07030315BUILDING DIVISION PERMIT
BUILDING 10 b uff"N TANTAU AVE
PERMH NO.
TBD — TO BE DETERMINED 07030315
OWNER'S NAME: PERMIT ISSUE DATE
�08/01/2007
HONE: - SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
o Zp LICENSED CONTRACTOR'S DECLARATION
U ffirm that I am licensed under provisions of Chapter 9 (commencing
with Sec Z tion 7000) of Division 3 of the Business and Professions Code. and my license is
a
in full force and cff
ZLicense Cl L.Ic. N
F,in Date Contractor
ARCHITE'TS DECL AkAr
I understand my plans shall be used as public records
m<
ail
WO h Licensed Professional
y OWNER -BUILDER DECLARATION
< 1 hereby affirm that 1 am exempt from the Contractors License Law for the
in 0 following reason. (Section 7031.5, Business and Professions Code: Any city or county
m which requires a permit to construct, alter, improve, demolish, or repair any structure:
prior to its issuance, also requires the applicant for such permit to rile a signed statement
? < that he is licensed pursuant to the provisions of the Contractor's Lkensc Law (Chapter 9
ts- (commencing with Section 7000) of Division 3 of the Business Land Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any viola on of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty, of
not more than rive hundred dollars (E500).
E] I, as owner of the property, or my employees with wages as their sole emnpensadon,
will do the work, and the structure is not intended or offered for sale (Set 70". Business
and Professions Code; The Contractors License Law does trot apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employers, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completive. Ilse owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale_).
❑ I, as owner of the property, am exdusively contracting with licensed coatrauora to
constrict the project (Sec. 7044, Business and Professions Code_) The Cootrsaoes 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) Ilcmmd pursuant to the Contractors
License Law.
E] I am exempt under Set , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Conant to self -insure for Worker's Compew
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued-
E] I have and will maintain Workers Compemation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is Lensed
My
FROM WORKERS
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
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 Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you should
become subject to the Workers Compensadon provisions of the Labor Code, you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
(-. I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
W Q Lender's Name
Z Lenders Address
U Q 1 certify that 1 have read this application and sate that dnc above infeamatiun is
I=. i— correct 1 agree to comply with all city and county ordinances and state laws relating to
0 E"'
building construction, and hereby authorize reprucntadwsofthis city toenter upnnthe
W above-mentionod property for inspccdon purposes.
y" a (We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may N any way accrue against said City
() Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOU U ONS
Signature of Applicant/Contractor iDasc
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant stom or handle haardous material
as defined by the Cupertino Murticipa ode. Chapter 9.12. and the Health and Safety
Code, Section 25532(a)?
p Yes o .
Will the applicant or future building occupant use equipment Or devices whicb
emir hazardous air contaminants az ed by the Bay AMR Air Quality Management
District?
❑Yes No
I have read the hazardous materials requirements under Chapter6.95 of the Califor-
nia Health & Safety Code, Sections 2550.5.25533 and 25534.1 understand that if the building
does not currently have a tenant, that it is my responsibility m rify the occupant of the
require n hich a Certf
Owncr or authorized agent YVy Date
BUILDING PERMIT INFO
BLDG ELECT PLUMB
Job Description
SEISMIC RETROFIT —ROOF SUB DIAPHRAGM & CONTINUOUS
CROSSTIES.
q. Ft. Floor Area
31618 03 5 r- 0 Number
Issued by:,
Re -
Type of Roof
$20000
Required Inspections
Valuation
Occupancy 'lype
Date J—', --
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