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08070076 CITY OF CUPERTINO BUILDING PERMIT I �Z 15�b BUILDING ADDRESS: 20900 STEVENS CREEK BLVD CONTRACTOR:B VERSOZA,INC ERMIT NO:08070076 OWNER'S NAME: UNION CHURCH OF CUPERTINO 3623 NOVATO ST DATE ISSUED:07 ITT OWNER'S PHONE: 4082524478 UNION CITY,CA 94587 PHONE NO:(510)505-9761 C� LICENSED CONTRACTOR'S DECLARATION �( BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. MECH RESIDENTIAL COMMERCIAL Contractor E5-\ Q� A L Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:NEW 5,000 SQ FT W/4 CLASSROOMS,2 OFFICES (commencing with Section 7000)of Division 3 of the Business&Professions &2REST Code and that my license is in full force and effect. 10/28/09-REVISIEVISION,RELOCATE THE BLDG&EXTEND SOUND I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,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 provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$400000 permit is issued. APPLICANT CERTIFICATION APN Number:35908024.00 Occupancy Type: 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 above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. L , Issued b�'"� Date:�Z�� /` SignatureI4 e� '"ct Date � 11d C OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Ow authorizegent: forthwith comply with such provisions or this permit shall be deemed revoked. / C. Date: /_ZVO J CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address cr -ind expenses which may accrete against said City in consequence of the g g of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point some regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature% l` G � Date( Z( /YI Licensed Professional CITY OF CUPERTINO `�•t T BUILDING DIVISION PERMIT � R7�1 � 1�d7L� T�� . BUILDING ADDRESS: PERMIT NO. 20900 STEVENS CREEK BLVD TBD - TO BE DETERMINED - OR070076 "'NER'S NAME: PERMIT ISSUE DATE I11110N CHURCH OF Q-11PEREPING 2099 PHON S A CONTROL NO. ARCH17ECf/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u p O LICENSED CONTRACTOR'S DECLARATION m I hereby affirm that I am licensed under provisions of Chapter 9(commencing lob Description Z with Section 7000)of Division 3 of the Business and Professions Code.and my license is °Z<y in full force and effect. NEW 5, Ci00 SQ FT W/ 4 CLASS ROOM, 2 OFFICES & 2 UJZ License Class Lic.� RESTRM� y o Date Contractor .0 , ARCHITECTS DECLARATION 1 understand my plans shall be used as public records Dgu ay Licensed Professional n y< OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the in O following reason.(Section 7031.5,Business and Professions Code:Any city or county (i which requires a permit to construct,alter,improve,demolish,or repair any structure y Z y prior to its issuance,also requires the applicant for such permit to rile a signed statement x`e that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation 34 t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 4 O O O O O > r that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). 35908024 . 00 ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.70",Business Required Inspections and Professions Code:The Contractor's License Law does 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.lf. 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 eo truct the project(Sec.7044;Business and Professions Code:)The Contractor's In- cense 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 Contractor's License Law. 0 lam exempt under thi Sea ,B&P CP C for ,74 e f :----%"•" Date WOR S-COMPENSXITONDECL71F I hereby affirm under penalty 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. 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 are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed lithe 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 man so to subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO CANT:If,after ng chis C¢niEestrof-Excmpttotr you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY Fr I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.) WGs.A Lenders Name Z Lenders Address U 0 1 certify that I have read this application and state that the above information is V.►" correcL I agree to comply with all city and county ordinances and state laws relating to 0 V building construction.and hereby authorize representatives of this city to enter upon the a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against to liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date 1'4 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO -POINT Issued by SOURCE REGULATIONS. (� ( 0 Re-roofs Signature o pp icam/Comrwt Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety -•tc,Section 25532(a)? All roofs ;hall be inspected prior to any roofing material being installed. ❑Yes �tNo If a roof i;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? 0 Yes 9�No 1 have read the hazaMrnsr_materials requiremcns under Chapter 6.95 of the Califor- nia Health&Safety Codc,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 occu t of the requirements which must be met prior to issuance of a Certificate of Occupancy. Signature Of Applicant Date �...