the following dodaradow..
❑ 1 hz.e ad will maintain • Certificamof Conserv m salt -insure fm WmkeraCmmpm-
sedan as pro for by Section 3700 of the Labor Cade. for W peAomanse of the
work for whichthis permit is issued.
❑ I have and will maintain Worker+ Compensation Insunnm, as reached by Section
3700 of the labor Code, for the performance of the wmlr for which this permit is Issued.
'
My WorkerWonpansation lnsua�a�n,m� ca,dmim and Policy number art:
Co
A&-O S 9
Cartier. (�14'L%/fC.- — Policy No.: -Z4 Z
X
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ms section need not W completed if W permit Is fortune hundred daVa s (SIM)
or iesa)
I candy that in the Performance of the work for which this Permit is issued, 1 shall not
employ any psmon in my manncfxn Y to become subject lobo Worked Compensation
Laws of California. Data
Applicant
NOTICE TO APPLICANT. If, after making this Ccniricsm of Exemption, you should
became subjccr to sire Workers Compensation provisions of site labor Cdc, you most
forthwith comply with such provisions or this permit shall W deemed mvuluuL
'
CONSTIUCTIONLENDINOAGENCY
1 herm Wt siert this construction lending agency for the perfamenee of
which
the work for which this permit Is iuued (Sec. 5097, Civ. C.)
Landers Name
,
lsrnders Addres
j 1 sonify dirt 1 have fed this application and state that the above information is
'
mnneet. 1 age m to comply with all city and county onA omCa and Stam laws rtladng in
Wilding construction, and hereby auNoria representative, of this city to cmc upon f
I above-mendmed property for inspection purpose,
(We) agar to save. indemnify and keep barrel. W City of Cupertino against
j Iiabilide,judgmens,co0s which may leany wayaemuc against said City
ina
I AP ICA7 Uf ERST NDS AND \ tLL MPLY WITH ALL NON -POINT
Issued by: Date
SOVRCE G TIONS.
/0-1-11i
e -roofs
Signamrt fApplicanuc Dam
AROO
HAZARDOUSMATERIALSts OSURE
Type of Roof ,
Will ft applicant Of futmc Wilding asupanr no sir handle havrdons material
dcrined by the Cupenince Municipal Code. Chapter 9.12, and the Health and Safety
25532(x)7
All roofs shall be inspected prior to any roofing material being installed.
:Section
❑ Yes
If a roof is installed without first obtaining an inspection, I agree to remove
Will W applicant or future Wilding occupant use equipment m devices which
..it handcus air contaminates as deEncd by Ne Bay Area Air Qmdfi, Management
all new materials for inspection.
Dis ric(7
0y.
I have mal the himmuntsmaterials requirements undarchapms6.95 ofthe Califor-
niailml &Safety Ca Rmms 505,25533md255M.1undcrssndthaffde building
d not to ly no•fun wt It is my responsibility an natty the mcuptnl of de
re reme Ito bomet *or insuanceafaCmrircQof ccupwmy.�
l—o
Signature of Applicant Date
All roof coverings to be Class'j}" or better
Owner Dae
or authoni:d agent