07010050t_11II Vr %_vai __.._
BUILDING DIvisiON PERMIT
BUILDINC, DDRESS:
M38 STEVENS CREEK BLVD
n^^E
.ZCR DEVELOPMENT
PHONE:
ARCHITECTIENGINEER
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
vith Section 7000) of Division 3 of the Business and Professions Code, and my license's
n full force and effect.
-icensc Class LleLic.#Contractor
Sate
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed professional
OWNER -BUILDER DECLARATION
i hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a pcMit to construct, alter, improve, demolish, or repair any structure
P.., ui 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
(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).
0 I, as owner of ft 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 professionsbuilds deor improves tritmesand .
Li-
cense Law docs not apply to ,_ owner of properly pursuant to the contractor's
who contracts for such projects with a contractor(s sed
License Law. B & P C for this reason
0 I am exempt under Sec.
Date AL1-
>.
PERMIT NO.
TBD — TO 3E DETERMINED 07010050
PERMIT ISSUE DATE
i.
I hereby afftrra.911 sd-peoalty-0f perjury one of the following declarations:
0 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
0 I have and will maintain Workers Compensation insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation insurance carrier and Policy number are:
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
Job Description
SUITE 20C/210 — TI COMMERCIAL RETAIL SPACE: NON
BEARING Vt'ALLS, FINISHES, MILLWORK, LIGHTING
Sq. Ft. Flo -ora
3 6 9 0 6 010 kPN Number
:artier. Policy NO.:
CERTIFiCAO OF FxE i T1 ONINSROM WORKERS'
CPE
(This section need not he completed if the permit is for one hundred dollars (3100)
)r less.)
I certify that in the performance of the work Coor whichct this
permit
Workers Compensation
ued. I shall not
employ any person in any in s�o et b
Laws of California ' /
Applicantu should
NOTICE CANT: If, after making this Cerificao of Exemption, ,
you mint
become subject to the WoLker_s Compensation provisions of the Labor Code,
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
LendersAddress
I certify that 1 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 consZion, and hereby authorize representatives of this city to enter upon the
-hove-mentioned property for inspection purposes.
(Wer) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND_ COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS. /Z, 7
Signature of Appticanu� ® `
H _ DOUS MATERIALS DISCLOSURE
Will the appit6ain or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
kc, Section 25532(a)?
0 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? (�N/
0 Yes o
1 have read the hazardous materials requircmen Oder Chapter 6.95 of the Califor-
nia Health & Safety Coder, Sections 25505.25533 l understand
o lmdtheaoccup of the
docs not currently have a bu
tenant, that it i responsibility
M . incn which must be met . to issuance of a Ceruficalc of Occupancy.
_._ _. .mss _ — / //l%
Owner or authorized agent - ` ,
Issued by
Re -roofs
Type of 1:oof
$50000
type
a 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 r iaterials for inspection.
f A licant
Date
Slgnatur. o pp
All roof coverings to be Class "B" or better