07060128CITY OF CUPERTINO
DIVISION
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BUILDING PERT
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BUILDING ADDRESS:
PERMIT NO.
19620 STEVENS CREEK BLVD
TBD — TO BE DETERMINED
07060128
NAME:
PERMIT ISSUE DATE
WEER'S
VERSHINE VI LP
01/03/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
sLDGO ELECT PLMECH
O O t�
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm Nat 1 am Immeted under movician of Chapter 9 (commencing
p
what Section 70M) ofDivision 3 of the Business and ProfcssiOn Cade, and my license is
NEW RETAIL/OFFICE SPACE
in full fares and erfeat. p ZQ 3
Licenm Chu .A Lm.g
BUILDING C
Dam Cont
ARCHITE(PSDECLARTION
(OFFICE SPACE 20,515')
1 understand my plans shall he used an public (sends
Licensed Professional
OWNER-BUILDER DECLARATION
•,
1 hereby afiren that I am exempt from the Canrectors License Law for the
following mason. (Section 7031.5, Business and Prafessmns Calc: Any city or county
which acquires a Permit to conuvc4 alter. improve, demolish, or repair say simulate
prior to its issuance. aim acquires the applicant forsuch permit in rile a signed summer,
that he is licensed to the of de Correctors Clews, Law (Chapter 9
Sq. Ft. Floor Area
Valuation
pursuant previsions
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$5500000
Nem
at 1¢ is expt therefrom and the bum Ne for alleged exemption. Any violation of
Number
Occupancy Type
P y yP
Section 7031.5 by airy applicant for a permit subjects tiro applicant to a civil penalty of
not mart than five hundred dollars ISM
3 69 06010 :1
❑ I.uawnerafthepmpeny.ormyemplaycuwimwagesutheirmlammpemsadm,
Required Inspections
will do the work and theatruaum m mitlmeMcd ora@ted farsale(S= 7044, Business
and Poofession Cade: The Contractors License Law tion not apply m an owner of
ns
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property who builds or hmpmvea memo., and who doessuchwork himutfof Waugh his
awn emplay nes, provided Natsueh improvements are not intended or oRemd foraak. IL
however, me building or improvement Is mid within one yew of mmpktion, lie awncr-
builder will have the burden of proving that he did act build or improve for purpose of
sale.).
❑ I. as owner of me property, am exclusively contracting with licensed co mumars to
comtm<t me pmjea (See. 7044, Base. wW Proleulau Cade:) The Comrecuer's U.
cause Law does not apply in an owner of property who builds or impraw Nemo, and
who comrecm for such projects wire a conBacmrm) licensed pursuant in the Contractor's
License law.
❑ lamexemptunder See ,B&PCformm..
Date
WORKER'S COMPENSATION DECLARATION
I hemby It,. under penalty of perjury one of the following decimations:
❑ I mvemnd will train er.CeNficaeof C. one .tmaelftim iefteWorkara Campen.
Milan, an provided far by Section 3700 of the labor Code, for me Performance of the
work for which this permit is intend.
I haw and will msinun Worker's Compensation Insurance, as required by Smctian
J700 of me labor Code, for the performance of the work for which this permit Is issued.
'
My Worked Sompen do Inmrsnce maniac and Policy number ant:
Grtier. Policy No.: 7(_= q I?I
C 'RTIFICA • OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(IDh sec,lrn need ant becompleed if me Permit is formic hundr d dolmas ($IOf)
or lav)
I certify that in the performance of me work for which this permit is issued, l shall not
..
employ any person in any manner an an m became subject m the Workers Compensation
Lawes of California. Data
Applicant
NOTICE TO APPLICAND If. aper making thin Cenificae of Exemption. you mauld
became subject in me Worker's Compensation provisions of the tabs Cade, you most
forthwith comply with inch prevision or this permit shall be decreed rewked.
CONSTRUCTION LENDING AGENCY
1 hereby alarm thin dorm U a conmnctian lending agency for the Performance of
me work for which this permit In issued (Sec. 3097, Cl,. C)
Lender's Name
Landers Add.
1 cenify that 1 have read this application mit sum mw me sinew Information is
collect 1 agree to comply with all city and county andinence, and arm laws relating in
building construction, and Inmby mhorive mpresmmfives of this city in enter upon the
above-mend seb d property for inspection purposes.
(We) agree to save, indemnify and keep hnmlesa the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against Mid City
in consequence of the grandnS of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOURCE REGULATI'
1 /3LR
Re-roofs
Type of Roof
Signature of Aplicamniplin4ractur Dam
HAZMDOUS MATERIALS DISCLOSURE
Will the applicant no future building e. e
Chaptatore andHealth anmaterial
Metl by W Cupertino Municipal Code. Chapter 9.13. mit the Health and Safety
t
Section 255320)7
❑Yu
All roofs shall be inspected prior to any roofing material being installed.
16No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant um equipment of devices which
cash hmallons air conuminants u defied by me Bay Ama Air Quality Management
all new materials for inspection.
District?
❑Yesu
I have mad the hauadous materials requirements under Chaper6.95afine Califor-
nia Health&Safety Code. Scetion25505.25533 and 25534.1 understand thtifthe building
dna not curmndy hew a mnml Nw it u mY responibilitY m notify me aaupmt of W
nequircuum nth' h tbu met prior In issuance of a Certificate ofOlpaac.
Signature.Of Applicant - Date
1
All roof coverings to be Class "B" or better
g
Owner '
or ambo'nl Dau