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CITY OF CUPERTINO
DIVISION PERMITQ
BUILDING
BUILDIt{/rgf)p�ES DE ANZA BLVD
TBD TO BE DETERMINED
PERMIT NO.
07090102
NER'S NLAlM1 E:
PERMIT ZSUE DATE
SYMANTEC CORPORATION
10/18/2007
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code. and my license is
INSTALL I LLUMINATEDD WALL SIGN
in full force and effec —
License Class Lic. #
Date 16A— Contractor
CHITECr,' DECLARA
I understand my plans shall be used as public rcdbfds
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for Clic
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structulc
prior to its issuance, also requires the applicant for such permit to file a signed statement
ContracLor's License Law (Chapter 9
Lc �q. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of the
Business Professions Code)
$10000
(commencing with Section 7000) of Division 3 of the and or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
3 6 9 010 35 A��1 Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom than five hundred dollars ($500).
_ t
❑ I, as owner of the property, or my employees with wages as thew sole compensation,
Required Inspections
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will do the work and the structure is not intended or offered for sale (Sec. 7044. Business
and Professions Code: The Contractors License Law does not apply to an owner Of
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 be did not build or improve for purpose of
sale.).
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractors LL -
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 Contractors
License Law.
I am exempt under Sec. B & P C for this reason
wrierDate
WORKER'S COMPENSATION 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 Workers 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 Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy nuam: C�
Carrier: ��/�iJ Policy No.m: r OL j u ` 7
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.) shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption, you should
become subject to the Workers 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
Lenders Address
i 1 certify that I 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
ahove-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
j liabilities, judgments, costs and expenses which may in any way accrue againstsaid City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS D WILL COMPLY WITH ALL NON-P01N'f
Issued by: Date
SOURCE
617r'C17
Re -roofs
Type of Rc of
Signature of t/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
iefined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
_odc, Section 25532(a)?All
roofs shall be inspected prior to any roofing material being installed.
❑Yes
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes gJINo
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
does not currently have a tenant, that it is my responsibility to notify the occupant of die
requirements wh' m met r to issuance of a Certificate of Occupy,
—v
Signature c f Applicant Date
dr/7
All roof coverings to be Class 'B" or better
Owner or autho n agcm Date