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C01V'RAC�TaR INFURMA'TT N
BUILDING DIVISION PERMIT
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BU"TVh 5TES§TEVENS'CREEK BLVD #208
APPLIED CONSTRUCTION TECH
PERMIT NO.
08010069
W NER'S NAME:
PERMIT ISSUE DATE
MENLO EQUITIES
1230 OAKMEAD PKWY
01/30/2008
HONE:
SANITARY NO. CONTROL NO.
(408)252-9990
ARCHI ECTAINGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
- lob Description
1 Monty affirm Nal 1 am II¢ved order provisions of Chapter 9 (mmracroo
Secuon7gg))af 3 the Bud a.y�(r}zloy[mf ucene is
REV RPLC EXTNG CEILNG 4 BTR SND, INCRS AREA T
with mon of my
in full cora and of '� b
Licenmo uc.s Yi Y'
INLD
Dam - ARCHMCi'30ECL 1 e
KTCHN CEILNG & MDFY CELNG DETAIL — ORIG #07110030
1 understand residues Nall Wood as puoil. mocads
.
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby alfiren that I am exempt (rare Ne Contactors License law for the
fallowing mason (Section 70313, Business and Professions Cade: Any city Or county
which mquins a permit to construct, alcor. improve, domollo, or repair my smmclun
prior to its issuance. also nqulres the applicant for such Permit 0 01e a signed Moment
is licensed of the Contractor's License Law 9
Sq. Ft. Floor Area0
Valuation
that he Famous, to the provisions (Chapter
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt lhom(rom and the Luis for the alleged exemption. Any violadon of
31649009 Aff
Occupancy Type
Section 7031,5 by any applicant for a peamit subjects Na applicant o a civil penalty ofNumber
not mom that fin hundred dollars (5.500).
❑ I, a aumr of the property, or my eeployces with wagons Iheirma compenudon,
Required Inspections
e
willdo Newark and thestrucwe lawtmundedoroaend rarsm(Sce.70N,8usirtw
and PrefeWans Code: The Conmcmr's Lkenue Law does roll apply e an owner of
9 P
property who builds Or improves thereon. and who does such weak Mmm1r a through his
own employee, provided that men improvements art not increase aronemd ronale. If.
however, the building or improvement Is sold within ons year of completion, the Owner.
builder will Ww the Nader of proving that he did not build or improve for putpom of
ick.).
❑ I, u owur of the property, am exclusively contracting with licensed CmnuaCbrs as
constmct the project (Sts. 7004, Business and Professions Code] The Coolmmes U-
ec m law does not apply in an owner of proNny who wilds of impmm thereon, and,
who contracts for such prejects with a eo mom ora) licensed pursuam to the Camrmnofs
lieu Law.
❑ l an aempt and x 3 , B& P C fm eau noon
ms Dam
WORKER'S COMPENSATION DECLARATION
1 hereby afllon make penally of penury No often following dalarWons:
E11r.. and will milnu). a CenifiOa of Contemn mtrduure for Wormes Canpen-
stim., u provided far by Socl,m 3700 of Ila hats, Code, fm the performance of manweak
for which this permit is iauod.
❑ I ave as will maintain Worker's Compensation Insurance, u required by Section
3700 ofthe labor Cao, for the performance often work forwhich this permit is inad.
'
My Work es ComPeu•tion Immmua carrier and Pellq number ace:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thtssecllon Net not N camplemd If the permit Is two= hundred dollars ($100)
M lata.)
I certify that in ac performance of Ne work for which Nu Permit is issued, 1 shill not
employ any person in any mmnrrlo u m become mbJecu. the WorkerCompensation
Laws of California. Dam I s -
AppOcert -a
.
NOTICE TO APPLICANT: 1 fuer making his Ceninam of Exemption. you should
become subject to the Worker's Compensation previsions or Ne Lamar Coda you roup
' forthwith comply with such provinces or this Permit Nall to doomed rooked
CONSTRUCTION LENDING AGENCY
I Mar than then is a connotation.30 lending agency for the per(ormemma of
the work fur which this perch ts Issued (Sec. ]097, Civ. C)
which ad
mms Name
Le
landeh Address
I comfy that 1 have read ads application and sure that the above information is
' correct. 1 agora m comply with all city as county on inances and awe lass rtlating to
Wilding construction, and hereby authorim reprocrunum of Nu city to enter upon the
t aNvcmmuoae property for Inspection puryores
(We) agree to ave, indemnify and kap humles, the City of Cupertino against
j Itabithialodgmenu.cosu andupensu which may In any way socnmgsinst said City
In conseq of roc gmdng of the perml.
' APPL1 UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date — J
SO U NS
�
Re -roofs
Type of Roof
ignu of Appl trCoatmmr Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant Of clure building excutpanlpore or handle hasrdous material
u denad by the Counts. Municipal Code, Chapter 9.11, and tin Needs and Safety
ate. Mcuo.25531(.)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yea air
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or (eue building Occupant ice equipment or devices which
emit haardou air contaminants at defined by the Bay Ana Air Quality Management
all new materials for inspection.
District?
❑YesNu
1 have mad the harmmus materials equlemmis under Chapter 6.95 ofthe Califor.
nia Health &Sdcty ,Socuous 25505.15533 and 25534. I unikmmd this if the building
does rot current a a mnenI. that It u my res,rability to notify roc Occupant of the
requimmon is armlammaaracwiZ^O�,�
Signature of Applicant Date
All roof coverings to be Class "B" or better
Dam
Owner or authorized agent