08050172BUILDING DIVISION PERNUT
BUIl�1 frr��cc��ppDRPSS: PERMIT NO.
1U5U5 MILLER AVE TBD - TO BE DETERMINED 08050172
OWNER'S NAME: PERMIT WUE DATE
FIRST BAPTIST CHURCH 09/12/2008
PHONE_ SANITARY NO. CONTROL NO.
ARCHITECT104GINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTIORS DECLARATION
I hereby affrm that I am licensed under provisions of Chapter 9 (commencing
With Section 7000) of Division 3 of the Business and Professions Code, and my licesm is
in full fora and effect.
License Class Lie. 0
Date _ contractor
ARCHITECTS DECLARATION
1 urndcraland my plain shall be used as public records
Licensed Professional
OWNER-B(11LDFR DECLARATION
1 hereby affirm that I am exempt from the Conuscrds Lkcnse Law for the
foliowing mason. (Section 70315, Budncss and Professions Coda Any city or county
which requires a permit to camuwet. alter, Improve, demolish, or repair any structure
prior to its iasuarne, Also requires the applicant for such permit to file a signed awcxoent
that he Is licensed pursuant to the provisions of the contractors Lkc= Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Busirrss and Professions Code) or
that he Is exempt therefrom and the basis for the alleged exemption. Any violation of
Sectim 7031.5 by a" applicant for a permit subjects the applianl to a civil penalty of
era more than five hundred dollars (SS00).
❑ L u owner of the property, or my employees with wages u their sole compensation.
win do the wort, and the structure Is not intended or offered for sale (Sec. 7014, Businnu
and Professionns Cafe The Cenuactors Lkense Law den not apply to an owner of
property who builds or improves thereon, and who does such wort him elf or thmagh his
awn employ. Pad that such improvement are not intended or offered forsale.1f,
however, the building or improvanem Is sold within one year of completion. the owner -
builder will have the burden of proving that he did not bndld or )mprmve for purpose of
sale.).
]_Y`] L u owner of the property, am exclusively convecting with licensed camactas to
construct the project (Sec. 7044. Business and ProGssiom Coda) The Cootncors Li-
cense Law does net apply to an owner of property who builds or improves thereon, and .
who conuscra for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
El I m �u n/¢� , B h P C fo this mason
Owe. i1 prdZ1.J `� S Dale9 — b
RRERS COMPENSATION DECLARATION
I hereby Affirm under penalty of perjury one of the following declaration
❑ I haw and will maintain a Catili ate of Consent to self-iesum 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.
❑ I have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for sire perforrnan¢ of the wort for which this permit Is Issued.
My Worker's Compensation htwn ice carrier and Polley number axe:
CartierPolicy Nor._
CFR77FICAIE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(rhos section need not be completed if the permit Is for one hundred dollars ($ 10G)
or less)
1 certify that in the performutrs of the wort for which this permit Is issued. I shall not
employ any person In any m " be m bject to the Warimrf Compensation
Caws of CaGtQorfa.
Applitan /S E LLl�
NOTICE�10�PLI—Cf, after making U46nificate of Exemption, you should
beobnne subject to the Worker's Compensation provisions of the Labor Code. you must
forthwith comply with such provisions or Urfa permit shall be danced revoked.
CONSTRUCTION LENDING AOFNCY
1 hereby LIfirm that Users Is a construction lending agency for the performance of
the work for which this permit is Issued (Sec. 3097, Civ. C.)
Lenders Name
Lenders Address
I crsdfy that I have read this appticatfon and state that the above information is
correct I sg= to comply with all city and county ordinances and state laws relating to
building consnuction, and hereby authoim representatives of this city to curer upon the
above -mentioned pmpcny for inspection purposes.
(We) agree to save, indemnifyandkeep harmless the City of Cupertino against
liabilities, judgrnems, cost and expenses which may in any way accrue against said City
in consequence of the granting of this pormlL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH All. NON -POINT
of
Dale
HAZARDOUS MATERIALS DISCLOSURE
Will the appl)canl or future building occupant sae or handle hazardous material
u defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Cafe, Section 23532(a)7
Cl Yes 0No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air eonuminans as defend by the Bay Area AJr Quality Management
DWM7
❑ Yes IANo
I have read the hazardous materials nequ6pncros under Chapter 6,95 of the Califor-
nia Health tit Safety Code, Sections 25505. 25533 and 25534. I wimitand that if the building
does curmndpha& mat. Ust it is my responsibility tonotify Lire occupant of the
be met prior of a Certificate of Occupancy.
Owner of a tit rind agent Date
Job Description
PARKNG LOT EXPANSION-50 SPACES & NEW TRASH
ENCLOSR(20,100SQ). ADD LIGHT POLES.
Sq. Ft. Floor Area 1 $ 3 0 0 0 0 0 Valuation
36916026.
Required Inspections
Issued by:
Re -roofs
TI pe of Roof
Occupancy Type
Date `Zc
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'n' or better