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CITY OF CUPERTINOAd
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BUILDING DIVISION PERMIT
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A,.
BUILDING DRESS:
PERMIT NO.
19�i�0 STEVENS CREEK BLVD
SAN JOSE CONSTRUCTION
08030071
OWNER'S NAME:
PERMIT ISSUE DATE
EVERSHINE VI LP
1210 COLEMAN AVE
05/29/2008
PHONE:
SANiTARY NO. CONTROL NO.
(408)986-8711
ARCHI7ECT(ENGINEEI :
BUILDING PERMIPR4rO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARAnON
Job Description
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 70DO) of Division 3 of the Business and Pmfcss'cms Code, and my "Ce"M is
DEFERRED SUBMITL AREAS PATIO BLD ARNG EXSTNG
in full fora and effect
License Class Lk.x
TREES, RPLC PALM TREES 'LOCT BACKFLOW DEVICE FOR
Date Contra=
ARCHITECTS DECLARATION
WTER
I understand my plans shall be used as public records
-
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 70315, 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 requites the applirsnt for such permit to file a Signed statement
nut he is licensed to tie of tie Contractor's Licartse Law (Chapter 9
Sq: Ft. Floor Area
Valuation
pursuant provisions
Section 7000) Division 3 of the Business and Professions Code)
$50000
(commencing with of or
brat he is exempt therefrom and the basis for the alkgcd exemption. Any violation of
3 6 9 0 6 010 !°�(
Occupancy Type
Section 70315 by any applicant for a permit subjects the applicant to a civil penalty ofNumber
not more than five hundred dollars (5500}
❑ L as owner of the property, or my employees with wages as thein sole compensation,
Required Inspections
es (1
win do the wodL and the structure is not intended or offered for rale (Sec- 7044, Business
and Professions Code: The ContracmiLicense Law does not apply to an owner of
property who builds or improves dreceon, and who does such wort himself or through his
own employees, provided that such improvements are not intended or offered 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
rale.).
61, as Owner of the property, am exclusively contracting with licensed eonuaaors to
construct the project (Sec 7044. Business and Professions Code:) The Conrracmrs Li-
eense 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 Contractors
License Law.
❑ I err act Ql undo Se , B & P C ft�rthis
Dam
P. C � "ON DECLARATION
1 hereby affirm under penalty f perjury one of the following declaratioet
❑ 1 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
wort for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Iesurana, 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 artier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S 100)
or less.)
1 certify that in the performance of the work for which this permit is issued. I shall not
employ any person in any nee to become subj est �mpensaticm
Laws of pa
Applicant
NOTICE PPLI NT: f; after this Certificate of Exemption, you should
become subject to the Workers Com natation provisions of the Labor Code, you must
forthwith comply with such provisions or this peimit shall be deemed revoked
CONSTRUCTION LENDING AGENCY
I hereby affirm that Here is a construction lending agency for the performance of
the work for which this permit is issued (See. 3097, Civ. C)
Lenders Name
Lender's Address
1 Certify that 1 have read this application and state that the above Information is
'
correct 1 agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorla 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
j liabilities. jodgmernts. costs and expenses which may len any way accrue against said City
in consequence of thegnntin permiL
APPLICANT UNDERST S WILL COMPLY WrrH ALL NON -POINT
Issued by: Date Z `/
SO
�
Re -roofs
Type of Roof
i a
Sign li ontractor+ r Date
HAZARDOUS MA DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
'
as defined by the Cupertino Muuici Code, Chapter 9.12, and the Health and Safety
Code. Section 2553200?
All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
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?
E] Yes o
'equirements under Chapter 6.95 of the Califor-
1 have read the hanr'25
nia Health & Safety Code,533and25534.1understandslutifthe building
vc a nsibility to rrodfy the occupant of the
f a cmutiieaie of OCN
Signature of Applicant Date
72
.. g •'t
All roof coverings to be Class "j�'` or better
owns �-f— Date
Guth rvrdag nl ,
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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTTOR INFORMA I4N.
RAC-
BUI LNG RESS:
STEVENS CREEK BLVD
SAN JOSE CONSTRUCTION
PERMIT NO.
08040089
WNER'S NAME:
PERMIT ISSUE DATE
EVERSHINE VI LP
1210 COLEMAN AVE
05/23/2008
PHONE:
SANITARY NO. CONTROL NO,
(408)986-8711
ARCHITECTYENGINEER:
BUILDING PERMIT INFO
-BLDG ELECT PLUMB MECH
0 0 0
LICENSED CONTRACTOR'S DECLARATION
Chapter v
Job Description
1 Iareby arfirn wt I am licensed sunder provisions of (commencing
with Section 70M) of Division 3 diNe Business and Professions Code. and my Homeut
REVISION—GREAT LINE MODIFICATION(P
in fun forte and effa7.
ucuracClareLie.0
2.1)ORIG#07060128 NO NEW PERMIT.
Dao: ConueWr
ARCHITECTS DECLARATION
,
I understood my piano shall be used u public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Conuamors Lieena Law for the
fallowing lesson (Section 1031.5. Business and Proreasioas Code: Any city a county
which repuiras a Permit to construct. alcor, impreve, dcmolW, ler repair any strmure
! prior w its issuance. also, requires the applicant for such permit to fila a signed suumem
that he is licensed W the of Nc Common's Lica. Law 9
Sq. Ft. Floor Arear•
Valuation
pursuant provisions (Chap=
(commencing with section]000) of Division 3ofiMBusireasand Indic nmCode)or
$0
I
Nat be is exempt derafrmn and the basis fm do Wlcecd mareptimn My violation of
Occas
Occupancy Type
Section 7031-5 by tory applicant for a Permit subjects the applicant as a civil penalty ofNumber
tat mom than five handled dollars ($SM.
36906010
❑I, asowncrofthe Property, army employeaswith wal as theirsolocmnpeesadon,
Basinw
and do the wan, Code- The
,poop Profesi,W Cade: Toe ConvecWre License law saes tat apply a an owner of
Lawam apply
Required Inspections
propertywhobuildsviimpmws0cimrantwht does Waugh his
ora
ted
Improvemmmintat concealmplaermt for ale If.
own maxi
ver. du building or improvaustachement the owner.
however. Ne bve
i m impmvemeot is hold within ane year of mprolve
Wilder will have 0te Laudon of proving Na he did out dtild ler improve far purya" of
th for of
aWj
owner of the with IfeeasW mnuanms t-
am areess
contractingfess
am!vely
maswcl Sec.7Property.
construct sad s Cade:) The vaanhamors
not (Sec. o
Law does an wner of property who lid
des chp1r a to owner or raper( who builds or improves Comoo, sot
who t
whocontractsLaw far such projects with a c.nlragWr(q licwed pursuant W the Convectors
r such
License law.
man
❑lama on See .B&PC fa Nia reason
0
w er Oau a
ity-opKER-SMPENSATION DECLARATION
1 hereby affirm on, pe ty of papery arc of the following declensional,
there and will Wo. Camf
aed..3roca of
cairn, far
provided far by gecuon 3700 of the labor Code. far Ne performanm of dm
the Laborthe
r
wort far which this permit is issued.
❑ I have and will maintain Worters Compewdon Insurance, as regvirtd by section
3M ofdc tabor Code, for the performance ofd" wan forwbich this Permit is lamed.
'
My Workers Compensation Warrants osier and Policy number H:
Caries Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(this section reed not bo complmed if tic Permit is for arc hundred dollar (S 100)
ler loss.)
I ¢deify that in the performance, of the won for which Nis Permit is count. l shall not
employ any person in say m r baso a subjeet a mfr Workers'Compasauon
Laws of Gl'f W of
m
APPllcros fi,� r
NMCE TI9 APF-LJC : If. afar king Nu Cenificam of Exemption, you should
become subjm m Ne Workers Co notion Pmri , of IM talar Coda- yav mum
fmshwith mmPly with such poridoro m this perni( Mail Ie deemed revoked.
CONSTRUCTION LENDING AGENCY
I herehy ai irm Na there its coasvuctimm lending agency far Ne perfurmarcc of
the wan for which thlh Permit u issued (Sc.. 3091, Civ. C.)
Lenders Nam
Landers Address
I certify, Na I have read this application and sou Na do above information is
correct. 1 agree to comply with all city and county ONlnuces and scab laws relating to
building c.dstmction, and hereby smhotiae representatives of this city w enter Open the
above-mentiarcd Pmpcny fariaspectim pwposes
(We) agree to live, indemnify anal keep harmless the City or Conclude again"
and expcnsuh which eery in my way accree again" rid Ciq
incomm unu , of duegrim
in c.n"querce of Ne grw(ing of Nu permit.
UN RSTRyyypppS AND WILL COMPLY WITH ALL NON -POINT
Issued by:Date
GU Omy$(x oU�,�OakRe-roofsof
NNT
li� De
HAZARD;1 MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building aceapant tome arhandle haysdomu material
as carload by the Cupertino Municipal Code, Chapur 9,12, and the Health and Safety
ode. Section 25532(.)'
CYas o
All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant at future Wilding arm ant us equipment or which
Pn e
If a roof is installed without first obtainingan inspection, I agree to remove
P g
mail e
nus air contaminan--ts//as defined by the Bay Arm Air Quality Managcmcnt
M...
all new materials for inspection.
,L7ha�
❑Yes f�mv
1 have rent the haaWuu msersdancquirementsunder Chapar6.95 of tin Califon
nu II&SarmyC 'Seesimu LSSU5,25533aal L553a.lundustondthaifdcbviWing
docz an,randy vea Irn t It is my resp rembllity to miry the m¢upN( ler the
wh'na orniiasmace.f.CmfcamafOmP
Signature of Applicant Date
r
All roof coverings to be Class '%" or better
owner. sutn '>cdacens n Date