07080145 CIT�' OF CUPERTINO ` /� �^+�. ` '
BUILDING DIYISION PERMIT �'��� �`�`� ������������ '
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BUILDI c� ADORESS: PERMITNO.
�U495 N DE ANZA BLVD TAISEI "ONSTRUCTION CORP 07080145 �
PERMIT LSSUE DATE
OWNER'S NAME:
SAND HILL/1200 SAN MATEO AVE 2180 BERING DR 10 03 2007
� T r SANITARY NO. CONTROL NO.
(714)886-1530
BUILDING PERMiTINFO
ARCHITECT/ENGINEER:
BLDC ELECT PLUMB MECH
C� 0 0 0
i p p LICENSED CONTRACTOR'S DECLARATION JOI� DeSCilptlOil
: V� I hcrcby aCfirm that I am licenscd uncicr provisions o( Chaptcr 9(commcncing
; z� with Sccdon 7IXx1) of Di�ision 3 of thc Business and Profcssiuns Codc, and my licensc is DEF ERRE D SUBM I TTAL FOR ELEVATOR
� 6 a in (ull Corec and cCCec�
�� z[.icensc Clus ��• # ORINGAL # 0 7 0 2 0 010
; F p pa� Conlractor
� ARCHITEGTS DECLARATION
i a a t undcrstand my plans shali bc uscd as puhlic reconls
>yU
' 4. F' Liccnscd Pm(cssional
� y � OWNER-BUILDER DECLARATION
1 hcrchy atTirtn that 1 am excmpt Cmm ihc Contractor's Liccnsc Law [or thc
� p O following rcason. (Scctien 7U31.5, Busincss and ProCcssions Ca1c: Any city or county
<°„ �i which rcquires a pctmit ro consuuc4 altcr. improvc. dcmolish. or repair any suuaure
�'" y prior io i�s issuancc, alsu rcquires �hc applican� for such pertnit to filc a signcd su�cmcn� �,
�_ � tha� hc is liccnscd pursuanl to thc pmvisions of thc ConUactar's Li��cnsc Law (Chaptcr 9 ,>q. Ft. Floor Area Va uation
r F� (commencing wiih Section 7000) of Division 3 nf tl�c Busincss and Profcssions Codc) or $14 5 0 0 0
L�., that he is exempt thcrctrom and �he basis [or the allcged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjccu �he applicani to a civil penalty of A Number Oeeupaney Type
not more than fiw hundred dollars (5500). 3 2 6 3 3 11- �.�
❑ I, as owncr of ttie property, oc my employcw with wages az their solc compensation,
will do thc work and �he structwe is not intendcd or otferd for sale (Sec. 7044, Busi�ss Required Inspections
and Protessions Cade: The Conuutor's License Law does not apply a an owner of
property who builds or imptoves thercon, and wha dces such work himself or Ihrough his
own emplayccs. providcd that such improvemenls are not intended or oRereA Car sale. IC,
however, the building or improvement is sold within one year oC complction, the ownu-
buitder w ve �he burden of pcoving �hat he did not build or improvc tor purpose o(
salc.).
as awna oC Uu property, am uclusivdy conuacting with littnsed rnnvactors to
conswct the project (Sec. 7044. Business and Profcssions Code:) The Coa�racwr's Li-
ccnu Law docs not apply a an owncr of propeny who builds or improves thneon, and ,
who conmcts Cor such projects with a comractaKs) licensed pursuant to �he Convactor's
License Law.
❑ I am uempt undee�ee. , B 8c P C for Wis mason
Owner / � Date � � _ .. _
WO KERS COM NSATION DECLARAI'ION
I hereby affirm under penalry o[ perjury one of the tollowing declaratians:
❑ I havc and wilt maintain a Cutificatc of Conscnt to sclf-insure (or Warker's Compen-
sation, as providcd for by Section 3700 of the Labor Code, for the performancc o[ Uic
work for which Nis pertnit is issued.
❑[ havc and will maintain Worker's Compensation Insurancc, as required by Scction .
3700 of the Labor Code, fw �he pedormance of tAe work tor which U�is permi� is issued.
My Worker's Com�xnsauon Insurancc carticr and Policy numbcr azc:
Cartier. Policy No.:
CERTIFICATE OF EXEMPIION FROM WORKERS'
COMPENSATIONINSURANCE
(This scctian necd not bc completcd if the permit is ku onc hundred dotlars (5100)
nr less.)
I certify thas in ihe perfortnance af ihe work for which �his permit is issued, l shall not
employ any person in any manncr m az to bccqry�subject w lhe �Co pe ' n
Laws of Califomia. Dalc j� K
Applicam
NOTICE TO APPLICAM: If, aftcr makin� ihis c' ca�c of Eccmption, you should
bccome subjcct to thc Workcr's CompcnsaUon provisions af ihc Labor Codc, you muu
� O forthwi�h comply wi�h sueh provisions or this permit shall be dccmcd rcvoked.
z '"' CONSTRUCTION LENDING AGENCY
[— r�-� I hcreby a[firtn �hat thcre is a consuuction Icnding agcncy for thc perfurtnance uf .
�, � ihc wurk Cur which �his permit is issucd (Scc. 3097, Civ. C.)
w� Q L.endcr's Namc �
� z t,cndefs Address
V � 1 ccnify ihat I have rcad �his applieadon and siatc �hai thc abovc inCormatiun is
�� cortcci. I agrce to comply wi�h all ciiy and county onfinances and s�ate laws relating to
� U building conswction, and hercby authori�e representatives of ihis city to enter u�mn Ne ,
� a atrovc-mcntioncd property (or inspccuon purEwses.
(Wc) agrce to save, indcm�i(y and kccp harmless ihe City of Cupertino against
„�'„� � liabitiues,judgmcn�s, costs and ezpenscs which may in any way accruc agains� said City
U z in consequence oC thc granting a( ihis permi� O 7
►'� APPLICANT UNDERSTANDS AND �yILL COMPLY WITH ALL NON-POINT Issued by: Date � r�
SOURCE REGULATIONS. � /
�-�� i � � v Re-roofs �j
Signature of ApplicanUConvactor �a� T e of R oof
HAZARDOUS MA?ERIA D[SCLOSURE yP
Will ihe applicant or futurc building acupant storc or handlc haiardous matcrial
as defincd by the Cupertino Munici 1 Cadc. Chaptcr 9.t2. and thc Health and Sa(cty
Cock, SccGon 25532(a)? All roofs �hall be inspected prior to any roofing material being installed.
❑ Ycs No
Will thc applicant or futurc building occupant usc cyuipmcnt or dcviccs which
If a roof i; installed without first obtaining an inspection, I agree to remove •
emit harardous air contaminan�s as dcfincd by thc Bay Arca Air Quality Managcmcnt all new m aterials for inspecrion.
Disu;ci?
❑Y� �
1 havc rcaJ the hvardous matcrials requiremcnLC unckr Chap�cr 6.95 o(�he Califor-
nia Flcalth & Safcty Codc. Sectiau 25505.25533 and 25534. ! undcrstand ihaz i( thc building
docs not curtently have s �enan4 �at i� is my rcspensiAility to noufy �hc occupant of the �
rcyuircmcn�s which must bc et �or to issuancc o( a Ccnifica�c of Occupancy� Signature of Applicant Date
J � All roof coverings to be Class "B" or better
Owncr or authori•r.cd agcm ���