05030117i
CITY OF CUPERTINO=
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BUILDING DIVISION PER 1Q160
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BUILDING ADDRESS: /iC
01
PERMIT NO. 05030117
OWNER'S NAME:
PERMIT`LSUEDATE
02/23/2006
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and efrecL
CONDO -3 STORY (2,5901 LIVING)
License uc.n
Da
Date Contractor
NEW ADDR WILL BE ASSIGN ON WILDFLOWER WAY
ARCHITECTS DECLARATION
1 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 Liccnsc Law for the
following reason. (Section 703 L5, Business and Professions Code: Any city or county
which requires a permit to construct. alter, improve, demolLsh, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$384840
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
APN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure isnot intended oroffered for sale (Sec.7044,Business
Required Inspections
es
and Professions Code: The ContractorLicense Law docs not apply to an owner of
q P
property who builds or improves thereon, and who does such work 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
sale.).
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractors Li-
cense Law ocs not apply to an owner of property -who builds or improves thereon, and
,
who con chs for such prof cts with a contractor(s) licensed pursuant to the Contractors
License 4jw.
❑ 1
DECLARATION
I hereby amrm un nasty of perjury one of the following declarations.
❑ 1 have and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 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 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($100)
or Icss.)
1 certify that in the perform nee of a wo for whit s p ht is issued. I shall not
employ any person in
deemed revoked.
" 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 (Scc. 3097, Civ. C.)
'
Lenders Name
,
r LcndersAddress
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
ahove-mentioned property for inspection purposes.
4 (We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, ju ems, costs and expenses which may in any way accrue against said City
in co
ting of thispermit.APPLI ANDSAND WILL COMPLY WITH NON-POIIssuedby:
DateR
MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Munici at Code. Chapter 9.12, and the Health and Safety
Code. Section 25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes o
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 contamul, as d rued by the Bay Arca Air Quality Management
all new materials for inspection.
District?
❑ Yes
Ihave read the ousmaterialsrequirements under Chapter 6.95ofthcCalifil
nia Health ety Cod_ Sections 25505, 25533 and 25534.1 understand at if the buildin
docs
Dat
CITY OF
CUPS ]NO
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: (408) 777-3228
FAX: (408) 777-3333
BUILDING DEPARTMENT
OFFICIAL NOTIFICATION OF ADDRESS CHANGE
TO: All Agencies
FROM: City of Cupertino
DATE: April 6, 2006
RE: Address Change (APN #366-19-071)
Please note the following address change: 1375 S. DeAnza Blvd has been subdivided.
The commercial bldg 1375 S DeAnza will remain. The added 2nd story will be assigned
1377 & 1379 S DeAnza Blvd. The six condos will be on Wildflower Way. Their
addresses will be 7375, 7373, 7371, 7369, 7367 and 7365 Wildflower Way. Please update
your records accordingly.
The new address will take effect thirty days from the date of this letter. If you have any
questions, please call me at (408) 777-3246.
Sincerely,
f
Susan Winslow
Administrative clerk
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