08070143CTT' OF CUPERTINO
BUILDING DIVISION PERMIT COkV�TRt�i(:T?R I+'C?]MATION..
BUILT1 SS: PERMIT NO.
�8D ESTEVENS CREEK BLVD STE CENTURY CONSTRUCTION 08070143
OWN R AME: PERMIT ISSUEDATE
MENLO EQUITIES 14650 CHARMERAN AVE 0872'0/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 892-3019
ARCHIT'ECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o p LICENSED CONTRACTOR'S DECLARATION
U P I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
Z w with Section 7000) of Division 3 of the Business and Professions Code, and my license is
y in full force and effect.
i� ? License Class Lic. # G1
cru Date 8 e: Contractor
ARCHITECTS DECLAR
i K a I understand my plans shall he used as public records
;aU
O h Licensed Professional
r 0 1 OWNER -BUILDER DECLARATION
lTi
a _J 1 hereby arm that I am exempt from the Contractor's License Law for the
1 00
following reason. (Section 703 1.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
athat he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
e (commencing with Section 70D0) of Division 3 of the Business and Professions Code) or
$ that he is exempt therefrom and the basis for the allcgcd.examption. Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicantt to a civil penalty of
not more than five hundred dollars (5500).
❑ I, 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 forsaLe (Sec. 7044, Business
and Professions Code: The Contractor's License Law does nbt apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
awn employers, provided that such improvements are not intended oraRerod 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.).
_ ❑ I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's U.
cense Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ 1 am exempt under Sec , B & P C for this reason
Owner Date _
WORKER'S COMPENSATION DECLARATION
I hereby of irm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued
My Worker's Compensation Insurance carrier and Policy number are: _
Cartier. —7-7 4, ,; %Uw'b Polity
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is fortune hundred dollars (5100)
or less.)
I cenif-v that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
�Z forthwith comply with such provisions or this permit shall be deemed revoked.
71
O CONSTRUCTION LENDING AGENCY
-r o --r I hereby affirm that there is a constructinn lending agency for the performance of
Y4 > the work rur which this permit is issued (Sec. 3097, Civ. C.)
QLender's Name
= Z Lender's Address
J Q I certify that I have read this application and state that the above information is
r -r correct. I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction. and hereby authorize representatives of this city to enter upon the
U ahove-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
rA liabilities, judgments, costs and expenses which may in any way accrue against said City
z in consequence of the granting of this permit.
'—'
APPLICA,NT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOUR REG ATIONS.
Signature of AppliCant/ConLmctor &5 Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
F1 Yes E] No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
F1 Yes ❑No
1 have read the hazardous materials requirements under Chapter x5.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building
does not currently bave a tenant. that it is my responsibility to notify the occupant of the
require a whi must he met prior to issuance of a CcnfIcale of Occupancy.
Z,)l
Owner or authorized agent 0 Date
Job Description
COMM'L TI BUS SPACE NON—STRUCTURL WL INCLD
(E/P)
i' NO RE—RF. CENTURY CONSTRUCTION PD FOR BUS LIC
7/21/08 $110.00
Sq. Ft. Floor Area $75000 Valuation
316 4 9 9 9 9 .)�Ttlggiber Occupancy Type
Required Inspections
Issued by:.
Re -roofs
Type of Roof
Date_ 'Zj�.
�f
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 Date
All roof coverings to be Class 'A" or better
CITY OF CUPERTINO BUILDING PERMTMSION
BUILDING ADDRESS: 19505 STEVENS CREEK BLVD STE 101
CONTRACTOR: CENTURY
CONSTRUCTION
43
OWNER'S NAME: MENLO EQUITIES 114650 CHARMERAN AVE I DATE ISSUED: 08/20/2008
OWNER'S PHONE: 4082823862 1 SAN JOSE, CA 95124 1 PHONE NO: (408) 892-3019 1
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # 5905-91
Contractor Date Z! Z J 1 a
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of'perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
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'authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the Cityof Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18. J
Signature 1Z,, -_7Z— Date Z
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, 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 & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation. Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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 authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino, Municipal Code, Section
9.18.
Signature Q: htZ Date 2-1zbo
BUILDING PERMIT INFO: BLDG F ELECT !r— PLUMB
MECH RESIDENTIAL r- COMMERCIAL
JOB DESCRIPTION: COMM'L TI BUS SPACE NON-STRUCTURL WL INCLD
(E/P)
& NO RE -RF. CENTURY CONSTRUCTION PD FOR BUS LIC
7/21/08 $110.00
80Zev6n-v?-e�oiPo�S'10cp L,,4n
his k tQm�;�✓h 1/ l o F Te-GUc l -11e, 5�4-r sY,
Sq. Ft Floor Area. Valuation: $75000
APN Number: 31649999.STE101 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
RE -ROOFS:
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:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner r aut rized A�PPg�nt:
oa UGYL�L�-, Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional