07100080 ' CITY OF CUPERTINO �����.� Z ����TI�� � ; ;
BUILDING DIVISION PERMIT
__.. � -..,:: ... . ..
.. .
PERMIT NO.
BUILDING ADDRESS:
10600 N DE ANZA BLVD NOVO CONSTRUCTION 07100080 �
PERMIT ISSUE DATE
R'S NAME:
SOBRATO DEVELOPMENT COMPANY 1042 HAMILTON CT 1 �
SANTfARY NO. CONTROL NO.
PHONE:
(650)701-1500
BUILDING PERMIT INFO
ARCHITECC/ENGINEER: B� ELO PLU�MH ME�C J H
� p � LICENSED CON7RACCOR'S DECLARATION JOb DBSCTlpt10f1
i V E" ��rcby �rm that I am liccnscd unJcr provisions aC Chap�cr 9(camm�cin;
; y W wiih Scction 7000) o( Division 3 of ihc Business and Profcssions Codc. and my liccnse is T I C OMME RC � L DRYWAL L, T — BAR , F L OOR I NG
>>� infuli forccan de f fect. ��.# �°/ � O'�,�. TEMP PERMIT� GOOD ONLY 3� DAYS� EXPIR E S N O V. 9� � 7.
j � ? Licensc Class ' d
p Datc �d Contrac�or
: t' � ARCHiTECTS DECLARATION
j a .�
a ( understand my plans shall bc uscd as public rccords
)aU
• a N Liccnsed Profcssianai
? y � OW NER-BUILDER DECLARATION
1 hcrcby alTirm �hat I am excmpt from ihc Conuaaors Liccnsc Law for We
� p o tollowing rcason. (Sccuon 7031.5, Busincss and Profcuions Catc: Any city or rnunty
<,°, �i which requires a permit to conswct, altcr. improvc. dcmolish. ar �cpair any ztn�cture
°" y prior w i�s issuancc, alsu ccquires ihc applicant Cor such pertnit w filc a signed stau�mcnt Valuation
S Ft. Floor Area $110 5 9 3 0
�? a that hc is IiccnscJ pursuant to thc pmvisions o( thc Conuactor's Lic�cnsc Law (C]up�cr 9 q'
x H� (commcncing wi�h Section 7000) of Division 3 of lhc Business and Profcssians Cadc) or
,v, �.. that he is uempt thcicfrom and �he basis (or t6e al(cgcd eumption. Any violacion oC QCCU aI1C T e
Section 7031.5 by airy applicant Cor a pe�mit subjccu the applicant w a civil penalty of 316 0 210 _�� Number P Y yp
n o t m o r e � h a n fi v c h u n d red dallars (5500�
❑ I. u owncr of ttie propercY• or my cmployces with wages az the'v solc rnmpenvtian.
wi1ldothcwork,andthestcuctureisnotintendedorafferedforu� Required Inspeetions
and Pmfessions Codc: The Conuactor's License Law das not sppty m an awner of
property who builds or improves thercon, and who does such work himself or thcou�h Ais
own employces, provided that such improvements are not in� or o[fered Cor sale. I[,
however, the building or improvement is sold within one year of complcuon, d�e owoer
huilder will have tlx bueden oC proving ihat he did not build or improvc [or pa�pose af
salc J.
Q I. ss awner of the pcopeny. am tacclusively convuting with licensed convaaars W
conswct the projm (Sec. 7044. Business and Professions Code:) The Cantrxtnrs Li-
ccnse Law dacs not apply �o an owncr of propeny who builds or improves We�. aod .
who convacts tor such projecLt with a conuactor(s) Iianxd pursuant w �he Conuxtars
License Law.
f� [ am uempt under Sec . B dc P C[or this Rswn
s Dale _ . -
WORKER'S COMPENSATION DECLARATION
I 6ercby �cm under penalty o( perjury one ot �he folbwing d�clara�ians
❑ I hsve and will main�ain a CeniGcatc of Conxnt �o self-insure for Workefs Compen-
sation, as providcd for 6y Secrion 3700 of U�e Labor Code. far the perfo�manR of U�e
work for which Uiis permit is issucd.
❑ I havc and will mainuin Workcr's Compensadon Insunna, as rt:quired 6y Scction ,
3700 0( �he Labor Codc, Cor thc performance of �he work !or which this pecmii a issued.
My Work� �s C�om Insucance carti r and Policy number are: —7
Carrier. N-ruc.v �.��$ ro�� ►ao.: 1�2a�99 �/
CERfIF1CATE OP EXEMPftON FROM WORKERS' ,
COMPENSATION INSURANCE
(Ihis scction necd not bc completcd if the permit is for onc hundred dotlazs (510� ,
or Icss.)
I certify thct in thc performancc o( �hc wark for which �his pertnit is issucd I sMall na
employ any person in any manncr so u to becomc subject ta ihe VNOrkcrs' Compensatian
L.aws of Cali(omia. Datc
Applicant
NOTiCE TO APPLICAM: !f, af�cr making this Ccnifcatc of Excmption, you shouW
become subject to �he Warker's Compensation provisions of the Labar Cade, you muu
� O (orthwith comply wi�h such pravisions or this permi� shall bc dccmcd icvotcd.
z � CONS7RUCTION LENDING AGENCY
(.� � 1 herehy a[firm that there is a conswcuon Icnding agcncy for thc perCormancc o(
a� ihc work Cur which this permit is issucd (Scc. 3097. Civ. CJ .
W Q Lendcr's Namc
j z Lcnder's Address
U � 1 ccrtifY tha� 1 havc rcad this application and s�atc �hat thc abovc inCortnatiun u
w � cortcct. I agrce to comply,wi�h all city and county onfinances and statc laws reladng w
r-J U buildiag conswction, and hereby authori�e represenutives o! �his city to enter u{�n the
ahovc-mcntioncd properry for inspccuon purEwses.
?" a (Wc) agse �o save, indcmnif keep harmless the Ciiy oC Cupertino against
H � Iiabilities, judgmcn�s, costs and e nscs w'ch may in any way accruc against said City
V z in consequence oC the granti r m�s ��m� . Date
�—+ APPLICAN7' UNDER S AND W LL COMPLY WITH ALL NON-POINf Issued by:
SO R GUL O S. ,
16 �7 Re-roofs
Signatuce af Appli o �� T e of R oof
HAZARDOUS MA7'ERIALS D[SCLOSURE YP
Will the applicant or future building occupantstore ar handle haiardous ma�crial
efincd by the Cupenino Municipal Codc. Chap�cr 9.12. and the Heal�h and Sa[ay
:. SecGon 25532(a)? / All roofs �hall be inspec[ed prior to any roofing material being installed.
❑vcs LTNo -
If a roof i� installed without first obtaining an inspection, I agree to remove
Will thc applicant or fulurc building occupant uac equipmrnl o�dcviccc ��h all new m aterials for inspecrion.
cmit haiardous air contaminanls u ncd b the Ba Atea Air Qualii Managcmenl
District?
❑ Ycs Nu
1 havc rcaci the haiardcws matcrials cier Chap�cr 6.95 of die Cal+farv
nia Hcal�h & Safcry Codc. Scctions 25505 533 7S5 .1 urdcruind thaz iC�he dulding
docs not curtcnUy havc a tcnan4 ihat i u my nsi lity �o noufy thc occupant nf ihe Date
rcyuire cn�s w h mu bc me �or iss cc of Ccrtificaic o�� u� D Signature of Applicant
� All roof coverings to be Class "B" or better
Owncr or aut ori�cd agcm �a