08060009CC
z
11 G
U C
UC_
lif
.O U
�a
�z
CITY OF CUPERTINO
-a••,Ig:mc , sx r xa;
BUILDING DIVISION PERMITC�NTRAGTnR�INF`OL��IA.TION'"
M •-- M. #.: 3zPFia xts v �r3t Fk .-.uxkar. '
"" IT4a "AARIANI STE C
BERG & BERG
PERMITNO.
08060009
NER'S NAME:
-
PERNIT ISSUE DATE
BERG & BERG
06/04/2008
PHONE:
SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMTTINFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
lvismas p
1 Wroby aRirm Nn I am licensed under pmof Chapter 9 (commencing
with Section 7")of Division Sof to Business and Professions Code. and my lleerom is
RMV APPRX 2800SF FLR SLB&SOIL APPRX 5'&RPLC
in full forte and offset
License Class Lia.a
SOIL&SLB. MINR PSSV UNDRSLB VNT SYS,MNR PRTN(NO
Dale
ARCHITECTSDECLARATIONBRNG)DEMO
ALL UNDR GRD
I undmaund my plans shall be wail u Public meards
Licensed Professional
OWNER -BUILDER DECLARATION
I W mhy affirm that I am exempt from the Contractor's License Law for the
following mason. (Section 1031.5, Business and Professions Cole: Any city at county
which no mires a Permit to construct. than. ex prme. demolish, or repair my structure
Prior it, its issuance, also mquims doo mplic nl (.,such permit to file.signed s ammcm
licensed to ft Contsxmr's Lues law(Chapter 9
Sq. FL Floor Area
Valuation
that he ts pursuant provisional of the
100M Division 3 NC Businem.nd Pmfessinns Codc)lir
200000
I (commencing with Section of of
• that he is exempt Htertfram and the basis fm the alleged exemption Any violation of
36901028 umber
Occupancy Type
Section 1031.5 by any applicant for a permit wbjecm the applicant to a civil penalty of
notammaafiehundreddalwaR5o).
.
O I, as owner of the prolw'ny, army mrployms with wages ss dab mle eompensadon,
Required Inspections
willda the wools and tk suuctum u notinandee moRead formic (See.1044, Business
and Profcesimts Code: The ConuacmYs Liao. Law docs not apply m an owner of
property wed build. orimprowatharece, andwhodoessuchwerkbi madfw Wough his
own employes, provided that such improvements are not intended woRered for sale V,
however. me Wilding or improvement ismld within one year of completion, the owner.
builder will have the Wrdcn of proving that W did net Wild or improve for purpose of
sale.).
u owner of the property, am exclusively contracting with licensed conmcuus to
conssmct the project (Sec 1044, Business and Profesvons Cade:) Tia Conuumbe. Li -
arse law does rat apply man o.nm of property who Wilds air improves thertan, and
who Contracts far such pm)LN wlth.cordir naris) licensed pum.att to dac Couracmr's
Lice. Law.
Olson. Sen .B&PCf m/fn
nu Dam
'S COM SA N CLARATION
Ibcm all-ummak pcuth fpespayoroofinefoliewingdeclantionse
,,and 'llmainuinaCuuGao.fConsentw tiff -imam far Wmlk sCo.,.-
mumn, as provided for by Section 3100 of the Luber Code, for me performance of the
work for which this permit is Vowed.
O 1 have and will maintain Wakces Compemation Insurance, as rryvimd by Section
37M.1 me IaWr Code, far the peolosm o of me wok for which this permit is issued.
'
My Worker's Compensation huursota carries and Policy number aro:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
.
mussecdca need net bccompleud lithe Permit is fmonc hundred dollars (SIM)
or less.)
I certify that in me perfmmame of the work Ice which this Permit ix issued. I dull not
employ any persen in myth - a wbjectm th warken' C.P..d..
Laws of Calif
me Lsbm Code, you most
funhwith—unply wi such pmvisi.ns ami amth shall W deemed rovoked.
I
CONSTRUCTION LENDING AGENCY
1 hcmby affirm that thea is a cntutruction lending agency for the Performance of
!
the work for which this permit is issued (Sec. 3091, Civ, C.)
Lender's Name
Lende'sAddress
1 cutify that 1 have read this appficatime and sum Wt the men mfam suun is
c0mctt I agree to comply with all city and county ordinances and sam laws relating to
'
Wilding construction. and hereby wineries rtpremnutives of this city m enter upon ter
.hove -mentioned Property for inspection purposes.
(We) agree to save. Indemnify and keep harried mC City of Cupertino agaimt
liabilities judgments. casts and expenses which may in any way .cava agaiast said City
'
in crnsmueme of the granting or this pemnit.
APPLICANT UNDERSTANDS A WILL OMPLY WITH AL NO INT
S
SI R
S MA AIS DISCLOSUREType
Of Roof
IthppiWilding oceupamsmm orhanfic hvatdousmaariaiasdefin
by Cucipal ode. Chapmr 9.13, and da Health and Safety
. radon 25532(,)1
Cy.
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future buildin ,tsceupant equipment Qu or device which
If a roof is installed without first obtainingan inspection, I agree to remove
P g
District? as air conuminanu as der by the Bay Area Air Quality Management
y A
all new materials for inspection.
District?
❑ Yos 0
Ihavemadthehvvdoumamm13mq immemsu DrChapar695 ofthe Califor-
ria Health&SafC Code,Sauuu .3553) 2553 lundcssund thuiftW Wil ing
1
doer t ntli haat a Ienws/ at loss, my oN(Q� tY m nrotifY me ac p+nt
mqulm
Signature of Applicant Date
All roof coverings to be Class '%Q." or better
Owm, or wtl i rd.gc am