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BUILDING DIVISION PERNUT
BUILDING ADDRESS: PERMIT NO.
20488 STEVENS CREEK #2050 TBD TO BE DETERMINED 08020161
OWNER'S NAME: PERMIT ISSUE DATE
STEVENS CREEK COMMERCIAL 04/21/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/EIVGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effect.
License Class Lie. K
Date Contractor
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following mason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to ctmsutc4 alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (i500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon. and who does such work himself or through his
awn employees, provided that such improvements are not intended or offered for sale. If.
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
31, as owner of the property, am exclusively contracting with licensed contractors to
. 'ruct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li-
cense Law does not apply.toalowner of property he builds or improves thereon, and,
who contractsprojects wiih+a conuactaRs licensed pursuant to the Contractor's
License Law
❑ lam axe undo Sec , B & P C or this ream.
Owner Date
I hereby afYrm under penalty of pgljury one of the following declarations:
❑ 1 have and ill maintain a Certificate f Consent to self -insure for Worker's Compen-
sation, as vided for by Section 37 of the Labor Code, for the performance of the
work fathe
tach this permit is issued
❑ 1 hd will maintain Worker's Compensation Insurance, as required by Section
3700 oLabor Code, for the performance of the work for which this permit is issued
My Worker's Compensation Insurance tamer and Policy number are:
'Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cniis section need not be completed if the permit is for one hundred dollars (f 100)
or less) —
I certify that in performance the work for which this permi ' d I shall nat
employ any perso 'n any m r so u become su ' to orkers' o nsation
Laws of California.
Applicant
NOTICE TO APPL1 : If, after making this C licac of Exemption, you should
become subject to the rker's Compensation pro " ions of the Labor Code, you must
forthwith com:�afflirin
wi such provisions or this pe t shall be deemed revoked
CONSTRUCTION LENDING AGENCY
I here that there is a construcdan lending agency for the performance of
the wont for which this permit is issued (Sec. 3097, Civ. C.)
fenders Name
fenders Address
I certify that I have read this application and state that the above information is
correct_ I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authoria representatives of this city to enter upon the
above-mentioned property for inspection purposes
(We) agree to sa-w—indemnify and keep har nl it of Cupertino against
liabilities judg fs, toss and ea w ' in way ac against said City
in conseque of the granting of perm I
APPLICANT�D_E_RSTAN AND W] COM Y WITH ALL ON -POINT
SOURCE REGLi�TIONS
Signature of Appli Contractor �&— r Dat,
RDOUS MATER! �IlDISCLOSURE
W ill the ap cantor future building aafpant store or handle hazardous material
as defined by the upertine Municipal Code spier 9.12, and the Health and Safety
Code, Section 532(a)? /
❑Y No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants defined by the Bay Area Air Quality Management
District?
Yes
❑
I have mad the hazaldausmatgdals requirements u r Chapter 6.95 of the Califor-
nia Health & Safety Sections 2550„ 25533 255 1 understand that if the building
does not currend have a tenant, that is my nsi ity to notify the upant of the
requirements whit tau be -gree i, to iota ce of a enificate of Oc5pancy. n
Job Description
TI -EXSTNG SPACE,PROJ TO INCRP EXSTNG ELECT(WITH
ADDTN), HVAC & DROP CEILING-ASANTE'S REAL ESTATE
OFFC.
Sq. Ft. Floor Area $45000 Valuation
3 6 9 010 6 6 qji Number Occupancy Type
Required Inspections
rt,
Issued by:
Re -roofs
Type of Roof
Date ,2 (�-
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant
A
Date
V.—