08020154CITY OF CUPERTINO
BUILDING DIVISION PERMIT
Bu1LMESkEVENS CREEK BLVD
OWNER'S NAME:
STEVENS CREEK LLC
PHONE
ARCHITE.CT/ENGMEFR:
O p LICENSED CONTRACTOR'S DECLARATION
or
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 70I10) of Division 3 of the Business and Professions qode. and my license is
H in full force a e _
z license Class . N
F, A Date Contractor
L CH S DECLARATION
C I d yplans shall be used as public records
>0.0
O y licensed Professional
y OWNER -BUILDER DECLARATION
f I hereby affirm that 1 am exempt from the Contractors License Law for the
` 00 following reason- (Section 7031-5, Business and Professions Code: Any city or county
3 _ y which requires a permit to construct. alter. improve, demolish, ur repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statrment
c 2 that he is licensed pursuant to the provisions of the Contractors License law (Chapter 9
(commencing with Secdon 7000) of Division 3 of the Business and Profesions 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).
❑ I, 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 sale (Sec. 7044, Business
and Professions Code The Contractors License Law does not apply to in owner 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_).
❑ L as owner of the property, am exclusively contracting with licensed contractors to
construct sire project (Sec. 7044. Business and Professions Code:) The Cootnuor's U-
ccnse 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 Contractors
License LAW.
❑ 11011 exempt under Sec , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self-insum for WorkcesCompen-
sat)on, as provided for by Section 3700 of the Libor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation insurance, as required by Section
3700 of the IAbor Code, for the performance of the wart for which this permit is issued.
My Worker's Co peroration Iw nce carries and Policy number am:
Carrier. Policy N.- Z;!!_—e&
CIEIMFICATE OF EXEMPTION FROM WORKS
COMPENSATION INSURANCE t7 /�j_
(Ibis section need not be completed if the permit is for one hundred dollars (SI00)
or less)
I certify that in the performance of the work for which this permit is issued. 1 shall not
employ any person in any manmrso 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
,z forthwith comply with such provisions or this permit shallbedeemed revoked.
O CONSTRUCTION LENDING AGENCY
F-r to I hereby affirm that Vert is a construction lending agency for the performance of
.-r
CG > the work for which this permit is issued (Sec. 3097. Civ- C.)
QLender's Name,
2 Lenders Address
V Q 1 testify that 1 have read this application and state that the above information is
(y correct. I agree to comply with all city and county ordinances and state laws relating to
O V building construction, and hereby authorize representatives of this city to enter upon the
above -mentioned property for inspection purposes
Car (We) agree to save, indemnify and keep harmless the City of Cupertino against
Hto liabilities, judgments, costa and expenses which may in any way accrue against mid City
U 2 in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL CPLY WITH ALL NON -POINT
SOURCE REGULATIONS. — �r
TBD - TO BE DETERMINED
PERMIT NO.
08020154
PERMIT ISSUE DATE
03/28/2008
SANITARY NO. CONTROL NO.
BUILDING PEP MIT INFO
-BLDG ELECT PLUMB MECH
Job Description
COMMrL TI OFC SPACE,STORE FRNT CHGS, WALL@BK OFC
Sq. Ft. Floor Area $ 9 5 0 0 Valuation
20289 STAM&TWEK BLVD I Occupancy Type
Required Inspections
Date (3— Z_�7
Re -roofs
Signature of Applicant/Con I r Date
HAZARDOUS TEAIALS SCLOSURE Type of Roof
Will the applcant or future b ding occup t atom or handle haurdous material as defined by the Cupertino Munici al Cods Chapter 9.12, and the Health and Safety
Code, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑ Yes a
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit ha-rardous air contaminants as rncd by sire Bay Area Air Quality Management all new materials for inspection.
District? -
❑ Yes o
I have mad the harardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534. I understand that if the building
does not currently have tenant. that it is my responsibility to notify the occupant of the
requimmcrus the inert rtn-^ ofaCertificateofOt Pancy. Signature of Applicant Date
Owner or authorrrcd
Date
All roof coverings to be Class''' or better