� ( t) own or authorized agent Dato All roof coverings to be Class's ``or better CITY OF CUPERTINO BUILDING PERMIT I �Z 15�b BUILDING ADDRESS: 20900 STEVENS CREEK BLVD CONTRACTOR:B VERSOZA,INC ERMIT NO:08070076 OWNER'S NAME: UNION CHURCH OF CUPERTINO 3623 NOVATO ST DATE ISSUED:07 ITT OWNER'S PHONE: 4082524478 UNION CITY,CA 94587 PHONE NO:(510)505-9761 C� LICENSED CONTRACTOR'S DECLARATION �( BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. MECH RESIDENTIAL COMMERCIAL Contractor E5-\ Q� A L Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:NEW 5,000 SQ FT W/4 CLASSROOMS,2 OFFICES (commencing with Section 7000)of Division 3 of the Business&Professions &2REST Code and that my license is in full force and effect. 10/28/09-REVISIEVISION,RELOCATE THE BLDG&EXTEND SOUND I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,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 provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$400000 permit is issued. APPLICANT CERTIFICATION APN Number:35908024.00 Occupancy Type: 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 above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. L , Issued b�'"� Date:�Z�� /` SignatureI4 e� '"ct Date � 11d C OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Ow authorizegent: forthwith comply with such provisions or this permit shall be deemed revoked. / C. Date: /_ZVO J CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address cr -ind expenses which may accrete against said City in consequence of the g g of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point some regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature% l` G � Date( Z( /YI Licensed Professional CITY OF CUPERTINO BUILDING PERMITS — == A T n n7no76-. � BUILDING ADDRESS: 20900 STEVENS CREEK BLVD CONTRACTOR:AXIS CONSTRUCTION I�FBMI—LIQ' li– s: INC NER'S NAME: UNION CHURCH OF CUPERTINO 2566 BARRINGTON CT DATE ISSUED:07/01/2009 O N ONE: 4082524478 HAYWARD,CA 94545 j PHONE NO:(510)732-6111 IJ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ff�L�_ COMMERCIAL License Class Lic.#L `37i�� / 3 NEW 5,000 SQ FT W/4 CLASSROOMS,2 OFFICES &2RESTROOMS. Contractor Date 1 PERMIT FOR MAIN PERMIT EXTENDED TILL 02/27/11. 1 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions 2/22/10-REVISION#2-ELECTRIC HEAT CHANGING TO GAS Code and that my license is in full force and effect. REVISION#2 EXTENDED TILL 1/22/11,3RD EXTENSION-ISSUED 1/20/11 1 hereby affirm under penalty of perjury one of the following two declarations: 1 have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the Valuation:$400000 performance of the work for which this permit is issued. Sq.Ft Floor Area: 1 have and will maintain Worker's Compensation Insurance,as provid d f r b Section 3700 of the Labor Code,for the performance of the work r w thi APN Number:35908024.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, / costs,and expenses which may accrue against said City in consequence of theDate• granting of this permit. Additionally,the applicant understands and will comply Issued by: with all non-p nt source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: �ignatur Date t ,l 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 all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Date: Signature of Applicant: 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. [will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(x)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cu Lino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec ' 255 3,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent Date: permit is issued. I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,1 become subject to the Worker's Compensation provisions of the Labor Code,1 must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)Lender's Name APPLICANT CERTIFICATION Lender's Address_ 1 certify that 1 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 above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION idemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the appliczutt understands and will comply with all nori-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO BUILDING PERMIT it / �Z•/�.b BUILDING ADDRESS: 20900 STEVENS CREEK BLVD CONTRACTOR: B VERSOZA, INC ER HT NO: 08070076 OWNER'S NAME: UNION CHURCH OF CUPERTINO 4623 NOVATO ST DATE ISSUED: 07 1 OWNER'S PHONE: 4082524478 UNION CITY, CA 94587 PHONE NO: (510) 505-9761 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Li, # - I Contractor Date 0dl I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION 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 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 accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 1 L (T 01 ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec,7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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 accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point s9nme regulations dr the Cupertino Municipal Code, Section 9.18. ;' /�f Signature (� � 1, — lG Ct Date BUILDING PERMIT INFO: BLDG F ELECT F PLUMB F MECH F RESIDENTIAL r— COMMERCIAL F JOB DESCRIPTION: NEW 5,000 SQ FT W/4 CLASSROOMS,2 OFFICES &2RESTROOMS. 