08050229BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
1.9648 STEVENS CREEK BLVD
TBD - TO BE DETERMINED
PERMrr NO.
08050229
OWNER'S NAME
F;VIsRSHINE GROUP
— -- - -
PERMIT ISSUE DATE
0872072008
PHONE;
SANITARY NO. CONTROL NO.
ARCH1177ECT/ENGiNEFR
BUILDING PERMrrINFO
BI-DG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
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I hereby affirm that I we licensed under provisions or Chapter 9 (commencing
with Section 7000)ofDiyWan3ofthe Business and ProkssimuCode.andmylteencts
BRACE EXISTING PARAPET WALL -THIS PERMIT DOES NOT
'n full force
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INCLUDE APPROVAL FOR EXTERIOR MODIFICATIONS.
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Dal Contractor
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ARCHITECT'S DECLARATION
I understand my shall he used as records
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plans public
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licensed Professional
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OWNER -BUILDER DECLARATION
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I hereby affirm that 1 am exempt from the Conuaetoes License Law for the
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following season. (Section 70315, Business and Professions Code: Any city or county
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which requires a permit to corsirwt, alto, improve, demolish, or mpair any atnxture
prior to its iasuatwe, also requires the applicant for such permit to file a signed swr.MML
Floor
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ibal he is licensed pmaa lL to tfe provision& of the Contractor's license Law (Chapter 9
Sq. Ft. Area Valuation
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(commencing with Section 7000) a Division 3 of the Business and Professions Code) or
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that he is exempt therefrom and the basis for the alleged exemption. Any violation of
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Occupancy Type
Section 70315 by any applicant for a Perron subjects the applicant to a civil penally of
not more than five hundred dollars (S-%M
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❑ Las owner of the property, or my employ= with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale (Sec. 7W4, Business
and Professions Code: The Cootra=es License Law does not apply m an owner of
property who builds or improves thereon, and who does such work himself o t1wough his
own employees, provided that such improvements are not intended or offered for sale If.
however, the building or improvement is told within one year of completion, the owner -
builder will have the burden of proving that he did not build or Improve for purpose of
Q L as owner of the property, we exclusively contracting with licensed contractors to
constrva the project (Sec 7044, Business and Professions Code:)Tbe Cwuactor's U-
cense Law does not apply to an owner of property who builds or improve thereon, and
who contracts for such projects with a contractor(i) licensed pursuant to the Contractor's
I.icnu Law.
❑ 1 am exempt . B & PtC for this m+•on
Owner ' ' � Date O -L'O
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I lui a and will maintain a Centficate of Consent to self -Insure for Werkmes Compen-
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 a the Labor Code, for the performance of the work for which this permit is issued.
My Workers Compensation Lnsuranee earner and Policy number are:
Policy No„
CERTIFICATE OF ECEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ills section need not be completed tithe permit is for oae hundred dollars MOD)
or lest)
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any matmgf so u to become subject to the Workers' Compensation
Laws of Catiforn;GG:9l /� `-
Applicant r—
NOTICE TO AlsE� If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Coda you mum
forthwith comply with such provisions or this permit shall be deemed revoked
CONSTRUCTION LENDING AGENCY
I 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-)
Leadees Name
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 reptiscina ives of this city to enter upon the
above -mentioned property for inspection purposes
(Wc) egret tm Sara itdemn ify and k=p harmless the City of Cupertino agalust
liabilities, judgments, costa and expenses which may In any way Learn against said City
in consequence of the granting of this pertrrlL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE RptULATONS.
_
Signature of AppIi onractor / Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant stoic or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.1Z and the Health and Safety
Code, Section 25532(a)?
❑Yes TNo
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contmninants as defined by the Bay Area Air Quality Managcmcot
District?
❑Yes �sNo
Issued by:
Re -roofs
I]rpe of Roof
Date
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.
1 bave mad the bvardous materials requirements under Chapter &95 of the Califor-
nia Health R Safety Coda Sections 25505.25533 and 25534, I undcrslantd that if the building
does not curmrid have a tenant. that It is my responsibility to notify the occupant of the
tt�uinemcnu wp h must 'eel prior W issuanrx of a Certificate of Occu
Owner or
Date
Signature of Applicant Date
All roof coverings to be Class V or better