07090073 CITY OF CUPERTINO `
BUILDING DIVISION PERMIT ������� ���������"
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PERMIT NO.
BUiLD �r,�s���esBUBB RD OPI CONMERCIAL BUILDERS 07090073 .
PERMIT LSSUE DATE
��ER'S NAME:
GARY LESSING 445 LEI GH AVE #100 � 11/14/2007
SANfTARY NO. CON'IROL NO.
PHONE:
BUI[.DING P£RMITINFO
ARCHiTECC/ENGINEER: PHASE II COMMERCIAL TI B� EO pL� �
� o o LICENSED CON7RACI'OR'S DECLARATION „ ' Job Description
m ���py a((�� that I sm licensed undct provisiona o( Chaptcr 9(commcncing ^"^' ^^ ^'" "'
� z� wiih Sccdon 7000) of Division 3 of Ihc Busincst and Profcssions Codc, and my licensc is
'� y in full force and effect
� v� Z Licenac Clus Conlraclar
r E , p Daic
� ARCHITECI'S DECLARATION
� � 1 undcrstand my plans shall 6c uscd as public recorda
m�
; u. y Liccnsed Prufessional
' y � OWNER-BUI(AER DECLARATION
I hcrcby afGrm that 1 am ezcmp� (rum ihc Canuactor's Liccnx Law for �hc
� p O Collowing mason. (Scc6on 7031.5, Business and Profcssions Caic: Any ci�y or county
k,°, Pi which rcquires a permit to consuuct, altcr. improvc. dcmalish. or ¢pair any strucwrc
�" y prior �o i�s issuancc, alsu requims Wc applicant for such permit io filc a signcd sutcmen� ` Valuation
Z< that he is license d pursuan l t o I h e p m v i s i o n s a f t h e C o n u a c t o r s L i c e n s e L a w ( C h a p t e r 9 C�. Ft. F� OOC AIC3
Y I�-� �(commcncing wiih Scction 70D0) of Division 3 of Ihc Busincss and Profcssions Codc) or
y�� ihat he is exempt thecetmm �nd the basis [or the allcgcd eumpaon. Any violaUon of
Section 7031.5 by ary applicant for a permit subjecu ihe applicmt w a civi] penaity ot ppN Number Occupancy Type
not morc �han fiw hundmd dollars (SS00)•
Q I. u owncr of the propecry. or my employces with wages as �he'v sole compensatlon,
wiUdothework.eedihestcucwceisnotintendedarofferedforsalc(Sa. Required Inspections
and ProCessions Cade: The Conuacwr's License Law dan not spp1Y w an owner of
property who builda or improves thercon, and who does such work himself or ihroagh his
own emplayces, providcd �at such improvemenu arc not imm�ded or otfered Cor sala If.
however, the building w impmvemmt is sold within one year of compledon, ihe owner-
builder will htw lhe burdee o[ proving �hat he did not build w improve far puryose of
sak.).
� I, as awner of the property, am acclusively conuscting wi�h Gttnsed rnnuactors a
uuct the pcojea (Sec. 7044. Businas and Protessions Cade:) The Con�ruwrs Li-
cense Law does not apply to an mvner of property who builds or improves �he�eon, and ,
who contrac�s for such p�ojects with a contnctor(s) licensed pursuant tn the Convactor's
License I�w.
l am �mpt under Sec . B k P C for �his �cason
_ ,ner �� Date ����.3�
W 'S COM ATION DECLARATION
I heroby sffirm under penalty of perjury one o[ the following declaraGons:
❑ I hsve and will mainuin a CeniGcate o[ Consent to xlf-insure for Worker's Compen-
sation, as provided for 6y Secdon 3700 af the Labor Code, far �he performan¢ of �he
work tor whieh Ihis pertnit is issued.
❑ I have and will maintain Workers Compensation Insurana, u required by Section ,
3700 of �he Labor Codc. Cor thc pefformance o( �he work for which thu pecmit is issued.
My Worke�s Compensadon Insurancc carticr and Policy number are:
Cartier. Policy No.:
CERI'IFICA7E OF EXEMPfION FROM WORKERS'
COMPENSATION INSURANCE �
(This section necd irot be completcd it the permit is far onc hundred dollara (S I00)
orlcss)
I cenify �hnt in thc performancc o( thc work for which ihis �crtnit is issucd, t shall nat
employ any person in any man u a hccomc subject to the Wortcrs' Compensation
Laws of Calif ia Da�c
Applicant
NOTICE 7'O A UCA •, aficr making cniGcatc of Excmp6o�, you should
become subjcct to �hc Warker's Compensation provisions of the Labor Codc. you muu
, z foMwilh comply wi�h wch provisions or this pecmi� shall hc dccmcd mrokcd.
O CONSfRUCfION LENDING AGENCY
[— .�-� I hereby a�rm Uut thcro is a consuuctinn lending agency !or thc performancc o[ .
a� ihc work fur which ihis permit is iuued (Scc. 3097, Civ. C.)
W Q Lendcr's Namc
a � L.ende�s Address
(� � t cenify �ha� 1 have resd ihis applieuion and statc ihat thc above infamatiun is
w � cortcn. I agrce w comply wiUi all ciry and county ordinances and state laws relaung w
0 U building consvuction, and hercby auehorine rcprescnutives of this ciry to cmcr upon the
w atwve-mcntioned ptopcny tor inspeaion purposez
� a (Wc) agree to save, indcmnify md kecp hermlesc ihe City of Cupertino against
� liabilitiu, judgmcnls, cosls and expenses which may in any way acccuc against said City
(� z in consequence a[ Uic granUng oC ihis permi� Date
�'" APPLICANT U RSTANDS AND W1LL COMPLY W17'H ALL NON-POINT Issued by :
S CE REGU TIONS.
�` `t � Re-roofs
s� � or uco��w� ° s� T of R�of
HAZARDOUS MA'fERIALS DISCLOSURE }
Will Ihc applicant w futurc building accupant srore or handlc ha•rardous matcrial
�cfincd by Ihe Cupenino Municipal Codc. Ctiap�cr 9.12, and �hc Hcal�h and Safety
,� Scction 25532(a)? All roofs : hall be inspected prior to any roofing material being installed.
�yu dNo
If a roof i: installed without first obtaining an inspection, I agree to remove
Will thc applicant or future buiiding occupant usc cyuipmcnt or dcviccs which '
emi� harardous air contaminants az dcfincd by the Bay Area Air Quality Managcmcn� all new m iterials for inspection.
District?
❑ Yes �] Nu
/�
1 havc m.x1 �he hvardau mauerisYs requiremcnu undcr Chap�cr 6.95 of the Califor-
nia Healih & Satcty Codc, Secuons 25505, 25533 aiu125534.1 undcrsiand ihat iCthe huilding
docs rwl currcntly havc a icnant, � it is my responsibiliry W noGCy �lu occupan� of �he
reyu' mcnls whic6 � m�� �;a� w su��� ora c�,;r� oro�N�r. Signature �f Applicant Date
�� � All roof coverings to be Class "B" or better
Ownc autho grni ��