08070160 CITY OF CUPERTINO +..�-k4«r -
BUILDINGDIVISION PERNIITCONTRACT.ORA'N ORMATIOPJ` ,
S &e"
BUILDING ADDRESS: PERMIT NO.
70563 STEVENS CREEK BLVD TBD - TO BE DETERMINED 08070160
R'S NAME: PERMIT ISSUE DATE
SA.FCH JOHN M TRUSTEE 07/22/2008
ONE: SANITARY NO. CONTROL NO,
ARCHI ECT0ENGINEE W: BUILDING PERMIT INFO
BLDG t� ELECT CS PD l�
O O LICENSED CONTRACTOR'S DECLARATION
I baeby SHIM to I,m licensed under previsions ol'Chapmr 9(commcreimg Job Description
wit Sadon 7000 of Diviscn 3 ofdm Engin Soul Prroofesdmu>Code.and my tectum u 1 NEW 44 . 85 NON-ILLMNT SGN; 2 NEW 41 . 63 SQ EA.
^<,to in fall force Soul effecNvr e 2 s�3
;qb License❑ ` Lie.,
ILLMNTD WL SIGNS
I F p Dam '/ —Cormeac r �-
i7W ARCHITECTS DECLARATION
G 1 undemad my place shall he used u Public records
g G Licensed Professional
OWNER-BUILDER DECLARATION
'� g! I hereby arcren tet I am.empt from the Contractor's License Law for the
O O fallowing moon.(Section 7031.3.Bear.and Profeuio.Code:My city er county
3$ which requires a permit to co.muc,alter,improve,demolish,or mpaic any smunum
_z prior to its fuentce,also requires th applicant for such permit u file&Signed statement
EEzp dicthtslicensed pormout to to pmvisimts of de Corroon',li¢rea,Law(Chapter 9 Sq.Ft. Floor Area Valuation
YF' (commencing wit Section7000)aDivision 3 of de Businm and Pmfcumme endo)m $14728
5 3 to he is esunpi there(avm and the bull for th alleged camnptim My violuipt of
Semlme 7031.5 by any applicant for a permit subjecu the applicant u a civil puully,of Number Occupancy Trot mom tan five huMmd dWkr.(5300). 32634044 . ane Type
P Y YP
❑I,u ower of to proprxy,a mY mPlaym wit wgn u te'vok mmpewtion,
will do to work.and the SWcture u out amended of offered formle(SM.WHO.BaLne31
and Pmreu(ona Code The Contrcta's blame Law does not apply m an owner of Required Inspections
propenrwho bund.oriropmwa fere m,ed who dasSuchworkhaualfortmugn M.
ownemployeca,provided to such impmvememta ice nam intended oroBered for Nn It,
however,to balding or improvement Is old winter one year of completion.the event.
Wilder M0 ham the buNrn of proving tat Ie did of build or improve for pugoe of
Of'.).
. 0 I.u away of to Property.w vtlusively...maedng wit Barued a mramon he
construct to Project(See.7044.Busam and Pmfessant Code:)That Cmbaerors ISL
ave law deem not apply an an owner of property who builds or improves Lemon.and
who contracts for such projects wit a mnmcta(a)licensed pmmam u the Conmacte's
Lk..law.
O lamesemPtunderSee ,B&PCfortisment
Dame
WORKERS COMPENSATION DECLARATION
I hereby affirm under inumby of perjury cane of the fallowing dec ura0ou
0 I haw and Nll maintain a Ceri fiom efc.ment u elf-i.um for Worker.Compmn
suction,as provided for by Section 37M of Ne Labor Cade.for de perfonnSoeo of One
went for which this permit n issued.
0 I low meed win retrain Worker's Compensation f c urea,u rcyuined by Scoot
3T10 of to labor Ounce/Wfor do u.prer�formance of to wvk roar which tis
it permit iawA
MCarrien ' �W"v/9/k'k• carrier ol�NO's?3011
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(chis aection need nuthcooplemd time permit morons hundred dollen(sloe)
or ic.)
1 certify tat in to performance of the wart for which ti.Permit is bound.I shall net
employ any lar mn in any mammro u u become object to to Worten'Compendon
laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making thin Certificate of Exemption,you should
become Subject u th Wohers Compe.adon provisions of de Labe Cod,you mua
.,z fortwit comply wit Such proviso.or to permit shall h rimmed mvatce.
?O CONST ucnoN LENDING AGENCY
I hereby affirm to them is a comrmNon lending agency fordo preformana of
C> de work In,whim tide permit 4 named(Sec.3097.Ci,C.)
W� Q lenders Name
z landerS Adder.
U O 1 aNfy tat I law mad Ise.appOcdon and State tho the Show informadu,la
gL H conem 1 agree u comply wit all city and county mdinenma and Sane set
laws ting u
0 V building construction.Sob hereby autortre mpmsentadwsof to city On now upon ftho
„ y , w-mcmiuned property for ivpenion puryves
(We)agree to Save,indemnify and kcep harmlm the City of Capedno agalvl
sew VI fiabllidea,judgments.cata end extemves which may in oY way rte agalml said City
fJ z in eovegeeve of the granting of its permit
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU?��0T3IQaNI9S.
�— 7
l_� — —Z _' Re-roofs
Signuu c of Appliemall om2 or ontoHAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applaanl or future building occupant time or handle hrordo.mamrkl
fined by the Cupertino Municipal Cade.Chapter 9.13.ail th and ul Safety
sedan ns3z(al7
Yes Iib All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
WSII the applicant or future building amvPanl Sox equipment m devices which P
itrhu� u u n.air commenandefined by ft Bay Area Air Quality Management all new materials for inspection.
0Y. 2M.-
I have read the harardoru materi,lnrequimmcots underChapter 6.95 of Ute Califor.
nice Real"Safety Code,Seaman;25W5.2!5533 anal=34.guy!/q w1lW We ate building l
ding
dour hot...uly have,terunt toritml. b 'the-aceetnantof
mquireme(�ma be mt pact.
s ^fQsapucy:,3
Signature of Applicant Date
Owner am0mi74dagent DaeAll roof coverings to be Class'%¢"or better