08100172 CITY OF CUPERTINO *'-'{ ;;T1,_771BUILDING DIVISION PE CO1�iTRACTORINFORMATIO,N ;-
_RzE,zR:?ffixu s., r.✓; s•.S'd.
BUILDING ADDRESS: PERMIT NO.
10300 N TANTAU AVE DEVCON CONSTRUCTION INC 08100172 '
"NER'S NAME: PERMIT L95UE DATE
PHONE: A O. CONTROL NO.
(408) 942-8200
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
cope LICENSED CONTRACTOR'S DECLARATION O O O O
WCI thereby affirm Nal l am licensed under previsions of Chapter 9(commencing Job Description
iW with Seen.,")ofDivision 3 orthe Business and Professions Codc.and my license is
in full force aM at COMM' L TI COMBINE 2STRG RMS INTO 1,RMV CEILNG IN
License Lie.N
=k,p Dam C f — ConMose L 1
ARCHITECTS DECLA ATION
��g I undcrsund my plmu shall be tied As public records RM &EXTND COVRG FO EXT SUS CLG BY ADDNG 120SQ
;du Licctued Pmfcssional INTO EXT SP;RWK ELEC,HVAC&SPRNKLRS
o
5OWNER-BUILDER DECLARATION
1 hcmhy from
that I am exempt from the Contractors License Law for the
C o O following reason.(Section 7031.5,Business and Preressinm Cade:Any city or county
1=9 which¢quires a parent to cmanwL alma impmw,&..)tsh.at repair any structure
_ito prior hs its issuance.ala requires the applicant for such permit to file asi,.d summr
e
s that he is licensed pursuant to the provisions of dim Cammctur'WanmLaw(chapter 9 Sq.Ft. Floor Area Valuation
xl-m (commencing with Section 70(k)of Division 3 of the B usinus and Profeaiorts Cnde)or $50000
y�$ that he h exempt therefrom and Ne basis for the alleged exampdon.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant 10 a civil penalty of APN Number Occupancy Type
oat more man five Imemddollars(M). 31618025 . 1&2 p y YP
❑I,as own,.of the Property,army amploy es.ith wages As deb sok compere adon.
will da the work.and the suactum is at mooned or offered for sale(Sec.7014,Bum.
and Precession Cade:The Con.ecmrs License law does ret apply to an owrcr of _ Required Inspections
property who builds At improves thereon,andwha emssuch work himselfor Waugh his
owoemployaes,provided that such impmwmenu art notimmnded aro@red foraele.If.
however.Ne building or improvement is sold within ane year of compledon,the owtws-
builder will have the burden of proving that Ire did not build or improve for purpose of
sale.).
1,As owns,of Ne prepeny,am extimimly eamncting with licensed commators to
construct the project(Sec.7014.Business and profesion Cade:)The Connector's U. _
cense law docs not apply to an owner of progeny who builds or improves Wn:nn.and.
who contracts for such projects with a contractor(s)licensed pursuant in the Contractor's
License Law.
❑1 om exempt under See. .B At P C for this reason
jVr Dau
WORKERS COMPENSATION DECLARATION
1 hereby affirm under pcmdty of perjury ons of the following declaetions:
❑Ihsw and will mainuinaCmifiauaf Cortsenuo xlf-insure fw Workers Compere
sation,as provided for by Section 3700 of the Labor Code,for the peAmmance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation buurana,As required by Scion
37M of the Labor Cade far the performance orate work for which this permit is issued.
My Workers Compensation Insurance carie,and Policy n-unmbkra,v AM:
Cartier. '? (j 11 Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(IDU section need notbccomplemd if Oar permit is for one hundred dollars(SIM)
a,leu)
I certify that in the,performance of me work for which this Permit is named.l shall not
..ploy any person in any mane,se as to become subject to the Workers'Cmnpewtion
Laws of Califoran,Data
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subjm in the Workers Compensation provisions of the Latour Code,you most
.J O foMwith comply with such provisions a mit this perahall Ac deemed muted.
Z � CONSTRUCTION LENDING AGENCY
I-s 1hemby.fBnn that dare iso construction lendingagency fen the parfomunce of
Ci the work fur which this permit is issued(Sec.3097,Civ.C.)
6Wi Q Landers Name ,
M z Lenders Address
V Q 1 certify that I have rad this application and sum met Use show information is
IL E" comma I agree m comply aim all rimy and county ordinances and mu laws relating,.
C V buildingconmauetian,and hereby Authorize repo_senudwsofmis city,.entarupon the
LU atawcmend...d property far im ciian...poses.
(We)agree to ave.indemnify and keep harnless the City of Cupertino agunst
ry liabilides,judgmenu,cath and expenses which may in any way Accrue against said Cimy
()z APPs pensdit.
LI9 NT UNDERSTANDS merfucance of the tharting of AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU7 REGULATIONS.
Z'I S Re-roofs
Sig o ppliuser Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or future buildinj Occupant store ser handle hanardous material
as deflned by the Cupenino Municipal Cade,Chapter 9.12.and the Hcalm and Safety '
Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes R
—110
Will the applicant or rutom It ilding Occupant use cquipmem or daviae which If a roof is installed without first obtaining an inspection,I agree to remove
c._A ha'rardnus air cuntsminanu As dc0ocd by the Bay Arta Air Quality Management all new materials for inspection.
District?
❑Yes
T have mad W Interaction,materials mequirtmenes under Chapmr&95 of dm Califor-
aikH lm&Saremy Code,Sauden305.25533 and25534.IuNersund thmifine building
does rot currently have a Mmo.mat it u my responsibility As notify the occumen or W
requi fits which met X met prior to issuance or a Cartifcate of Occupancy. Signature of Applicant Date
7
10 -0
All roof coverings to be Class'W'or better
0 armanom7X cot Dam.'