08080222CITE' OF CUPERTINOINF
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BUILDING DIVISION
BUILDING ADDRESS:
10745 S DE ANZA BLVD
GPS SPECIALTY CONSTRUCTION
PERMIT NO.
08080222
OWNER'S NAME:iNu
PERMIT ISSUE DATE
HSBC
4240 ROSEVILLE RD
09/23/2008
PHONE:
SANITARY NO. - CONTROL NO.
(916) 485-3333
ARCHITECT/ENGINEER:
BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job DOSCTIpt10n -
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000)ofDivision3oftheBusiness and Professions Code, and my license is
ONE AWNING OVER ATM MACHINE AT HSBC BANK-9'
in full force4d aa'e
License Classs Lic #t
,
FABRIC
Dale/ 1 Ql�r�� Contractor i'S �'P%z�_IArL%'f'i
ARCHITECTS DECLARATION Goh1 -
COVERED METAL FRAME.
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
Sq. Ft. Floor Area.
Valuation
prior to its issuance, also requires the applicant for such permit to rile a signed statement
Contractor's License law (Chapter 9
that he is licensed pursuant to the provisions of the
Business Professions Code) or
3 2 O O
(commencing with Section 7000) or Division 3 or the and
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
�p,� Number
38923017 '
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the,applicant to a civil penalty of
not more than rive hundred dollars ($500).
.`ITIJ
❑ I, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
9 P
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractors License Law does not apply to an owner of
_
property who builds or improves thereon, and who does such work himself or through his
,
own employees, provided that such improvements are not intended oroffered 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.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business and Professions Code:) The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon, and •
who contracts for such projects with a contractors) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under Sec. , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm 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 Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Carrier. .`7�1 G�MC' Policy No.: 692-
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
'
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 Workers' Compensation
Laws of California. Date
'
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compcnselion provisions or the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
a CONSTRUCTION LENDING AGENCY
+ I hereby affirm that there is a construction lending agency for the performance of
y the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name
Landers Address
1 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
a building construction, and hereby authorize representatives of this city to enter upon the
for inspection
above -mentioned property purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
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APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
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Issued by: Date
SOUSE GULATION .
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Re -roofs
Type of Roof
Sig Lure of ApplicanUContr. or Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant storc or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safely
Code, Section 25532(a)?
❑ Yes P"`°
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
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
all new materials for inspection. -
District?
❑Yes
1 havc read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenant, that it is my responsibility to notify the occupant of the
re u cn which must be met prior, rsgacee or Cer ificato of Occupancy.
Signature of Applicant Date
All roof coverings to be Class'" or better
Ow er or authorized agent Date '