05110003CITY OF CUPERTINO
BUILDING DIVISION
BUILDING ADDRESS:
10026 ORANGE AV
PERMIT NO. 0 511 0 003
,.
OWNER'S NAME: PERMIT ISSUE DATE
05/04/2006
PHONE: SANITARY NO. CONTROy NO.
I
I
ARCHITECT/ENGINEER: BUILDING PERMIT INFq
BLDG ELECT P~B ! MECH
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; ~ f: I hereby a[firm that I am licensed under provisions of Chapter 9 (commencing
~ z ~ with Seclion 7000) of Division 3 oflhc Busincs..'i and Profession.1i Codc, and my license is
~:3 e; in full force and effecl
i!a~ ~i~~nseclass-----~~~l~ae-lo-r--------;i ~ ARCHITECTS DECLARATION
2ffi ~ I under-Oland my plans shall be used as public records
) Q, U
:"1;; Licensed Professional
=0"" OWNER-BUILDER DECLARATION , "'..J I hereby affirm lhat J am exempt from the Contractor's License Law for the2:;: :::E
_00 following reason. (Section 7031.5, Business and ProCessions Code: Any city or county
~~ Il: which requires a pemit to construct. aller, improve. demolish. or repair any structure
u-'" p~r~i~~uan~,~w~uires~applicwfursoch~mil~n~asigocds~~mcn( :~:;: that he is licensed pursuanl to <he provisions of the Contr:tclor's License Law (Chapler 9 ~i= ~ (commencing with Section 7000) ofOivi.sion 3 of I1lc Business and Professions Code) or
~~~ lhat he is exempt therefrom and the basis for the alleged exemption. Any violation or
Section 7031.5 by .ny applicant for a penni. subjee.. the applieanllo a civil penally of
not more than five hundred dollars ($500).
o I. as owner of lhe propeny, or my employees with w.ges as their sole compensation,
will do the work. and the structure is not intended or orrered ror sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply 10 an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvemenlS are not inlended or offered ror saJe. lr,
however, Ihe building or improvement is sold within One year or completion. Ihe owner-
builder wiJI have the burden or proving that he did not build or improve ror purpose of
s.le.).
[jJI(as owner of the properly, am exclusively contracting wilh licensed contractors 10
construct the project (Sec. 7044. Business and Professions Code:) The Contractor's li
Job Description 1
I
COMMERC IAL BLDG. -1932 I I
THIS PERMIT IS FOR FEES ONLY/SEE #05110002
~------=-=~=--~--------~---------~~~-~---~------Sq, Ft. Floor Area Valuation$2 0612 r'l,
f------,---;--;:;:~~:-_;---------+-------:;::::_----.:.--=---+------APN Number Occupancy Type
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cense Law does not apply to an owner or propeny who builds or improves thereon, and .
who contracts ror such projects with a contractor(s) licensed pursuant [0 Ihe Contractor's
License Law. o I am exempt under Sec. , B & PC ror this reason
Owner {~~~DECLARA~~~NJ~-V"· of:.
I hereby aflinn under penalty of perjury one of the following declarations:
o I have and will maintain a Certificate orConscnt to selr-insure for Worker's Compen
sation, as provided for hy Section 3700 or the Labor Code. [or the perfonnance or Ihe
work for which this pennit is issued.
o I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, ror the performance or the work ror which this pennit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier:__--======-===""=Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nm be completed if <he permit is for one hundred dollar.; ($1(0)
or less.)
I ccnify lh~l in the pcrfonnancc of lb.e work for which this pcnnil is is.'iucd. I shall not
employ an)' person in any manner so as Lo become subject to the Workers' Compensation
Laws of Caall~if:or~n~i,oa~~~D~a~le~;,j~~(;-~~Q~·~~c~·;G~·~:;;;=;;:;Appliea",;:; .v
ing this Cenilieate of Exemption, you should
become SUbject (0 the Workef'S Compensation provisions of lhc Lahor Code. you must
forthwith comply wilh such provisions or this permil shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affinn that there is a construction lending agency for Ihe perronnilncc of
the work ror which this pennit is issued (Sec. 3097, Civ. C.)Lender's Name _
Lender's Address _
( certiry Ihat I have read Lbis application and stale thai the above infonnaliun is
CorrecL. I agree to comply with all city and counlY onlinances and Slate laws relaling to
building conslruction, and hereby authori7e represeOlaLives of this CilY LO emer upon tl1e
ahovc-menlioncd property ror inspection purposes.
(We) agree lo save. indcmnify and keep hannless the City or Cuperlino againsl
liabilities, judgmenlS, COSlS and e:s:penses which may in any way accrue againsl said Cily
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOUR1~~ .....1,;., <L.', t.' b
Sign e
HAZARDOUS MATERIALS DISCLOSURE
WilIlhe applicant or ruture building occupant store or handle hv.ardous material
as delined by the Cupenino Municipal Code. Chapter 9.12. and the Health and Safety
Code, Section 25532(a)1 • ",,'
DYe, EI No
Will the applicant or ruture building occupant usc equipment or dcvices which
emil ha7.ardous air cont.aminanLS as defined hy the Bay Area Air Qualily Management
District?
DYes rv·No
ReqUire Inspections
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~. =-.: (__"'.' ,G'Issued by: Date ~ 7' ......
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Type of Roof
All roofs shall be inspected prior to any roofing material being installed. I
If a roof is installed without first obtaining an inspection, I agree to remor
all new materials for inspection.
I
I have n::ad the hazardous malerials n::quiremenLS under Chapter 6.95 or the CalirorI
nia He,lth & Safely Code, Sections 25505.25533 and 25534.I undcrs"",d thal iflhe building
docs nOl currenlly have a (en an!., that it is my responsihilily to notify the OCCUpilJ1( or the
rcquircm ~ " (.... 'f~r-.~.~. All roof coverings to be Class "E" or better