06090157CITY OF CUMKIL P'lu
BUILDING DIVISION PERMIT
BUILDING ADDRESS: I ADACON CORP
^ VNER'S NAME:
PHONE:
ARCHITECTIENGINEER:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and rofessiuns Code, and my license is
in full force and effect � 7?;7'p
License Class Lic. A
Date Contractor
ARCHITECPS DEC
1 dcrs nd my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 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 permit to construct,m
alter, improve. demolish, or repair any structure
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
(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 1, as owner of the property, or my employees with wages as their salt 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.).
[11, 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. B & P C for this reason
0 I am exempt under Sec.
'ner
Date
WORKER'S COMPENSATION DECLARATION
Ct
FN
�+>
WQ
a
az
UC
wF
L
LL
CL
U2
r—
I hereby affirm under penalty of perjury one of due following declarations:
I have and will maintain a Certificate of Consent to self -insure for workces Compen-
ation, as provided for by Section 3700 of the Labor Code, for the performance of the
cork 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.
ny s Comp�ensa�tio�n Insurance carrier and Policy number
:arri Poli
ERTIFI�AFXEMPTION OM WORKERS'
.C%�SATION INSURANCE
(This section needpleted if the permit is for one hundred dollars (S 100)
)r less.)
i certify that in the performance of the work for which this permit is issued, I 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
I 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
I 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
Wilding construction, and hereby authorise representatives of this city to enter upon the
about -mentioned property for inspection purposes.
(We) agree to save, indemnify and p less the City of Cupertino against
liabilities, jud cosy and expect hich ay in any way accrue against said City
in conseq a oC granting of th' rmit.
APPLIC U ERSTANDS D L COMP ITH ALL NO -POI
SOUR RE I ATIONS. I(/ /�
Si aturc pplicanUCo t Date
HAZARDOUS 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
,de, Section 25532(a)?
0 Yes r ---Q No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management
District?
0 Yes 0-1-W No
I havpeM the hvardous mate
niaHcal 'Sad Codc,Scctions
docs n urs y have a tenon tit
rcQu' cn hich must be prig
authorized
ements under Chapter6.95 of the Califor.
and 25534.1 understand that if the building
soonsibility to notify the ocgjpant of #c
PERMIT NO. 06090157
PERMIT ISSUE DATE
SANITARY NO. ' CONTROL NO.
BUILDING PERMIT INFO
Job Description
PARKING LOT RESTRIPING, REPL LIGHTING FIXTURES
REPL SPRINKLER HEADS. NO SANITARY CONDITIONS
Sq. Ft. Floor Area
31607043.00
Required Inspections
Y
Issued by:
Type of Roof
NM
Occupancy
Date
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
All roof coverings to be Class "B" or better
Date