08010082 CTTY OF CUPERTINO
BUILDINGDIVISION PERMIT ,VQilt��'" � IQd1\ ,
BInLg��c�I�RE DE ANZA BLVD TAISEI CONSTRUCTION CORP P-6tSUr�q
D10082
OWNER'S NAME: PERhffI ISSUE DAIS
SAND HILL/1200 SAN MATEO AVE 2180 BERING DR 03/18/2008
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
COMM'L T. I . — -BLDG ELECT PLUMB MECH
300 LICENSED CONTRACTOR'S DECLARATION O O O
Fy 1 hereby alfim that 1 ore licensed under poaNsionsof Chapter 9(cummaming lob Description
MMN Section 7")or Diviaan 3 ofthe Buausu W PoafoeaonsCode,and my license
i in full(am AM elect.
3 License a. Lle.i
5 DateContractor
ty ARCHITECT'S DECLARATION
q 1 unaerataml my plana shW he used as public meet&
ksea Licensed Professional
OWNER-BUILDER DECLARATION
M 1 hcmby aRrm Nat I em exempt foam the Comhaumes License Law for the
p o following moon.(Section 7011.5,Businessand Prefessium Code:Any city or county
9 which aviation a Permit to CMm t.alar,impare,demalwh.or repair my mmmre
�r prior to its nausea,also mquima the applicant forsmh permit to fla a signad statement
5F< thuheis licensed purumtothe provisions ofthe Conuocier's Lice=Law(Cbapor9Sq.F FlFloor,'rea Valuation
Sa (canmencing with Sccdm 7000)of Division Sof the 9usinwand Pretensions Carle)or
w
Nan W muccom therefrom and the bow fm the alleged exemption.Any violatlm of
Section 7011.5 by my applicant fees permit subjects the applicant to•civil penalty of APN Number Occupancy e
.1 mom Ihm Bw hundred dollars(5500). P Y TYP
❑I,uownerofdieproperty,mis wployemwithwagea NeshateeampensNan,
osiness
and dothewmk,ander he nomwants License Law Wce met
70an Bnerof
anti Pmrmat W Codec The thromre sad.1W
law dam ant apply lf m ower of _ Required Inspections
progenywhobuilds i impmwaderma,Onawho dataoahwork croffeedthrmle his
awn mnployaa,poaWErE that such impoawmwt see not year moQaud roe Owner
Wilmer mNe buildingftorImpoawmantIanhathwithinamywofmprowfrtheawusr-
builrlm will haw the harden of proving that he did ant bulla m imgow far purpose of
sew..
u awusr of the property,w exclusively conosning with licenses cenuonms o
wan thla(inject(sec.7014.Business and prof..in.Cade:)Than ContMors IJ-
aw Law dose ant apply M an awnm of property who builds or snpeow thereat.and,
who concis for such projects with acmmuct licensed personal in the Conuc7oM1
Lkew LAW.
❑lam ex.mp�n ,BdkPCfar thi4muon
Owver I WMKER5 PENSATION DECLARATION v
1 hereby a0im under Funnily of perjury arc of the fallowing decla odanc
has.andwill for by •tion37 taof Camebwself-inswv fm Wmtrrs Compeo-
an,u which
this
far mi is Issued.1700 of Ne labor Code,!m the perfommxe of W
wank for rMch This pcmit is IOucQ
❑I haw real will maintain Worked CompeuNon Insurance.as rationed by Section
3700 of the labor Code.for de perfamance of the work far which mis permit is Wood. '
My Wmicre.Cor ohnn.Inannum prier and Policy number art:
Cartier. Policy No.;
CERTIFICATE OF 13XEMMON FROM WORKERS'
COMPENSATION INSURANCE
main section used mt tecan plead lines permit is fm ane hundred do0w($IBM
or lana)
I clarify Out in tlo perfmmanco of the work for which this permit is issued,l null not
employ anyCalionan I.any DOW mmncrsoumhmma subject wthe Worts ompema0on
Lawn of Cniifami Date Lsf-G�� 'T ,
NOTIApplCE
NOTICE TO APPIJe Work IC alum m i w Certinute M Utuar on,yon aurum
become habjcn y it Workers Csmpewam provisions of the Ia d Cade,you must
wJ O foMwith eamP1Y with mese provisions or this permit shat m deemed hawked.
�y CONSTRUCTION LENDING AGENCY
p. I hereby slim that dem Is a construction lending agency for the performance of
(>:7 the work for which dds permit is iumA(Sec.3097.CN.C)
0..Q Laners dName
0z Leaders Add.
U Q I amify Nu I haw rad this application and sum that the.bow Information Is
17r torten.I as=m comply with all city and county andinmce,and sum laws painting m
O SU' building construction,and hereby mthorion mpmammiwa of thin city m enter upon 0e
Ui above-mentioad property,fm inspection purposes.
0. (We)agree in sew,indemnify and kap seamless the City of Cupertia against
Uy liabilities,judgments,cars and seam•...which may in my way accrue Oninsl said City
7 in cmxyanm of the iraaing of this North.
r1— APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONpOINT Issued Date
SOURCE REGULATIONS. ,I // brJ
Signstum of AppuanuCommutoorrDXUam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will 0e applicant or future building acearm nt more Or handle hourhons materia
an&flwd by the Cannon.Municipal Cade,Chapter 9.13,and IM Health and Safety
Code,Sad.35513(.)?
❑Yon Qt�////1No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or fuom building macaroon use equipment at deices which If a roof is installed without first obtaining an inspection,.1 agree to remove
40 In huaNnus air antsminsmb u defend by the Bay Amo Air Quality Management all new materials for inspection.
rict7
❑Yes
1 hew mad the huaNau muerioumquiremenu under .Clupterb.95 athe Califon
nu Hcalhldi SafctyCab,Soniats 25.505.25531 bad 25534.I madereuM Nulfuse Witting
dna at currently now a tense t it s m mponsibiliny m mitt de/a:cupant of Ne
mquimmcrm which msec m arm' anceofa Crm�tp('0�ccupmry. Signature of Applicant Date
Owner or authorized sent II �1 DDem All roof coverings to be Class'%¢"or better