09060066';~': ,': ......,.CITY OF CUPERTINO
BUILDING DIVISION ····.·.·.·€OmRA.€rF0BlNE(lf{M.;\:I:lQN!.··PERMIT ," "/ ~'.:.:.:.'.: : ·············:·;.. ;····;;:::>\·::·;·f..:: ···:(:r:?:::~;::{:~:_:::;::;-·
BUILDING ADDRESS:
19333 VALLCO PARKWAY RTonr-. A DPR CONSTRUC'TICJN Tl\Tr'
OWNER'S NAME:
71T"lT"lTT:' 1Acn ,7I7\T...., ~TT~
~w rJ-J
Tl\Tr'
PHON!;,
(650)474-1450
ARCHITECTfENGINEER:
LICENSED CONTRACTOR'S DECLARATION
I hereby alJinn lIIat I am licensed under provisions nr Cllapler 9 (commencing
Job Description
wilb Section 7(00) orDiyision 3 Dr Ibe Business and Proressions Code, and my license is
in fun ron:e and effect DEMO, 115,000SQ, COML TI BLDGI? Lie. # 519'&4 bLicense CJ~ZI
Dale ?iI, 10 Conlraetor .lt7?-fi9yS=f7?<!<57¢N UTLTY
ARCHITECTS DECLARATION
I understand my plans shall be used as pUblic records
WORK
Licensed Pn,rcssional
OWNER·BUILDER DECLARATION
I hereby .!TInn 1b.1 I am exempl rrom Ibe ConlraCtor's License Law ror Ibe
rollowing ""ason. (Sectiun 7031.5, Business and Proressions Code: Any city or county
which requires a pennit lo conslruCt. alter. improve, demolish. or repair any slruclure
prior to its issuance, also requires the applicant (or such pcrmil to fiJe a aigocd statemcnt
lhiU he is licensed pursuant to lhe provisions of the ContnlCtor's License: Law (Chapter 9
Sq. Ft. Floor Area
(commencing wilh Section 7000) o( Division 3 of the Business and Professions Code) or
Ibal he is ..empl Lbc",rrom and the basis ror Ibe alleged exemption. Any yiolation or
Section 7031.5 by any applicant ror a permit subjee,", Ibe applicantlo a eiyil penalty or
APNNumbernOI more Iban five hund"'d dollars (S5OO). 31620075.BLDGAo I. as owner of !.he property, or my employees wilh wages as lheir sale compensation,
will do Ibe work. and Ibe struelure is not inlended or offered rorsale (See. 7044. Business
and Proressions Code: The Conttaetor's License Law docs no' apply to an owner or
Required Inspections
propcny who builds or improves lhc",on, and who docs such work himselr or Ibrough his
own employcex, proYided lIIat such improvements arc not inlendcd or offered ror sale. Ir,
however, the building or improvement is sold wilhin one year o( comp'ction. the owner·
builder will have lhc burden or proYing Ibal he did not build or improve ror purpose or
sale.).
o I. as owner o( the property, am exclusively conlnCling with licensed contr3elDrs to
construetlbe project (Sec. 7044, Business and Proressions Code:) The Contractor's Li·
cense Law docs not apply to an owner of property wbo builds or improves lhcreon, and .
who conuacts for such projects with a COnlrIClOr(s) licensed pursuanlto the Contractor's
License Law.
D I ... exempt under Se.. , B & PC ror Ibis .....on
Owner Dale
WORKER'S COMPENSATION DECLARATION
I hereby alJinn under penalty or peljury one or lhc rollowing declarations:
o I have and will maintain a Certificate orConsenl to sc:1(~insure forWorker'sCompen~
sation, as proYided ror by Section 3700 or Ibe Labor Code, ror Ibe performance or Ibe
work ror whieb Ibis pennit is issued.
D I haye and will mainlain Worker's Compensation Insunnce, as required by Section
3700 or Ibe Labor Code, ror the performance or Ibe work ror which Ibis permit is issued.
My Worker's Compensation Inslnncc carTier and Policy number arc:
Carrier: .,)U/S f.j~ brF:r4cA Policy No.: l1.J0m 06 U
CERTIACATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be eompleled ir the pennil is rorone hundred dollars (SIOO)
or Ie...)
I certify !.het in the performance of 1.hc work for which this pennit is issued. I shall not
employ an)" person in any manner so IS 1.0 become SUbject to lhe Workers' Compensation
Laws or Caliromia. Dale
Applieanl
NOTICE TO APPUCANT: Ir, afIU making Ibis CertiJieale or Exemplion, you sbould
become SUbject to the Worker's Compensation provisions o( the Labor Code. you must
(ortbwith comply with such. provisions or !.his pe~it sh.aH be deemed revoked.
CONSTRUCTION LENDING AGENCY
Jhereby affirm !.hat 1.hcre is I construetinn lending agency ror 1.hc performance of
Ibe work rur which lhis pennit is issued (Sec. 3097, Ciy. C.)
Lcnder1s Name
Lender's Address
I certify that I have read Lhis application and state thal!.hc above in(onnauun is
COITCCI. I agree lO comply with all city and county ordinances and state laws relating to
building conSlJ'Uction. and hereby au!.horil.e rcprc~cntalivcs of this city to enter upon the
abovc~mentioned property (or inspection purposes.
(Wc) agree to .ave, indemniry and keep harmlcss lhc City of Cupenino against
liabilitic.s,judgmcnlS, coslS and expenses which may in any way acCrue against said City
in consequence o( 111e granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON·POINT Issuod by: ~6ilsJij
SOURCEnO', % ./,,[
"a"
SURE
Type of Roof
WiIllbc applicant Dr rUIUre building occupantslo", or handle hazardous maleria!
as defined by lhc Cuperlino Municipal Codc. Chapler 9.12, and lIIe Hcallb and Safety
Cnde. Section 25S32(a)7
All roofs shall be inspected prior to any roofing material being installed. DYes erNo
If a roof is installed without first obtaining an inspection, I agree to removeWill the applicant or (uture building occupant usc equipment Dr dcvices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Manlg::menL
all new materials for inspection,
District?
DYes pNa
I baye ",ad the hll7.anlous malerials ",quiremcnlS undcrChapler6.95 orlbe Caliror·
nia He.11b & Safely Code, Sections 25505, 25533 and 25534.1 undel'SUUld thBl irlhc building
~/-e/~docs nol currently have a tenant, that it my responsibility 10 notify the occupant of the
",qUire~';(~ to issuance ora CertificalC of CeCO?"!" (DC S
::
PERMIT ISSUE DATE
~~ " " "" s~R'rM:'" v ~ J CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
[:::=J CJ [:::=J [:::=J
A, UNDERGROUND
Valuation
5125000
Occupancy Type
-
Date t/-I (-17'
~
(/ ht ~ £
Date I