09110158 REV1CITY OF CUPERTI NO BUILDING PERMIT
BUILDING ADDRESS: 10120 N DE ANZA BLVD CONTRACTOR: SPC CONTRACTORS, INC. PERMIT NO: 09110158
OWNER'S NAME: ST. JOSEPH OF CUPERTINO SCHOOL 859 SAVAKER ST DATE ISSUED: 02/1912010
OWNER'S PHONE: 4082526441 SAN JOSE, CA 95126 PI{ONE NO: (408) 298-5759
0 LICENSED CONTRACTOR'S DECLARATION
G
License Class _ _ LIC. #
Contractor P C cl t jl:\tj-f OrSDate
1 hereby affirm that 1 ant licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, 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 provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
_APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18. /v
Signatu9!;1,_ �- � GC _ Date
ri OWNER -BUILDER DECLARATION
ereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
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 & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for (lie:
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify that in the performance of rte work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of Califomia. If, afier making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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 building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
posts, and expenses which may accrue against said City in consequence of the
,,ranting of this permit. Additionally, the applicant understands and will comply
,vith all non -point source regulations per the Cupertino Municipal Code, Section
1
irgmature Date
BUILDING PERMIT INFO: BLDG ( ELECT r PLUMB F
MECH F- RESIDENTIAL r COMMERCIAL. r
JOB DESCRIPTION: TENANT IMPROVEMENT OF EXISTING BUILDING FOR A
PRESCI IOOL & I IOMEOWRK ROOM(2880SQFT)
4/23/10 REVISION 41-GLULLAM BEAINS,STRENGTHENING, AI:fERNATIVE
WINDOW STRENGTHENINO & ADA RESTROOM REVSION-APPROVED ON
ALTERNATE METHODS & MATERIALS PER ARNOLD & ALBERT 7/14/10.
(4L1-1 � ; 41� : J'.S c, -OA 7- -L -t — to
Sq. Ft Floor Area: I Valuation: $298000
APN Number: 31626091.00 I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
I
RE -ROOFS:
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: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 255320i should I store or handle hazardous material.
Additionally, should 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & afety Code, Sections 25505, 25533, and 25534.
Ott rt a
Date: (�
CONSTR TION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
For which this permit is issued (See. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
understand my plans shall he used as public records.
Licensed Professional