09050073BUILDING DIVISION PERMIT
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BUILDING ADDRESS: PERMrr NO.
199�2s5 STEVENS CREEK BLVD DEVCON CONSTRUCTION INC nqo5oo73
11� 5 U&:2 5 0 A PERMIT `EUE DATE
PHONE: S A 9 G 9 CONTROL NO.
(408)942-8200
ARCHnECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 70(M)) of Division 3 of the Business and P_rtofe;si s Code�my license is
in full force and effect �(q 66
License Cl Lic. N
Dale Con
RCHrIECTS DECLARA ION
1 understand my plans shall he used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 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
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the previsions of the Contractor's License Law (Chaptcr 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
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
not more than five hundred dollars (S500).
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 We (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
awn 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.).
0 1, as owner of the property, am exclusively contracting with licensed contractors to
construct 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 contractors) licensed pursuant to the Contractor's
License Law.
rl 1 am exempt under See. B & P C for this reasoq
;ner Date
ttr WORKER'S COMPENSATION DECLARATION
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 Workcfs Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
M 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 C mpensauon Insurance carrier and Policy number am:
Carrier. Polity No.: a 7`9C' � l
CER77FI TE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the 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 manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
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
1 hereby affirm that them is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name —
Lender's Address
I 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 consuuction, and hereby authorim representatives of this city to enter upon the
above -mentioned properly 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
in consequence of the granting of this permit.
APPLICANT UNDEgS'fANDS AND WILL COMPLY WITH ALL NON -POINT
SOURC UL ONS.
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ppli ntra I r m
AZI=OUS MATERIALS DISCLOSURE
e applicant or future building occupant store or handle hazardous material
tt Ined by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety
_ode, Section 25532(a)?
Yes No
Will the applicant or fut building occupant use equipment or devices which
emit hazardous air contaminan defined by the Bay Area Air Quality Management
District?
Yes u
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health &SafctyCode, Sections 25505.25533 and 25534.1 understand that if the building
does not currently ve a tenant, that it is responsibility to notify the occupant of the
Muuircmcnls/W.beh must be metlewTo issuance of a Certificate of Occupancy. p
Job Description
TEMP PERMIT DEMO CEILNG TILES(NOT GRID),,LIGHTS
&CARPET.INSTL NEW CEILNG TILES, NEW CARPT,
REPAINT, NEW LIGHT. BLD 2 NEW OFCS; ORG PERMIT#
Ft. Floor Area
APN Number
31621089.STE150/250A
Required Inspections
Issued by:
Re -roofs
Type of Roof
Valuation
0000
Occupancy T
Date \_ /,Xf
All roofs shall be inspected prior to any roofing material being installed.
I-f-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