07110085 CITY OF CUPERTINO '' -
BU(LDING DIVISION PERMIT ��l�R��t?� �����T��� '
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BUILDING ADDRESS: PERMIT NO.
20283 PINNTAGE PKWY M L NIEGSEN CONSTRUCTION 07110085 .
_ .JNER'S NAME: PERMIT ISSUE DATE
TOWN CENTER VILLAGE H.O.A 4608 ENI'ERPRISE CMN � 11/16/2007
PHONE: SANITARY NO. CONTROL NO.
(510)657-6764
ARCHI'IECI'%ENGiNEER:
BUILDING PERMR'INFO
BLDG ELECT PLUMB MECH
0 0 0 �
a O p LICENSED CONTRACTOR'S DECLARATION
� I Yxrcby affirm Uut 1 am liccnscd under provisions o[ Chaptcr 9(commcncing Job Description
��� with Section 700()) of Division 3 of thc Businesv and Profcssions Code, and my liccnx is RE P LC 2 W I NDOW S& RE LAT ED S'1'UC �.' �
�� y in full foice and ef
j v� z I,icenac Class G— G� �. �t 7i
� F, p Datc 1� Conuacwr �t
�' ARCHITECI'S DECLA ATION
� I undcrstanJ my plans shill be wcd u public records
m<
e.
U
4 O y Liccnsed Prufcssional
y 3 OWNER-BUILDER DECLARATION
.� t� 1 Ncrcby aRirm �at 1 am excmpt Gum thc CoNrattors Liccnsc Law far thc
y p O following icason. (Scction 7031.5, Busincss and Profcssions Cak: Any city or county
K$ Pi which rcquims a pcmiit to consuuct, aimr, improvc, dcmulish, ar ic�wir any swcturc
y Z� prior w ils issuancc, aLw rcquims �hc applicant for such permit to file a signcd sutcment
_< that hc is licenscd pursuanl to thc pmvisions of ihc Cnnuxtor's [.icensc Law (Chapicr 9 Sq. Ft. Floor Area $ 5 O 0 O Valuation
y t- $(commcncing wi�h Sccdon 7000) of Division 3 of ihc Businrss and Profcssions Codc) or
y �.. that he ia exempt theechom and ihe basis for t6e slleged exempdon. My violaGon of
SecGon 7031.5 by arty applicant for a pecmit subjecu ihe appiicmt w s civil penaity of umber Oceupancy Type
�rot mme �haa five hund�ed dollars (5500� 3 6 9 4 7 0 3 9��
❑[, u owner o[ tlie property. or my employces with wagea u the'v sole compensadon,
will do �he worlc, and the stcucwre is not intended or o[fered for sa� (Sec. 7044, Busineaa Re uired Ins eetions
md Professiana Co�:'ILe Conuactor's License Law docs not apply to m owner of 9 P
propeny who 6uilds or improves Uurcon, and who dxs such work himself ar Uuough Ais
own employces, provided that such improvemm�s ue not imm�ded or oRered for sala If,
however, the buiiding or improvement ia sotd within one year ot compicdon, the ownu-
builder will haw the burden o[ proving that he did not build or improve fa purpose of
sak.).
❑ I. u awna o( the propeny. am exclwively conuacting wi�h licenud rnnuacWrs w
coastnrct Uie pmject (Sec. 7044. Businm and ProCessions Code:) The Contrxtor's Li-
ccase Caw dacs no� apply w an ownu of propeny who builds or improves themon, and ,
who conuacts Cor such pmjects with a conuactor(s) licensed pursuant W the Controctors
' �cense Law.
1 am exempt under Sec. , B& P C for this reason
�wner �o�
WORKER'S COMPENSATION DECLARA170N
1 hercby aflirm under penalty of perjury one of the tollowing deciaratians:
� I hsve and will mainuin a Ccrtificate o! Consent to ulf-inswe for Workera Compen-
ution, u providcd for by Section 3700 at the Labor Code. [or ihe pedormance oC the
wwk for which ihis permit is issued.
havc and will mdntain Worlccr's Compensation Insurana, ss rcquircd 6y Scction
3 of �he Labor Codc, Cw Nc pedormance oC �he wort for which this permit is issued.
My War� s Compensau; n�� �c� numbcr re: _
° n� �-
cM;n: 2 d wee a� o�is� tao.: 1�+ �
Cexn�cn� oF �rnox �xoM woRxExs
COMPENSATION 1NSURANCE �
(ihis scctian need irot bc compleled if the pecmit is for anc hundrcA doAars (5100)
or Icss.) •
I cenify ihat in Wc performancc of Idc work fw which �his permi� is issucd. ! shall not
rmploy any person in any man ��so �s� `�� � bject w �he Workcrs' Compcnsation
Laws of Califomi /� �
Applicant
N077CE 7'O A ��CANT: If, a r making ihis CcniCca�c of EccmpGan, you should
become subjett to U+e Worlcer's Compensation provisions of the LaAor Code, you must
� O forthwith camply with such provisions or this permit shall bc dcemcd n.wokcd.
Z ""' CONSTRUCTION LENDING AGENCY
�- � I hc�cAy �rm Wat thcre ia a conslruction Icnding agcncy for ihc perCartnanx uf
a� the wurk for which this permit is issued (Scc. 3097, Civ. C.)
W Q Lendcr's Namc •
] z Lcndec's Address
V � I certi[y �hat 1 have tead iMis application and siate U�u thc above informariun is
w F cortcc� I agree w comply with all ciry and county oNinances and sute laars celating w
0 U building consvuction, and hereby wUforia representadvcs of Ihis ciry W cnlcr upon Ihc
� W alwvc-mentioned property for inspenion purposes
(We) sgrce to save. indemni(y md kecp humless ihe Ciry o[ Cupertino against
�� liabilides, judgmcnts, cosu and expenscs which may in any way acccue againat said City
V z in cansequencc oC t�c granting of this permi� Date /����'� /
�"� APPLICAM UNDERSTANDS AND W1LL COMPLY W17'H ALL NO POINT Issued by;
SOURCE E LATTONS.
l � � °7 Re-roofs
Sign ure of Applicant/Con r Da ��
HAZARDOUS MATERIALS D[SCLOSURE Type of Roof
Will �he applicant or future building oaupan[ storc or handlc harardous ma�crisl
�e�ned by �he Cupertino Municipal Codc. Chaptcr 9.12, and the Health and Safcty
_.,�, s«uo� usszcen � All roofs ;�hall be inspected prior to any roofing material being installed.
❑ Yu
Will ihc applicant or future building occupant usc equipmcnt or Jeviccs which If a roof i: � installed without first obtaining an inspection, I agree to remove
emi� harardnus air con�aminanls aa Jefincd by 1he Bay Area Air Quali(y Managcment all new m aterials for inspection.
District? l�/�
Q Ycs � �vK,
I havc read the ha�ardous maicrials requiremcn�s undcr Ctupicr 6.95 of thc Cali(or-
nia Ekalth & Safcty Codc, Sectians 25505. 25533 and 25534.1 undcrs�and Uim iC �c huilding
does not curtcn0y havc a trnan4 �et it is my responsibiliry to notify thc occupant of thc�
rcyuircmcn�s whi uu bc met priorto issu c�r�� ar o��P�r. Signature of Applicant Date
� ll �`
Owncrorau�hori�.edagcnt %� Datc A�l IOOf COV0C1IlgS t0 be CIBSS "B�� or better