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BUILDING DIVISION PERMIT
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DING ADDRESS:
PERMIT NO.
20510 STEVENS CREEK BLVD
TBD - TO BE DETERMINED
08060010
'S NAME:
PERMIT ISSUE DATE
EVERTRUST BANK
07/11/2008
NE:
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
DEMO EXTNG TLR CNTR,FLRNG,
BLDG PLUMB MECH
O 0
LICENSED CONTRACTOR'S DECLARATION
Description
licensed under provisions of Cpwr 9 (Commencing
1 hereby aOium that 1 am W
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with Section 7") of Division 3 Busimss and Profession Crew,, arol my Ikenm is
in
Lifull fmla andef(ea
Lice= Clue 46 Le.L—_ ]2761?_y
Date Cmuacw
ARCHITECTS DECLARATION
1 undcrstaml my pairs shall a used u Public mooma
Licensed professional
OWNER -BUILDER DECLARATION
1 herehy aRmn that 1 am exempt from the Contractors License Law for the
following mason. (Section 7M IS, Business and Profession Cade: Any city or may
which require a pmmir w ConflnlcL alter, improve, demob ls. Or repai, any summore
poor w its issuance. also mquiTy the applicant for such permit to rile a signed statement
that he is licensed pursuant to the previsions of the Conuscwr'. U.. Law(CNpter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Divrdca 3 of tW Businenand Prematm u Code) tar
that he h exempt Wemlwm and the thesis for the alleged exemption. Any violation of
Section 7031.5 by any applicant ler a permit subjCcrs this Applicant to a Civil penalty Of
APN Number
Occupancy T
P y ype
not mart Wan five hundred dollars (55001•
❑Lu thepeopcty,amy
worof
intendewithngeutheysokcompenssdon,
will wont, and u net intendede fmssk (Sec. Runners
Required Inspections
and r fe e: he Corm to sm
Cade: The COnucmY. Licame Ise doe Out apply lf ,t owmr of
Professionsate Cls
eny who W andwho doesauchwaed his
enywhe Wiprovidmproveu th
we orofffarWmugh
awnemployee.provided Improvementsnot earofdmo@ud formic. If.
mpr
such utas
balder, the mid wheat We owner,
or imPmrPovinu sold
po
did tic year of Comove
builder will bare Ik thuNen of Proving War k did rot build m improve (w purpose of
have ft a for
ssk.7
El 1, u owner a We property. w asclusivcly contracting wild Bcsned contraetms in
Consumer the Mica (Sec. 7004. Business and Profession Code:) The Coeuactor's U.
CoAhe law doe Out apply w an owner of property who Wilds or improves Women, and,
who contracts for such Projects with a eometac ) licensed pursuant On We COmtramols
Lw"we law.
Iatnucmprondor See ,e&PCIorWismsem.
Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury One, of the following declan some
❑ I ham and will maintain acertifinteo(concnr w cl(-inure fmwerteYs Comped -
sedan, ss provided for by Second 3700 of de Labor Cadt fm dna perfmmame of am
work for which this permit is issued
1 have and will maintain Woramr. Compensation Insurance, as noqu'ued by Section
3700 of NC Liber Code,. for the performance of the work for which this peord, is issued.
'
My Workefa COmpe add on Iman .. Cartier and Policy number am:
Cattier. ICFG i+alASGi Polity No.: t'3z;'J S{ft"Z
CERTIFO OFEX PH), FROM WORKERS'
COMPENSATION INSURANCE
(This rasion and ned W cempkted if We permit a faces hundred dollar (SIM)
or les)
I certify Wal in We performance of We work for which Wia .it is issued. I shall not
employ any person in any manner so U w become mbject w the Werkets' CompenadOn
Laws of Calif..]. Dam
Applicant
NOTICE TO APPLICANT: If, after malting this Camillus, of Exemption, you sWuw
become subject w tae Workch Compmushown provision of IW Lahor Codi, you nun
forthwith Comply with such provision m this permit shall W deemed invoked.
CONSTRUCTION LENDING AGENCY
I hemby alliem that them la a construction lending agemy far We performance, of
We work for whim this permit is issued (Sec. 3097, Civ. C.)
Lcnd r Nene
Lrn .Adders+
I Oceiry tel 1 have read this application and saw am use shove wmem.unn is
COOCCL 1 agree to comply with all city and county dNinwtce and state Ian relating w
Wilding consumction, and hereby.ushodre mpmstowli s of this City to enter upon Ih
a ow-mandoned property, for inpecurm purpmes
(We,) agree to save, indemnify and kap hcmless de City of Cupertino til
liabilities Judgments, costa and eaperman, which may m any way lame against said city
APLIC NT of We granting of that D WILL
UNDERSTANDS AND WILL COMPLY WITH ALL NON
ISSUed
-POINT
SOURCE
SOURCE RE_G/ULATIONS.
b y Date
R %k A-71 10T
Re -roofs
slL vcn� we
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
/
Will lite app0ant u rnows, Wilding eavpantstom m osedk haar0ous material
fined by the Cupertino Monicipsl Code. Chapter 9.12 and the Health and Safety
. Section 8532(.)?
❑Ya ANo
All roofs shall be inspected prior to any roofing material being installed.
Will the applieant or future Wilding occupam tic equipment Or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
hmwiludon air conuma,unu u dcfircd by We Ray Ama Air Quality Mangcmcm
all new materials for inspection.
QYe IgNo
I have mad We hate mast maderiaHmquimmenu under Chapk,6.95 ofthe Califor-
niaHuaW&Safely Code Secdmu8NB,8533am1M5M.lundcmmld Wcifdte Wilding
dais not cmmmly horn a mea r. Wt h u my mapomihility w notify de Occupant nr We
mgaimmenrs wMm be met Priormissuutee Ofa Cerurkac er Occvpwey.
�✓��a S —� 1�t
Signature of Applicant Date
All roof coverings to be Class 'W' or better
Owner or amhorined agent D.w