08060127CITY OF CUPERTINO
BUILDING DIVISION PERMIT
d A' r• w ;
BUILDING ADDRESS:
PERMIT NO.
20400 MARIANI AVE BLDG 3A
XL CONSTRUCTION
08060127
OWNER'S NAME:
PERMIT ISSUE DATE _
AJ111I,E
851 BUCKEYE CT
08/20/2008
PHONE:
SANITARY NO. CONTROL NO.
(408)271-2425
ARCHTTECTIENGINEER:
BUILDING PERMIT INFO
BLDG EL.ECr PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby 1 licensed Chapter 9 (commencing
Job Description
affirm that am under provisions of
calms«don 7000)ofDivision 3ofthe Business dPr r i niCode. arid mylicense is
T, I—DEMO&NEW CONST OF PARTITIONS r M/E/P& LMTD
and errecLLie
�an�foree
STRUCTRL APPRX 3 6 0 0 SQFT—ANNEXED TO RMDL NEW
Dam �• u0 Contractor
ARCH=SDECLARA ON
FNSHS&
I understand my plarts shall be used as public records
WILL BE INSTLD THRU—OUT . (E) K I TCHEN WI LLBE
COMPLTLY
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
following Mason. (Section 7031.5, Business and Professions Cade: 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 rile a signed slatemcot
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$ 8 0 0 0 0 0
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
316 2 2 018 Number
Occupancy
P Y Type
Section 7031.5 by arry applicant for a permit subjects Lhe applicant to a civil penalty or
not more than rive hundred dollars (M).
.`
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Conuwtor's License Law does not apply lo an comer 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.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Cootractors U-
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 Contractors
License Law.
❑ 1 am exempt under Sea B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby afrum under pensity 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 Iabor 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 Cod far the performance of the work for which this permit is Issued.
'
My Wo s Compens ion Insurance carrier and Policy n e are:
a�a�
• W
Grrim " Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rhis section aced not ba completed if the permit Is fox one hundred doll= (f 100)
or less)
I cerify that in the performance of the work for which this permit is issued. 1 shall not
employ arry person in any manner so as to become subject to the Workers' Compensaton
Laws of California Dam
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers 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 consltuction lending agency for the performance of
sire work for which this permit is issued (See. 3097, Civ. C.)
Lender's Namc
Lenders 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
building construction, and hereby authorize reptesenlatims 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 arty way acme against said City
in consequericz.2Lhegranting of this permit.
APP ERSTANDS AND WILL COMPLY WITH ALL NON -POINT
-�y
I
Issued by: Date —L41 W
S A �j f� — -w -O06
Re -roofs
Syogirc, of pplicanUCo r Dale
Us Ala DISCLOSURE
Type of Roof
Will the applicant or fu mavpant store or handle hazardous material
as dcfined by the Cupertino Murd I Code, Chapter 9,12, and the Health and Safey
code,scttionzs532U)?
All roofs shall be inspected prior to any roofing material being installed.
❑Ym No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or fultrre (ding occupant use equipment w devices which
emit harardnus air contsminants defined by the Bay Ara Air Quallly Managcmcnt
all new materials for inspection.
District?
❑Yes Nu
I have read the harardoasmaterials requirements under Chapter6.95 of the Califor-
nia Health& Safety Code, Sections 25505, 25533 and 25534.1 understand that if the buildng
doer no rat vc a truant, Out It is my responsibility a notify the occupant of the
req men tpriortoissuanceofaCertifrcarOfOccZ
Signature of Applicant Date
roof co
All f coverings to be Class"A" N or better
g�`
Dam '
Ownc or authorirrd agent