07080266 CITY OF CUPERTINO ` ' ` ' '
BUILDING DIYISION PERMIT �������� Z���'��� '
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BUILDING ADDRESS: PERMIT NO.
19505 STEVENS CREEK BLVD APPLIED CONSTRUCTION TECH 07080266 �
PERMIT LSSUE DATE
R'S NAME:
MENLO EQUITIES 1230 OA]�MEAD PKWY 1 7
SANITARY NO. CONTROL NO.
PHONE:
(408�25:?-9990
BUILDING PERMiTINFO
ARCHITECT/ENGINEER: HLDG ELECT PLUMB MECH
� 0 � �
i p o LICENSED CONTRAC!'OR �ECURanox Job Description
i V� t hcrcby aCGrm Wat ( am licenscd unckr provisioas oC Chaptcr 9(commcncing
; z� W�m sccuon �ocx�1 ot on 3 of ihc Busincss and ��cssions C o� c� m ��censc is COMMERC : CAL T I—NO SAN I TARY REQU I REMENT S.
� a a in full Corcc an d e f fect
j�? LicenscClass � �•K ~ NEW RES`['ROOMS, T BAR CEILING, ELECT, MECH
: �,,, �p Datc ..7 � A'1 Conuac�nr
� ARCHITECTS DEC
j� a t undcrstand my pians shali bc uscd as public records
)aU
' u. F' Liccnscd Profcssional
: � < OWNER-BUILDER DECLARATION
'}� [ hcrcby alTirm ihat 1 am czcmpt Crom thc Camractors Liccnsc Law far U�c
� p O [ollowing reason. (Scctian 7031.5, Busincss and Profcssions Ca1c: Any city or caunty
�,°, ( which 2quires a permit to conswct, alicr. impmve. dcmolish, or repair any s�ructu�c
°" y prior ui i�s issuancc, alsu rcquires thc applicant for such permit to filc a signcd statcmcnt �, Valuation
-? e that hc is liccnscd pursuant to thc pmvisions of thc Convacux's Licrnsc Law (C]u(HCr 9 .� Ft. Floor Area
ti F� (commencing wiih Section 7000) of Division 3 of Ihc Busincss and Profcssions Cadc) or $15 0 0 0 0
i�� that he is exempt Nerefrom and the buis Cor the allegcd acempdon. Any violatian at
Section 703I.5 by airy applicant [or a permit subjccu the applicant to a civil penalty ot Number Occupancy Type
not more than five hundmd dollars (5500). 3 1 6 4 9 � 0���
❑ I. as owncr of the propertY. ar my employces with wages u their solc rnmpentation.
willdothework.and�hes�uaumisnotintcndedoro[Cendforsale(Sec. Requirzd Inspections
and Professions Code: The Conlr�tor's License Law doe: iat apply to an avnu M
propeny who builds a improves theccon, and who daes such work himself ar Wougd his
own employccs, provided �hat such improvemenls are not intended or otCered Cor sale. l[.
however, the building or improvement is sold within one year of completion, tlx owner-
builder witl have the burdee o[ proving ihat he did not build ar improvc for pmpox af
salc.).
❑ I. as owner of the property. am exclusively contracting with liansed convac�as a
consuvct the pcojm (Sec. 7044. Business and Professions Cade:)'1Le Cnnt�actnls Li-
ccnse Law docs ool apply �o an owncr of propeny who builds ar improves �heROn. and ,
who conuacts !or such projects wi�h a comractor(s) licensed pursuant to ihe Conuxtors
License Law.
f� I am exempi under Sec , B dc P C for this reuao
:r Dale _ . -
WORKER'S COMPENSATiON DECLARATION
I hereby afCirtn under penalty of petjury onc of the fallowing dxlazations:
❑ t Iwve and will maintain a Cenificate of Consent to sel[-insure for Worker's Compen-
sation, u provided for by Secrion 3700 of the Laboc Code, far the pedartnance of the
work for which this pertnit is issued.
❑[ havc and will maintain Workcr's Compensation Insurance, at �cquired 6y Section .
3700 of the Cabor Cade, Cor tpe performance of �he worlc for which �his permit is issued.
M Wo s n om q�a[ion tnsurance carticr and Policy �n � ��,�
Camer.�,vN �0 ` � C.r Policy No.: �—
CERTIFiCATE OF EXEMPI'ION FROM WORKERS'
COMPENSATION INSURANCE
(7Lis section ucd not bc cample�cd if the permit is far onc hundred dotlars (5100)
or Icss.)
I cenify ihni in thc performance of Ihe work for which Utis {krtni� is issue4 1 sball nol
employ any person in any mannc� so at �o become subject ta the Workers' Compensation
Laws of Califomia. Datc
Applicant
NOTiCE TO APPLlCANT: If, attcr makin� �his Ccnifica�c of Excmption, you shou4l
bccome subjcct ta ihc Workcr's CompcnsaUon provisions of thc La6or Codc, you muu
� O forthwi�h compty wi�h such provisions or this permi� sha116c dccmcd rcvokcd.
z ""' CONSCRUCTION LENDING AGENCY
(— ��-+ I hcreby a[firm ihat thcre is a conuructinn Icnding agcncy for thc perfortnancc of
a� ihc work for which ihis pertnit is issucd (Scc. 3097, Civ. C.) ,
W Q Lendcr's Narnc
a z Lender's Address
U � 1 certify that 1 have rcad this application md state �hat the above info�matiun is
� ►" cortccL I agree to comply with all city and county ordina�es and s�ate laws rcladng m
� U building conswction, and hercby authoriit represenutivcs of this city to cntcr u{xm Uu
� a ahove-mcniio d property (or inapccuon purposes.
(Wc ree to save, indcmni(y and kecp harmless the Ciiy oC Cupcnino against
�� liabilities d en�s, cosls and expenses which may in any way accruc against said City /
V,'�' in co ue oC tAc granting ot �5 ��,��. Date /� � l�"j
� APP CA NDERSTAN AND WILL COMPLY WITH ALL NON-POINT Issued by
SO CE R TT NS ��� �,�i
� � � �' 0 Re-roofs
Signatu pplicant/Con[ractor �a� T of Roof
HAZARDOUS MATERIALS D(SCLOSURE YP
Wilt thc applicant or fuwrc building occupantstorc or handlc harardous matcrial
'cfincd by 1he Cupenino Municipal Codc. Chapter 9.12. and �hc Hcalth and Sa[Uy
�. Scction 25532(a)? All roofs �hall be inspected prior to any roofing material being installed.
❑ Y� r� .
0
Will the applicant or futurc building occupant use eyuipmcnt or devices whie6
If a roof i� i alled without first obtaining an inspection, agree to remove
cmit ha�ardous air contaminan�s az dcfined Ay the Bay Area Air Quality Managcmcni all new : t 'als for inspection.
asu;���
❑ Ycs Q'1�
1 havc hvardous matcrials rcquircmcn�s undcr Chap�cr 6.95 of �hc Cali(or- � i `/ ��� /�/ � S / � r�
niaHcalth atc Sccdoat25 25S33and25534.Iundcrs�ind�huiFihc �/ V�
does nol ntly a tcnan4 responsihility to notil'y the occupant of �hc
rcyuire n�sw et " CcnificatcofOr�cu�nry /� �ignature of Applicant Date
� v All roof coverings to be Class "B" or better
wncr or authorizcd agcn� ��u