07060135CITY OF CUFEK111N"
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
19240 STEVENS CREEK BLVD
OWNER'S NAME:
TD AMERITRADE INC FKA TD
4 &-IA MVT:)t_TnTTL1V
ARCHITECT/ENGINEER:
l a a LICENSED CONTRACTOR'S DECLARATION
UI hereby affirm that I am licensed under provisions of Chapter 9 (commencing
z with Section 70(10) of Division 3 of the Business and Professions Code, and my license is
a a in full force and effect. (JOCA3
v�� z License Class Lic•
Date G, /'J1 Contractor
ARCHf1ECl -S DECLARATI N
i a a 1 understand my plans shall be used as public records
>yU
U. y Licensed Professional
O a OWNER- BUILDER DECLARATION
ia I hereby affirm that I am exempt from the Contractor's License Law for the
p O following reason. (Section 7(131.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
r — H prior to its issuance. also requires the applicant for such permit to file a signed statement
? < that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
t=- (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
❑ 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
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not 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 U-
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.
❑ I am exempt under Sea B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
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PERMIT
TURNER \.ONSTRUCTION CO 07060135
PERMIT L55UE DATE
(408)295 -7598
SAN17ARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB
Job Description
REVISIOD -MOVE OF AN EXISTING BEAM AT BREAK ROOM
OF
COMM OFFICE. ORIG PERMIT 406090155 NO NEW
PERMIT.
I hereby affirm under penalty of perjury one of the following declarations:
j I have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
ation, as provided for by Section 3700 of the Labor Code• for the performance of the
rork for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as required by Section
700 of the Labor Code• for the performance of the work for which this permit is issued.
4y Worker's Compensation Insurance carrier and Policy number arc: (; �p t
:artier. 1A 1��tUR(,` PolicyNo.: 'Lf0 -6 l
CERTI MATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
tr less.)
certify that in the performance of the work for which this permit is issued, 1 shall not
.mploy any person in any manner so as to become subject to the Workers 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
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
1 certify that I have read this application and state that the above information is
correct. 1 agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
above - mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgrp ts, costs and expenses which may in any way scenic against said City
in consequ' WERDS permit.
APPLICANT D WILL COMPLY WITH ALL NON -POINT
SOURCE RE Signature of ApDale
ATERIALS DISCLOSURE
Will the ilding occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Yes ❑ No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
❑ Yes ❑ No
I have read the hazardous materials requirements under Chaptcr 6.95 of the Califor-
nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenant, that it is my responsibility to notify the occupant of the
requirements which must be met prior to issuance of a Certificate of Occupancy.
Owner or authorized
Date
Sq. Ft. Floor Area
37506006 ``.�R Number
Issued by
Re -roofs
Type of Roof
-31
r1YPe
Required Inspections
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better