06120170 CITE'OF CUPERTINO
BUILDING DIVISION PERMITS GTa�INEt?RMATIOI�i*
BUILDING A DRESS: PERMIT NO.
1033 N WOLFE RD WESTLAND PROPERTIES N V 06120170
R'S NAME: PERMIT ISSUE DATE
WESTLAND PROPERTIES N V 05/18/2007
PHONE: SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ARCHITECTIENGINEER:
BLDG ELECT PLUMB MECH
i C Q LICENSED CONTRACTOR'S DECLARATION Job Description
vF.. I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z U with Section 7000)of Division 3 of the Business and Professions Code,and my license is MACY S T--/DEMO— OF NON STRUCTURAL PARTITIONS,
r a in full force and effect.
> �
License Class Lic.B CEILINGS & FINISHES IN AN EXISTING COMMERCIAL
E w Date Contractor
ARCHITECTS DECLARATION SPACE
i z a 1 understand my plans shall be used as public records
)yU
U.H Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
<m 0! which requires a permit to construct,alter,improve,demolish,or repair any structure
Z r prior to its issuance,also requires the applicant for such permit to file a signed statement l; ,Ft. Floor Area Valuation
=G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Q $86500
4 F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
W 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 of64 Number Occupancy Type
not more than five hundred dollars(5500). 31620064 L7
:
❑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 Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of Q p
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.).
,as owner of the property,am exclusively contracting with licensed contractors to
tract the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law docs not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractors)licensed pursuant to the contractor's
License Law.
r1 I am exempt underSec. B&P'CCfforr this mason
WORKER'S COMPENSATWN DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I 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.
❑I have and will maintain Worker's 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:
Cartier, Polity No.:
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 subjec o the Workcrs'Compensation
Laws of Califomia. arc
Applicant14
NOTICE TO AP r ihJkinftKJ14KM9l5tr of FxenGptibn7yjw46oukI
become subject to the rker's Compensation provisi ns of the Labor Code,you must
O forthwith comply with such provisions or this permit shall be deemed revoked.
z(4 CONSTRUCTION LENDING AGENCY
(�►�-+ I hereby affirm that there is a construction lending agency for the performance of
a the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
Z Lender's Address
U 0 1 certify that I have read this application and state that the above information is
Cr~ r-" correct.I agree to comply with all city and county ordinances and state laws relating to
ubuilding construction,and hereby authorise representatives of this city to enter upon the
W above-mcnuoncd properly for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
Ce] liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
Re-roofs
Signatu A UCantract r
HAZARDOUS MATERIALS DACLOSURE Type of R.)of
Will the applicant or future building occupant store or handle hazardous material
'caned by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
C.
section 25532(a)? All roofs,hall be inspected prior to any roofing material being installed.
❑Yes 0010
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new m.Iterials for inspection.
District?
❑Yes PAP
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs not currently have a tenant,that it is my responsibility to oufy the occupant of the
requirements whit must be met I r f of Oce D� Signature A Applicant Date
All roof coverings to be Class "B"or better
Owner or auth z d agent Datc