06100193 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
Cd) RAGTCIR I }R1i4T��N:
BUILDING ADDRESS: TA I CONSTRUCTION CORP PERMIT NO.06100193
10495 N DE ANZA BLVD
OWNER'S NAME:
PERMIT ISSUE DATE
SANDHILL PROPERTIES 6261 KATELLA AVE 10/26/2006
)NE: SANITARY NO. CONTROL NO.
(714) 886-1530
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
1 o p LICENSED CONTRACTOR'S DECLARATION Job Description
U r— I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is
'.may in full force and effect. DEMO BUILDING 2 STORY
?M? License Class Lic.#
t, Date Contractor
ARCHITECTS DECLARATION
2 cid 1 understand my plans shall be used as public records
�yU
O in Licensed Professional
n OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county 9 5 0 0 0
`<'.ff which requires a permit to construct,alter,improve,demolish,or repair any structure
Z
In prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area
F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i 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 r Occupancy Type
not more than five hundred dollars($500).
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sae.).
ETI,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense law does not apply to an owner of property who builds or improves thereon,and,
who contracts for such prole with a contractor(s)licensed pursuant to the Contractor's
License Law-
C:]
I am exempt under$ B&P C for this reason
Owner Dare
OR ER'S COMPENSA ON DECLARATION
I hereby affirm under penalty o rjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compcn-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 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 Polity number are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(S(00)
or less.)
I certify that in the performance of the work for which this permit is issued.1 shall not
employ any person in any manner so as become bject to the Workers'Compensation
Laws of California.Date
Applicant rz
NOTICE TO APPLICANT:1f,aflcr making this Ccrtiroa)c of Exemption,you should
become subject to the Worker's Compensation provisioilecif the Labor Code,you must
O forthwith comply with such provisions or this permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
(--t►�-+ 1 hereby affirm that there is a construction lending agency for the performance of
p+ the work for which this permit is issued(Sec.3097,Civ.C.)
W ALender's Name
� Lender's Address
U O l certify that I have read this application and state that the above information is
v. " correct.I agree to comply with all city and county ordinances and state laws relating to
0U building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
CL (We)agree to save,indemnify and keep harmless the City of Cupertino against
V2 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 NO WILL COMPLY WITH ALL NON-POINT Issued by: -
SOURCE REGULATIONS.
e-roofs
Signature of ApplitarrUContrDate Type of Roof
HAZARDOUS MATERIALS ISCLOSURE
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
Cote,Section 25532(a)? �o All roofs shall be inspected prior to any roofing material being installed.
❑Yes
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 Area Air Quality Management all new materials for inspection.
District?
❑Yes
I 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 at it ism responsibility to notify the occupant of the
requirements which must be mel rior to is ancc er a certificate of Occupancy. Signature of Appl ieant Date
All roof coverings to be Class"B"or better
Owner or authorized agent W Date