8070103 CITY OF CUPERTINOat
BUILDING DIVISION PERNUT ;,CONTRACTOR INF',UR ATI,,�1V ;
PERMR NO.
BU ILgIV9" DE ANZA BLVD SOUTH BAY CONSTRUCTION CO 08070103
NER'S NAME: Ttle FERMITLSUEDATE
SAND HILL/1200 SAN MATEO AVE 170 KNOWLES DR 07/15/2008
E SANITARY NO. CONTROL NO.
(408) 379-5500
ARCHnECT/ENGTNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uop LICENSED CONTRACTOR'S DECLARATION
aF 1 hucby snore that I sen licensed under provisioes of Chapter 9(mmmmening Job Description
Zym wird Session]allll)o(Di on3afdm Butineu and Prafadom Code,aM mylke�at DEMO INTER WLS& CEILNGS& DOORS
a�F ;n runforaammc rrl. 1487
:)E96 Limen
Chis Luc.a
-p pateconRxmr,
�'7W ARCHnECTS DECLARATION
' U 1 uMewnd my plans shall be used as public records
B Licensed Professional
3 OWNER-BUILDER DECLARATION
.� A 1 hereby afrom that I am exempt from the Contractors License Law for the
p o fallowing mance.(Session NO 1.5,Budnas and Professions Code:Any city m county
3:Tice which¢petro•p=it to co-1.alter,improve,demolish,mar-pair my stmctum
-Z�, prior bits ttiWMS.slur RQuin the applicant for such Permit in file a a;gaed sumemcnt
pp < tha,he is lieenscd punwnt m the provisions the Conuwux•s Licence Law(Chapmr 9 Sq.Ft. Floor Area Valuation
y�g (commencing with Section]DOD)of Division s of dse Students and Profession Codc)Or - $20000
Nat he is eanmpl therefrom and the bun for Ne alleged exemption Any violation of
Semon 7031.5 by any sppGant fm a permit subjects the applicants to a civil penalty or �,r9T�t Number Occupancy e
an,more dun five hundred dollars(3500). 3 2 6 3 3110.' W, P y Typ
❑I.uowrn of the propmry•amY wplgm wird nBexuthb tele compensation,
will de th,anot and Ne swmurt is not intended oroQered Tarsale(Stu,](N4,Business
and Pentland.Cade:The Canuacmrs L;atsa Law does Out apply m m..of Required Inspections
property,who Wilds or ire proves Burton,aM who docs such wmk himself m through his
own employees,provided thatsuch improvements are not intended moRertd[mule If,
known..Ne building or Improvemrat u sold within am rw of mmplatio t.the ow¢-
builder will love the human of proving that he did nut hold or improve for puryase of
tile.).
❑I.u o-xrcr of dm property am exclusively contracting with licensed enntrutams to
cmutmct Ne project(Sec.7044.Business,and Profecdoes Code:)The Contractors V-
cense law doe not apply to an owner of property who builds or improves Norton,and, _
who cantmcts for such projects with aeonuacer(s)Baued pursuant m the Condemnors
License Law.
❑IamessumptundreStu ,B&PC[stitiaa.n
no Date
WORKERS COMPENSATION DECLARATION
1 hereby affum under penalty of perjury arc of tie fallowing declamations:
1 have end will maintain•Cartifiateaf Cautious in self-luurt for WmicersCompcn-
sedan.az provided fm by Section 3]IXl of the latest Cade,fm the pedormartx of the
work for which this permit is issued.
❑1 have and will maintain Worieses Compensation Inmvana,u required by Section
y'/(IO of the,labor Code,for Nc performance.(ft work for which this permit is issued
MY Worke1rs�IC..o_me�pensuion I..arum and Policyn//yyyyyymmm'mmm'Isar art:
Cartier. VVN21T1Lc Pol7"'..r7 64R3y-o1
FICATE OF EXEMP
� ION FROM WORKERS
COMPENSATION INSURANCE
(That secttm need am he compleed tribe permit;s fortune hundred dollar(510(y
or beet)
I comity that in the perrmmanm of the work for which this permit at Owned.I shall not
employ any person in any meaner.u On become wbjw in the Wmkms'Compenudnn
Laws of California.Date
Appliats
NOTICE TO APPL ICAW.-IL after matin&this Cenifunt:of Exemption,you ihwld
became subject in the Workers Cocepetwtion provisions of the Latta Cade,you mum
.JO forthwith comply With each provitions m Nn ielonk shall be deew
deemed reked.
'Z n CONSTRUCTION LENDING AGENCY
C4
CI hemhy,alarm Nat ft.it.construction mending apancy far the parlstmance of
C4
the work for,which this permit a iunmd(Sec.3097,Civ.C.)
tp tenders Name
jz Lenders Md.
U Q 1 mnifY Nat 1 have read this application and sate the Ne aboveinfotmatiun b
!'
building
1 agree m caoplY wird all city W taunts oN;i e s of and sate tan relating m
Wilding rdomadan arty for ire wNama representatives of this city w cntm upon Nc
yaMve-mantion n property ve for impassion papp ha
(We)agmen to ave,indemnify and keep harmku the of Cupertio nsaid
at
rliabilities, temU ua
,Judgmen .eand which may in any way
acemuc agilutsaid City
U z in
handle haurdou material
u defnc0 by Ne Cupertino Mumcipal Code.Chapter 9.11 and the Health and safety
.oon us3ua>] All roofs shall be inspected prior to any roofing material being installed.
YG U
Nall the applicm,art f um building occupant use equipment m&A.which If a roof is installed without first obtaining an inspection,I agree to remove
it huaNnm air cmuminants u definc l by Ne Bay Ams Air Quality Muugcman, all new materials forins ection.
Dimd<tT �C// P
C]Y. Dg No
Ihave real the ha,Sece.amdalsrtquiremm�ts4.1 Chammrd.93irthe Widint
ilia Haiti&Sof ,
Date
�
Owner sd agent Oeste"� All roof coverings to be Class'%¢"or better
m wt�iori