07020115 CIT;f OF CUPERTINO
BUILDING DIVISION PFi, lr
BUI G ESS: PERMIT NO.
/ / GRANADA AVE (BLDG 2 E) TBD TO BE DETERMINED 07020115
OWNER'S NAME: PERMIT ISSUE DATE
03/11/2008
PHONE: SANn'ARY NO. CONTROL NO.
ARCHTI'ECT/ENGLNEFA:
BUILDING PERMIT INFO
NEW COMMERCIAL SPACE 2ND BL.DG ELECT PLUMB MECH
W
m p LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
Z W with Secdon 70D(Y)of Division 3 of de Business and Professions Code,and my license is
''F„ in full fora and effect.
12 z License Class Lie.a
i l— Date Contractor
ARCHITECTS DECLARATION
1 a t 1 understand my plans shall be used as public records
yU
O t; Licensed Professional
OWNER-BUILDER DECLARATION
M I hereby affirm that I am exempt from the Contractors License Law for the
m 0 following reason.(Section 7(1313,Business and Professions Code:Any city or county
which requires a permit to construct,alter.improve,demolish,or repair any n=um
z prior to its issuarsa,also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
(commenting 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
Season 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more thao five hundred dollm(SS00)-
❑1,u owner of the property,or my employees with wages as their sole compensation,
will do the work•and the structure H not intended or offered for sale(Sec.7044,Business Required Inspections
eC[IORS
and Professions Code The Contractors i.icense Law does not apply in an owner of Q p
property who builds or improves tbereon,and who does such work himself or through his
own employees,provided that such improvements we not intended or offered for sale.If, -
however,the building or improvement is said within one year of completion,the owner-
budder will have the burden of proving that he did not build or improve for purpose of
sale-)_
titL as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractors U-
censc Law does not apply to an owner of property who builds or Improves thereon,and,
who contracts for such projects with a conuacter(s)licensed pursuant to the Contractors
License Law,
❑I am exempt under Sec B&P C for this reason
Ownz;�)16A 1�"s,.---• ( �rr�--Date
L-'/ ' ''WORKER'S COM SATIO ECLARATION ,
1 hereby&Ttm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-Inwrs for Workers Compan-
sation,u provided for by Section 3700 of the Labor Code,for the performance of the _
work for which this permit is issued.
❑I have and will maintain Worisrs Compcnvdon 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 carrier and Policy number are:
Carrier, Policy No.:
CERTIFICATE OF EXEMPTION FROM WOR3 ERR
COMPENSATION INSURANCE
(Ilis section need not be completed if the permit is for one hundred dollars(S 100)
or less)
I certify that in the performance of the work for which this permit is issued,1 shill not
employ any person in any mapper sops in bexpuge subject in the Workers'Compensadon - -
Laws of Cali(�wurp���aa..Date •7 — I/ ��„,HH n
Applim. i�7�lif P,
NOTICE TbrA� P�CANT:If,after making this Cenificae of Excirrip6on,you should
become subject to the Workers Compensation provisions of the Labor Codc,you must
z forthwith comply with such provisions or this permit shall be deemed revoked
O CONSTRUCTION LENDING AGENCY
w_4 00 1 hereby afrom that there is a construction lending agency for the performance of
Y > the work for which this permit is issued(Sec.3097,Civ.C.)
QLcndds Name ,
= z lenders Address
0 1 certify that I have read this application and state that the above information is
L coreeL I agree to comply with all city and county ordinances and state laws relating to
V building construction,and hereby authorise representatives of this city to enter upon the
W above-mondtmed property for inspection purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
"4 Of] liabiliLim judgments,costs and expenses which may In any way accrue against said City
z in consequence of the grandug of this permiL
--i APPLICANT UNDERSTANDS AND WILL COMPLY WiTH ALL NON-POINT Issued by: Date
7Rs cE REc "TIONS. / y . 3-/1-0 6
__ dW -CA .44 z'.' Re-roofs
` ipatumofApplicantiCnnuaetor if Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupaut store or handle hazardous material
u defined by the Cupertino Municipal Code.Chapter 9,12.and the Health and Safety
Code,Section25532(a)? �[�� All roofs shall be inspected prior to any roofing material being installed.
❑Yes `v�fvo
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 hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes JNo
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nut Health&SafetyCode,Sections 25505.25533 and 25534,1 understand that if tiic building
does not currently have a tenant.that it is my responsibility to notify the occupant of the
`m.,enLs w hill be met or in Issuance of a Certificate of Occupancy. Signature of Applicant Date
Owner or authorbedagent Date) All roof coverings to be Class'"or better