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08060018I ad U00 !_Lu _<7y 7 v�jZ a` 7u. ;a.E �04 y�yh� YOC n4- t —r. 'EEC Y�ca i ^ 0 Z zC CITY OF CUPERTINO y4 BUILDING DIVISION PERMIT Bu1L.nc,MT"TEVENS CREEK BLVD TBD+' - TO BE DETERMINED PERMIT NO. 08060018 OWNER'S NAME: - PERMIT ISSUE DATE KCR DEVELOPMENT 07/07/2008 PHONE: - SANITARY NO. CONTROL NO. ARCHTIECTIENGINEER EXTERIOR FACADE UPGRADE T BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 9 1 hereby affirm that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is - in full fora and effect - License, Class Lic- # . Date Contractor ARCHITECTS DECLARATION 1 understand my plaits shall be used as public records - - Licensed Professional OWNER -BUILDER DECLARATION - I 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 Stnxture prior to its issuance, also requires the applicant for such permit to file a signed statement Contractor's License Law 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the (Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code) of that he is exempt therefrom and the basis for the alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (SS00). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7044. Business and Professions code: The Contractors Liar Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his _ re own employees, provided that such improvements anot intended ar 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 rot build or improve for purpose of sale.). it 1. as owner of the property. am exclusively contracting with licensed contractors to nsuuct the project (Sec 7044. Business and Professions Code) The Contractnes Li- cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Cmntraetors - License Law. ❑ 1 am exe tun Sec ,DBa�& P C fa this reason WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -inure for Worker's Compen- sation, as 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 Workers 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 Insurantx carrier and Policy number are: Carrier. Policy No.: - CEAr1FICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This section need trot be completed if the permit is forme hundred dollars (S I00) or less) 1 certify, that in the performance of the work for which this permit is issued. 1 shall not employ any person in any mw4r�9,a�o become subject to the WOriera' Compensalion ==ff Laws of Calif a.t�atc t� Applicant .:Z NOTICE APPLICANT: If, alter making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be decreed revoked. CONSTRUCTION LENDING AGENCY 1 hereby arum that there is a construction lending agcrmry for the performance of the work for which this permit is issued (Sec- 3097, Civ. C-) " Lenders Name , Lenders Addres. j 1 certify that 1 have read this application and suite 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 mIrmsentatises 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 j liabilities, judgments, touts and expenses which may in arty way accrue against said City '- in consequence of the granting of this permit ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT - - Issued by: Date SOU t ONS. I� rO - ( / Re -roofs Type Roof Signature of ApphcanUContractor Date HAZARDOUS MA713UALS DISCLOSURE of Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.17, and the Health and Safety Code, Section 25532(a)? ❑ Yes 0 No - 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 Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Ames Air Quality Management all new materials for inspection. District? Cl Yes No - 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Cock, Sections 25505.25533 and 25534. I understand that if the building does not currently have a tenant. that it is my responsibility to notify the occupant of the mgarnc most be met ptior m issuance of a Certifcae of oerap� Signature of Applicant Date -3 1h,,d All roof coverings to be Class'%.'' or better wneroragcm Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19750 STEVENS CREEK BLVD CONTRACTOR: JOHNSTONE PERMIT NO: 08060018 MOYER, INC. OWNER'S NAME: KCR DEVELOPMENT 1720 S AMPHLETT BLVD STE 250 DATE ISSUED: 07/07/2008 OWNER'S PHONE: 4083431088 SAN MATEO, CA 94402 PHONE NO: (650) 570-6161 ❑ LICENSED CONTRACTOR'S DECLARATION j— r- F_ BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. to j— r f - MECH RESIDENTIAL COMMERCIAL Contractor Date l hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION; EXTERIOR FACADE UPGRADE T S'I'OREFRN"T SIGNAGE (commencing with Section 7000) of Division 3 of the Business & Professions PORTAL rr ABV PROJ ADDRESS: STRUCTURAL & ARCHTECTURAL Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $60000 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this "Type: permit is issued. APN Number: 36906008.00 Occupancy APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. if a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALI, ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should 1 store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality,.Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the health & Safety Code, Sections 25i05, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: Date: 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 Worker's Compensation laws of California. If, after making this certificate of exemption, 1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must 1 hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's 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 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 liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date