08100173 CITY OF CUPERTINO `a�••,
BUILDING DIVISION PERMIT -�COMMX61bR INFORMATIQN,'t
BUILDING ADDRESS: PERMIT NO.
10900 N TANTAU AVE DEVCON CONSTRUCTION INC 08100173
W NER'S NAME: PERMIT ISSUE DATE
ONE: A CONTROL NO.
(408) 942-8200
ARCHf1ECOFNGINEFR:
BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
uoo LICENSED CONTRACTOR'S DECLARATION
r�V 1 hareby afRrm that 1 am licensed under provisions of Chains'9(mmmcncing lob Description
with Seek.7")af Division Stardm Emirates and Proressia ode.and my license is
"oH '"rullramevWefrtts 31-116.5 ADDTION 688 ' SOLAR CAR PORT-2 STORY SHELL BLDG
S mn? Licence Clan Lk.g
-f,O Da¢ C n.' I ON
ARCHITECT'S DECLARATION
I Mukomnd my plus shall he used as public.0mas PERMIT 08020156 .
JyU
g LL Licensed Professional5LicensedOWNER-BUILDER DECLARATION
'yy St I herchy otTirm that 1 am exempt from the Contractor's License Law for the
i
00 following moron.(Section 71131.5,Busircss and Professors; Any city or county
o
m V. which requirea a permit to conswe4 almr,improve,dcmnlish,or repair any smmmium
_Iy prigbis issuance.dsu req uirtatheappliemnrorsuchpermitmfieasignNitammenl
s< that he is licensed pmaaanua die provision of the Contracmr'alJave law fchapiv9 3q.Ft. Floor Area Valuation
Yt-0 (commencing with Section 700(1)of Division 3 of na Business and Proleasions Code)or 65000
y hat he u exempt therefmm and the basis for the alleged esempuon.Any violation of
Section 7031.5 by any applicant for a Permit subjccu the applicant m a civil penalty of APN Number Occupancy Type
Out more than rive hundred dalhn(ssom 31609029 . 01
❑1.as owner of de property.or any employees with wage as thea mm compensation.
will do he wall and the somemmis an,munWed or offered for sam(Sec.7044,Business Required Inspections
and Pmrassiaru Cade:IN CmMacMe3 License raw dos Out appy m an own e of q P
property who builds or improve dmrrem,andwho daeisuchwork hica lfor Ruough his
owmcmpkYwas,provided man such impmvemeu arm.1 Mounted coffered rentals,If.
haweve,me building or impmvertmt u sold within arc yse'of campmtion.the Mwms-
Wilder will have hon When of proving that K did net build or improve for purpose of
met I.
❑1.as owner of he pmpeny.em exclusively contracting with licensed mntracmrs m
contract the project(Sec.7W,Business and propeatian Cade:)The Ca.bacemr's Li.
cense law does not apply or an Manor of property who Wilds or improve hereon,and
who contracts for such projects with a eoonetor(s)licensed pursuant m the Commetor's
License Law.
lam exempt under See ,B k P C for his mason
caner Dam
WORKER'S COMPENSATION DECLARATION
1 Mmby alarm under penalty of perjury one of he following decimations:
A
I have and will mdmam a Canmesm of Cement to self-imus for Walker's Compeer-
sa ion as provided for by Section 3700 of he labor Code.far the performance of the
work for which this permit is issued.
1 have and unit oxiMm n Worker's Compensation Ins.nn¢,as required by Section
3700 of he labor Code,for he peRarmmee of he work for which his permit u issued.
My Worker's Compensation bsunnce currier W Policy number am:
Cartier:.70eAs/I /1/Pl 'z0/'//kdPolicy No.: '29 2qo'..i—6$
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mnia section need not W completed if the Permit is fame hundred doilan(SIM)
err less.)
I certify dot in he performance of the wars for which his Permit is issued,l stall not
employ any person in any mannerm as to bceome subject to nM WorkeK Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Cenirscam of Exemption,you should
become subject to he Worker's Compensation previsions of the Labor Code,you most
.J vz foMwih comply with such provisions or hts Permit shall bo decreed rcvakcd.
Z O CONSTRUCTION LENDING AGENCY
[—i Ihereby affirm that Vert is a construction lending agency for he Performance of
TL .moi the work for which this Permit ts ironed(Sec.3097,Civ.CJ
fA Lender's Name
z L<ndefs Address
U Q I canify that I have read this application and sum that the above information is
Ls.E' carton.l agree to comply with all city and county andinanm and sum laws retail.,m
O V building construction.and hereby authorim repreaenuums ofthis city m inter upon the
rw above-mentioned property for inspection purpose.
pw (We)agree to save,indemnify and keep banmlest the City or Cupertino against
liabilities,Judgments,cam and expenses which may in sty way emus against mid City
U Z in consequence of he granting of this permit.
^^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date Z• ��
SOU EGULATIO S.
u 1Z11 7101:f Re-roofs
SignaturepplieData
HAZARDOUS
US MA7ERIALSDISCIASURE Type of Roof
Will the applicant or forum Wilding c,Chapter
9A or handle hau'don mamriJ
u defined DY the Cupertino Municipal Code.Chapter 9.13,and he HW h and Safety 4V
Cndc,Section 355331a)7 All roofs shall be inspected nor to an roofing material beim Installed.
C]Y. IFJNo P P � Y 8 8
Will the applicant or future Wilding occupant sac equipmmi or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
emit haraNnus air ca.umi...B as defned by he Bay Arca Air Quality Management all new materials for inspection.
D s0ic0
[I Y. 1$J4u
I have real he hvaonusmawrials requirements un@r ChMxa6.95 of Ne Califor-
nia Health h SafelyCole,Seeuan2550,25533 md25534.I understand thmif ths Wilding
dos not currently ham a mmol that It is my remeandbility to notify he Occupant of the
mquinmrns muubemIprior mlss...ofaCcnlriesmarOcMMpmny. Signature Of Applicant Date
Owner art soha dagent Dam All roof coverings to be Class /?. or better