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CITY OF CUPERTINO�
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BUILDING DIVISION PERMIT�JND
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BUILDING ADDRESS: 0
PERMIT NO- 05030118
OWNER'S NAME:
PERMIT ISSUE DATE
:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
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 fora and cffecL
CONDO-3 STORY (2 6 8 2 ' LIVING
Date Conlraclor
Conte
Date Contractor
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NEW ADDR WILL BE ASSIGN ON WILDFLOWER WAY
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I 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
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 (Chapter9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$ 3 218 4 0
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 rive hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as thew sole compensation,
Required Inspections
will do the work, and the structure is not intended or offered forsalc (Sec.7044, Business
and Professions Code: The Contractor's 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 orolfered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder III have the burden of proving that hcdid not build or improve for purpose of
wner of the property, am exclusively contracting with licensed conuaaors to
Vnr-uct
the project (Sec. 7044, Business and Professions Code:) The Contractor's Li-
w does not apply to an owner of property -who builds or improves thereon, and .
who con for such projects with a contractor(s) licensed pursuant to the C ntractor s
License w
❑ I am a
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 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.
❑ I have and will maintain Worker's 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 Polity 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 less.)
1 certify that in the performance of tit ork or which this p rmi is issued, 1 shall not
'
employ any person in
Exemption, you should
become subject to the Worker's Compe tion provisions of the Labor Code, you must
' forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
i
I hereby affirm that there is a construction lending agency for the performance of
the work for which ibis permit is issued (Sec. 3097. Civ. C.)
'
Lender's Namc
,
Lender's Address
I certify that I have read this application and state that the above information is
4 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
above -mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
j liabilities, judg cns, costs an pcases which may in any way accrucagainstsaid City
A21
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Type of Roof
Will the applicant or futurelding occupant store orhandle hazardousmaterial
as defined by the Cupertino MuI Code, Chapter 9.12, and the Health and Safety
Code. Section25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes
If a roof is installed without first obtaining an inspection, I agree to remove
Will theapplicant or future building occupant use cyulpmeni or devices which
emit hazardous air contaminants, as d ncd by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes o
I ve read the hazardous materials reyuircmcns under Chapter 6.95 of the Califor-
nia Heal SafctyCodc, Scedons 25505.25533 and 25534.1 understand that if the but ding
does n
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CITY OF
CUPE ]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: April6,.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,
Susan Winslow
Administrative clerk
O F F I C E O F C O U N T Y A S S E S S O R S A N T A C L A R A C O U N T Y, C A L I F 0 R N I A
BOOK BOOK PJLAGE
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