08080147CITY OF CUPERTINO
DIVISION PERNIITliCJ�I
Y
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BUILDING
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Bu1Ir��,1�D�tFsT�IARIANI AVE BLDG 3A
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XL CONSTRUCTION
PERMrr NO.
08080147
OWNER'S NAME."
PERMrr ISSUE DATE
APPLE
851 BUCKEYE CT
09/26/2008
PHONE:
SANITARY NO, CONTROL NO.
(408)271-2425
ARCHrrECrfENGINEER
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions code, and my license is
COMM ' L DEFERRED 2 0 0 0 S Q OF F C S PAC E) I NC LUDE S
in full force and effect.
License class Lic.t► yob
CONFERENCE RMS, OPEN OFFC & SKYLIGHTS—ORG
Date o Contractor ARCHITECTS DECLARATION r
#08060127
1 understand my plans shall be used as public records
NO NEW PERMIT CLOSE THIS OUT WHEN ISSUED.
Licensed Professional
owNER-BUILDER DECLARATION
1 hereby affirm mat 1 am exempt from the Contractor's Licemc Law for the
following mason. (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 issuances 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
Code)
Sq. Ft. Floor Area$
0 Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions or
out he is exempt lberc rom and the basis for the alleged exemption. Any violation of
31622018
Occupancy Type
Section 70313 by any applicant for a permit subjects the applicant to a civil penalty of,Number
net more man five hundred dollars (S50O)L
❑ L as owner of the property, at my employers with wages as their sole compensation,
Required Inspections
will do the work and the structure is not intended or offered forsale (Sec. 7044, Business
and Professions Code The Contractor's License Law does not apply to an owner or
property who builds or improves thereon, and who toes such work himself at through his
.
own employees, provided that such impmsementa 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
sate.).
❑ L as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Codc) The CDoun ror's Li-
cerae Law does not apply to an owner of property who builds or improves thereon, and,
wbo contracts for such projects with a conuw=r(s) licensed pursuant to the Contractor's
L.icenae law.
.
❑ i am exempt under Sec . B & P C for this won
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm, under penalty of perjury one of the following de clary ons
❑ I lave and will maintain a Cerdliate of Consent to self -insure res Workes Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of Ibe
work for which this permit is issued.
❑ 1 have and will maintain Workcfs Compensation Insurance, as required by Schon
3700 of the Labor Code, for the performance of the wort for which this permit is Issued
My Wo CompeInsan* Insurance aerie and Policy nmb�cram:�
Carrier. t Cc V" PolicyNc.: 506 /C�6V/yU
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if Ibe permit is for one hundred doll= (S 100)
or leas)
I certify that In the performance of Ibe work for which this permit is issued, I shall not
employ any person in any manner er so as to become subject to the Workers' Compensation
'
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, alter making this CeniOe'ne of Exemption you should
become subject to the Worker's Compensidon provisions of the Labor Codi you must
,
forthwith comply with such provisions or this permit shall be deemed revoked
CONSTRUCTION LENDING AGENCY
-
I hereby alrtrm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
L.endcfs Name
,
Lender's Address
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
budding construction, and bereby authorize represemativcs 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
liabilities. judgments, costs and expenses which may in any way accrue against said City
ung of this permit
APP ST ND WILL COMPLY W ALL ON -POINT
in coFE�Rll
Issued by: Date 2�
SOU0 Q
° a
Re -roofs
Type Of Roof
Si f ApplianUCon r Date
nus TER1ALs DI esu
/
WTam
01 the applicant u ding occupant e or handle hazardous material
as defined by the Cupertino Code Chapter 9.12 and the Health and Safety
code, section 25532(a)7
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 Arca Air Quality Management
all new materials for inspection.
District?
❑ Yes o
1 have read the hazardous matcrials requirements under Chapter 6.95 of the Califor-
nia Health & Safety C Sections 25505.25533and 25534.1understand that ifthe building
docs 11a t, that tt is my rsponsibility to noufy t or rite
reenena maul p=ct rtoissuanceOraccrific
Signature of Applicant Date
ems;
All roof coverings to be Class'} or better
Date
o r errauthorizedag