08020060BUILDING DIVISION PERAM
auiiI);1c�5 0 VALLEY GREEN DR
OWNER'S NAME:
APPLEC
PHONE_
ARCHITEC IENGINEFR:
u O ed p LICENSED CONTRACTOR'S DECLARATION
mr I hereby affirm that 1 are licensed tender provisions of Chapter 9 (commencing
Zwith Section 7000) of Division 3 of the Business and Profession Code, and my license 1s
"> in full force and effect
E z License Class Lie. N
= — ❑ Date -�-�s� Contractor _V0
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
�a
Licensed Professional
O
n y S OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
po following reason. (Section 7031-5, Business and Profession Code: Any city or county
m 0l which requires z permit to construct alter, improve, demolish, or repair any structure
- — to file w prior to its issuance, also requires the applicant for such permit le a signed statement
< that he is licensed pursuant to the provisionsofthe Contractors License Law (Chapter 9
zt=- (commencing with Section 7000) of Division 3 of the Business end Professions Cade) or
i that he is a pt therefrom and the basis for the alleged exemption. Any viola; on of
Section 70315 by arty applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (SSW).
❑ 1, as owns of the property, or my employees with wages as their sole cmnpenaadon,
will do the work and the structure is not inua mded 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 wort 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 ban the Louden 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 Contractor's Li -
cerise Law does not apply to an awner of property who builds or improves thereon. and .
who contracts for such projects with a contracto(s) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under Sec , B & P C for this reason
Owner Due
WORKER'S COMPFNSATTON DECLARATION - -
1 hereby affirm under penalty of perjury one of the following dcclerathons
❑ 1 hsvc and will maintain a Certificate of Consent to self -inure for Workers Compat-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 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 Workers Compensation Insurance wrier and Policy nomb arc}:''�
Carrier. Policy No: V Li -U
CERTIFICATE OF EXEMPTION FROM WORKERS -
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S 100)
or less)
1 certify that in the performance of the wort for which this permit is issued, 1 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 Ccnificate of Exemption, you should
become subject to the Workers Compensation provisions of the Tabor Code. you mug
,J z forthwith comply with such provisions or this permit shall be deemed revoked
CONSTRUCTION LENDING AGENCY
F+ 1 hereby affirm that them is a construction lending agency for the performance of
R4 > the work for which this permit is issued (Sec. 3097. Civ. C.)
WD. Q Lenders Name
] z Lender's Add,=
V O 1 certify that 1 have read this application and sate that the above information 1s
Lj, "" correct. I agree to comply with all city and county ordinances and state laws relating to
C CE.) 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
ak
V) liabilities, judgments. costs and expenses which may in any way accrue against said City
U z in consequence of the granting of this permit.
►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOU$ vv'4ULATIONS. I I-0J
Signature of Applicant/Contrarlor - Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as dcfined by the Cupertino Municipal Code. Chapter 9.12, and else Health and Safety
Code, Section 25532(a)?
El yes �No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Amu Air Quality Management
District? `
❑Yes Xf90
1 have read the hazard,,us mata-ials tcquimmcnts undcrChapicr 6,95 of the Califor-
nia Health & Safety Code, Sections 25505. 25533 and 25534.1 uodasand thu If the building
does not currently have a tenant that it is my responsibility to notify the occupant of the
requirements which must be me�.pnor to issuance of a Certif of occupanry.
rti�lcX I
Owner or authorized agent Ihto
CLASSIC GLASS INC
780 CHESTNUT ST
(408)293-7606
PERMIT NO.
08020060
PERMIT ISSUE DATE
02/11/2008
SANITARY NO. CONTROL NO,
BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
Job Description
TEMP PERMIT,COMM'L TIRE-ARNG 2 EXSTNG TSTNG RMS
TO DIFF CONFIG.PERMIT GOOD THRU 3-11-08
Sq. Ft. Floor Area
32610053 .W Number
Issued by:
$0
Required Inspections
Valuation
Cy Type
Date 2- ) f -e-4
Re -roofs
Type of Roof C
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 "B" or better