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CITY OF CUPEXI INL)
BUILDING DIVISION PERMIT
BUIL ly /'5P1EStTEVENS CREEK BLVD
OWNER'S NAME:
EVERSHINE GROUP
NE:
ARCHITECT/ENGINEER:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in ful��ans
LicenClic. #
Dateontractor
S DECLARATI N
sed as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior w its issuance, also requires the applicant rot 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 (5500).
0 1, 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.).
0 1, as owner of the property, am exclusively contracting with licensed contractors to
constmtt 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 Contractors
License Law.
0 1 am exempt under Sec. B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a Certificate of Consent to self -insure for Workcfs 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 1 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 re:
Carrie. /J Policy No.: Z
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
I certify that in the performance of the work for which this permit is issued. I shall not
employ any person in any manner so as to become subject to the Workcrs' 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 tabor Code, you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
I hereby of fin that there is a construction lending agency for the performance of
Q! the work for which this permit is issued (Sec. 3097, Civ. C.)
[Ll Q Lender's Name
a2 Lender's Address
U 0 I certify that I have read this application and state that the above information is
4t~ ►+ correct. I agree to comply with all city and county ordinances and state laws relating to
0 U building construction. and hereby VAon7.e representatives of this city to enter upon the
W above-mentioned property for i coon purposes.
CL (We) agree to save, in mnify and keep harmless the City of Cupertino against
fF—t v) liabilities,judgments, costs x ch may in y way accrue against said City
U z in consequence of the of this it.
APPLICANT UN D NDS AND LLC PLY WITH ALL NON -POINT
SOURCE REGU S. _ _
Signature of Applican ontractor
F*kZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Codc,Section 25532(x)?
0 Yes )V"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? �
0 Yes R(N.
I have read the hazardous mate
niaHcalth&Safety Codc ons 251
docs not curtcntl ha nt, door
requirements whit u met prio
Owner
-ements under Chapter 6.95 of the Califor-
and 25534.1 understand that if the building
sponsibility to notify the occupant of the
T,4 a Ccnificatc of Occupancy.
PERMIT NO.
SMI CONSTRUCTION INC 07050210
PERMIT ISSUE DATE
595 MONr'AGUE AVE 05/31/2007
SANITARY NO. CONTROL NO.
(510) 35:.-3288
BUILDING PERMIT INFO
BLDG ELECT PLUMB
Job Description
REVISED ROOF TOP CURB FOR ODOR CONTROL-ORIG
#06040100 NO NEW PERMIT. THE NEW ROOF TOP EQUIP
MUST NO`.' BE VISIBLE TO THE PUBLIC VIEW.
sq. Ft. Floor Area
3690600'3 q Number
Issued by
Re -roofs
Type of Roof
ation .
$0
Type
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 IT aterials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better