10/28/09-REVISION,RELOCATE THE BLDG & EXTEND SOUND Sq. Ft Floor Area: I Valuation: $400000 IAPN Number: 35908024.00 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued byf` Date:;��lf'�� RE -ROOFS: 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 all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections,25505, 25533, and 25534. Ow authorize gent: Date, CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec, 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20900 STEVENS CREEK BLVD I CONTRACTOR: B VERSOZA, INC PERMIT NO: 08070076 OWNER'S NAME: UNION CHURCH OF CUPERTINO 14623 NOVATO ST 1 DATE ISSUED: 07/01/2009 1 OWNER'S PHONE: 4082524478 0 LICENSED CONTRACTOR'S DECLARATION License Classy _ Li., # 6 -7 2 [ C8 Contractor ]-,(SLti Date 0 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations. I have and will maintain a certificate of consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION 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 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 accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point �-s% source regulations per the Cupertino Municipal Code, Section 9.18. Signature - �/l�dl Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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 accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regal atins per the Cupertino Municipal Code, Section 9.18. , UNION CITY, CA 94587 PHONE NO: (510) 505-9761 BUILDING PERMIT INFO: BLDG r— ELECT F PLUMB MECH r RESIDENTIAL F COMMERCIAL F JOB DESCRIPTION: NEW 5,000 SQ FT W/4 CLASSROOMS,2 OFFICES &2RESTROOMS. 2/22/10 - REV#2 - ELECTRIC HEAT CHANGING TO GAS jjP qq cc,, v Sq. Ft Floor Area: ( Valuation: $400000 APN Number: 35908024.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: �� —�� Date: Z �j C! RE -ROOFS: 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 all new materials for inspection. Signature of Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owlgthorized cut: _i - Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Ad ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Date .2� Z4 0 Licensed �U, C, 2 z C: gdtiu >u'C �WF 0� �OC <m� -Z> ExC Y FCC'a i5- CITY OF CUPERTINO PERMIT +Gfi�TRC)R�A�kF- BUILDING DIVISION BUILDING ADDRESS: PERMIT NO. 20900 STEVENS CREEK BLVD TBD — TO BE DETERMINED OWNER'S NAME: PERMIT ISSUE DATE PHONE: S A CONTROL NO. ARCHMCTIENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job DOSCLIptlOn I hereby afftmt that 1 am licensed under provisions of Chapter 9 (commencing with Section 70W) of Division 3 of the Business and Professions Code, and my license is NEW 5,00Q SQ FT W/ 4 CLASS ROOM, 2 OFFICES & 2 in full force and effect. License Class Lie. n Date Contractor RESTRMS r ARCHITECTS DECLARATION l 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 file a signed statement License Law 9 that he is licensed pursuant to the previsions of the Contractor's (Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 4 O O O O 0 I 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). 3 5 9 0 8 Q 2 4• Q Q ❑ I, as owner of the property, or my employees with wages as their sole compensation, Required Inspections q 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 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.). 41, as owner of the property, am exclusively contracting with licensed contractors to Codstroct 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 contractor(s) licensed pursuant to the Contractor's License Law. ❑ 1 am exempt unger.Sec, -•--- -- - - , B & P cc fo this ason Owner- Date `/ 0 -'— -- WOR '3-cOMPENSATION-DEEL AR ON I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure forwarkees 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 Worker's 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 far 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 manrlctso l� otclDasubject to the Workers' Compensation Laws of California. Date 4r /� ��'�/ Applicant --- NOTICE TO CANT: if, after 401Tong--this- Certificate of Excmptimr, yatrshould become subject to the Worker's Compensation provisions of the Labor Code, you must " forthwith comply with such provisions or this permit shall be 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 (Sec. 3097, Civ, C.) Lender's Name L.enderis Address 1 certify that t 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 or this city to enter upon the inspection above -mentioned property for 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. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO -POINT Issued by: Date �� — t✓� SOURCE REGULATIONS. Re -roofs Sr'grrawre oplicanUConuacler-� Date Type Roof HAZARDOUS MATERIALS DISCLOSURE Of Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal 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 §4No 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? ❑Ycs TIO 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor. nia Health & Safely Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant, that it is my responsibility to noury the occup t of the requirements which must be met prior to issuance of a Certificate of Occupancy, Signature of Applicant Date roof coverings to be Class','.`' or better Ow/neeorauthorized agent _.-r.�•.---^----J Dale -All