07110082 CITY OF CUPERTINO � `
BUILD[NG DIVISION PERMIT �!������ ��������� . :
, ;.:. _ . ; .
,:, .. ,,: _ . .
PERMIT NO.
BUiLDING ADDRESS:
10061 BUBB RD OPI COMMERCIAL BUILDERS 07110082 .
PERMIT LSSUE DATE
dER'S NAME:
GARY LESSING 445 LEIGH AVE #100 � 11/14/2007
SAMTARY NO. CONTROL NO.
PHONE:
BUiLDING PERMfC INFO
ARCHI'IECi/ENGiNEER: CONSTRCT UNDRCEILNG DEMIZIN BLDC E�cr PWMB MecH
� 0 � 0
a p Z p LICENSED CONTRACfOR oecuennoN Job Description
;� V 1 hcrcby �cm tMat I am liccnscd undcr provisions of Chapicr 9(commcncing
� wiW Secdon 7000) o( Division 3 of Uu Business and Professions Code. and my license is
�� y in full (oree and e f tat
� v� z Licensc Class Conuacwr
y F , p Daic
� ARCH[7'ECCS DECLARATiON
��< I undcrsund my plans shall be uacd as public records
m
; � ,F Liccnsed Pmfcssional
y � OWNER-BUILDER DECLARATION
1 hcrc6y affirm that 1 am excmpi Gum tho Canuactors Liccnsc Law for thc
� p O following rcason. (Scction 7(Yi 1.5, Busincss and Profcssions Cafc: Any ciry ar rnunty
K,°, Pi which rcquires a pcmiit to cnnswct, alter, improve, dcmolish, or mpair any structuec
y Z} prior a i�s issuancc, also requims thc appliant [or such permit io filc a signcd sta�cmen� � F t. Floor Area Valuation
£ _ � that hc is Iiccnsc J pu[suan l to t h c provisio n s o[ t h c C u n t n c t a r' s L i c e n s c L a w ( C h a p t c r 9 �] •
y t- $ (commencing wi�h Sccdon 7000) of Division 3 of �hc Busincss and Profcssions Cadc) or
y �., that he ia exempt �heretrom and tAe besis [or We allegcd eumpuon. Any vioiation of
Section 7031.5 by arty applicant for a pertnit su6jecu ihe applicant to a civil pcnalty of APN Number Oeeupaney Type
not more �han five hundred dollars (5500).
� I. u owner ot tt�e propeccy. ar my cmployces with wages as the'v sok compensadon.
wiu do the work, and �e stmctu�e is nocintended or ottered ror sale (sa.7au. H�sines+ Required Inspections
and Professians Code: The Contrxwr's Lianse Law do¢s not app�Y w a� o�'"�r of
propury who builda or improves �heccon, and who docs such work himselt or throng6 his
own employces, provided that such improvements are not intended ar o[kred for sale. I[.
however, �he building or improvanent is sold wi�hin one year ot compleuon, ihe owner-
builder will luw the birden of proving lhal he did nol build or improve for puryose of
sakJ.
I. u awner of the property. am exclusively contracting with licensed rnnuactas W
cpnseruct the project (Sec. 7044. Business and Professions Code:)'Ihe Conux[or's Li-
cenx Law does not spply �o an owner of propeny w6o builds or improves ihemon, and ,
who convacts Cor such pmjec�s with a conuactor(s) licenxd pursuant to �he Conusctor's
License I.aw.
'( am exempt under See. , B R P C for this rcason
� Da
O ' O SAT CLARATIO
I hereby affirm r penalty of perjury one of the foUowing declarations:
❑ I hsve and will mainuin a CcniGcate of Consent to xlf-insure for Workcc's Compen-
sarion, as providcd for by Secrion 3700 of the Labor Code, for �he pedormance of the
wort Cor which wis pe�mit is issued.
❑ I havc and will maiMain Workcts CompensaUon Insurana, u required by Scction
3700 of �hc [abor Codc. Cor �hc performanu of �he work for w6ich this permit is issued.
My Worker's Compensation Insurannce carticr eod Poliry number am:
Carrier. Policy No.:
CERTIF[CA?E OF EXEMP'CION FROM WORKERS'
COMPENSATION [NSURANC6 �
(7Lis section need mt be complemd it We permit is for onc hundred doilars (S I00)
or Icu)
I cenify thnt in thc performance o[ thc work for which Ihis pcm�it is issucd, I shall not
employ any person in any manner so u baome subject w �he orlcecs' CompensaGon
Laws o( Cslifomia. �e
Applicant .
N077CE TO APPU : 1f. aking ihis Cc ' of Exemption, yau shoulJ
bccane subjcct a thc Worlc�r'a CompcnsaGon provi s of thc Labor Codc, yau must
� O forthwilh comply with such provisions or thia pecmit shall 6c dccmcd mrokcd.
Z � CONS7RUCt10N LENDING AGENCY
E.r i--� I heroby aRrm ihat there is a conswctinn Icnding agcncy for �hc performancc uf .
p; � ihc work for which �his permit is iseued (Scc. 3097, Civ. CJ
W Q Lendcr's Namc
� � L.cnde�s Address
(� 0 I certify Ihat ] have rcad tltis applica�ion and siatc Uut �hc abovc infom�atiun is
w� cortcn. 1 agrce to comply wi�h all city and counry ontinancu and sute laws relaring w
0 U building consuuction, and hcrcby auchorin RprcscntaGvcs of ihis ciry to cntu upon tAc
� W above-menuoned propcny tor inspenion purposes
a (Wc) agiee to save, indemnify and kecp hannless �he Ciry o[ Cupertino against
�� IiabiliUa, judgmcn�s, costs and expenses which may in any way ucruc against said City
V z in consequence oC thc gnnting of Wis permi�. Date
►�+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-PO1M' Issued by:
S011R REGULATI .
�� �`� Re-roofs
Signuu Appl' ontractor �s� T of R � )Of
AZARDOUS MA7'ERIALS D[SCLOSURE }r�
�Il lhc spplicant w futwc building occupant storc or handlc ha•rardous ma�cria!
cfincd by the Cupenino Municipal Codc. Chapmr 9.12, and the Hcal�h and Safcty
.�. Scction 25532(a)? All roofs : hall be inspected prior to any roofing material being installed.
� y� �tVo
If a roof i� installed without first obtaining an inspection, I agree to remove
Will �hc a�licant or futum building accupant usc equipmcnt or Jcviccs which '
emi� ha•rardous air con�aminan as dcfincd by the Bay Area Air Quslity Managcmcnt all new m; iterials for inspecr.ion.
Disvict?
❑ Yes
I havc rcad che hvandous ma�crials requircmcnu undcr Chapicr 695 of Ihc Cali(or-
nia Elcalih & Safery Cade, Sectians Z5505, 25533 anJ 25534.1 undcrsund �hatiC ihe building
ciacs not curtcntly have a tcnan4 ihat it is my responsibiliry w nodfy ihe axupant ot Ihe
mq ' men�s which be mei prior w�ssuance ota Ccnificaic of �a� . Signature �f Applicant Date
�� All roof coverings to be Class "B" or better
Own or au e gcm a