04080248 CITY OF CUPERTINO - -'�-,�i`iu T
BUILDING DIVISION PERMITCONTRACT-,OR INFORMATION.t4
BUILDING ADDRESS: SC BUILDERS INC PERMIT NOD4080248
18912 FORGE DR
OWNER'S NAME: PERMITISSUEDATE
RAZA MICROELECTRONICS 491 E EVELYN AVENUE op/in/2no4
E:
SANITARY NO. CONTROL NO.
(408) 328-0688
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
_op LICENSED CONTRACTOR'S DECLARATION O O O
w Job Descripti
I hereby affirm 1 am licensed under provisions of Chapo:r 9(commencing
m N ���®
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with Sect IX1U)of Division3of NC Business dProfeumm Cade.and my license is
imm�ra dent l�}15 � DEMO (E) PARTI-WALLS
Liccras Class N r
i F p Dam b-1_O Camrumr SEP /3 �y
ty ��� ARCHnECTS D ATIDN TOO
¢-+ I undcraund my plms shell M usetr as public recnm
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a.t-, Licensed Professional
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OWNER-BUILDER DECLARATION �Ip\\\"Tffl
1 hereby alfirm Not I oro cxempa from the Conhonar's License Law far the `1
r.O O following reason.(Section 703 1.5.Business and Pmfmadiom Code:Any city or county
K m which aquirw a permit to Construct.alter,improve,demobh,or repair my nructum
priorur isissuancc,on."cmadne.pplicant fmsuch permitto filcasigxdsutcomm
Nn W is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
as I— (cammenimr,with Section 7000)of Division 3 of lM Business and Prefoo imu Cadelur
y Nn he is exempt therefrom and she basis for He alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects On cpplicmt N a civil penalty ofDALPR ®far 0 0 Occupancy Type
not mare 0m five hundred dollars(g ).
❑1,as owner of the property,or my employees with wages as their son compensstion,
will do the work,and the suuctum is not intended moReted raraaic(See 7f144,Business
and Professions Cade:The Contrmtor's License Law does not apply to an owner or Required Inspections
property who Wildsorimproves Hereon,and who doessuch work himsclfor through his
Own employees,provided Hat such improwmcnu are not intended croRered for sales If.
however,Of Wilding of improvement is mid within am yeti of completion,Ne owner.
builder will have tion location of proving Nat M did not Wild or improve for purpose of
mea).
[D 1,as owner of the property,am exclusively contracting with licensed contractors to
conswm the project(Sec.7044,Business and Profusions Code)The Conoacursa Li.
Comm law docs not apply to an owner of pm xeny who Wilds or improves Neeson,and.
who contracts for such projects with a eontncmrW licensed pursuant to the Comrmmr's
License Law.
1 son exempt under Sec .B is P C for this amount
Owner Dat
W OuBREWS COMPENSATION DECLARATION
1 hereby inn nder penalty of perjury one of the following decimations:
1 haus and will mainuin a Certificate of Consent to Ulf-inmu for Worker's Compcm
action,m provided for by Section 37M of the tabor Code,for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Imarmce.as acquiad by Semon
3700 of He Labor Code,for He performance of IM work for which this remain is bound.
My Worker's Compensation Insurance,omfw and Policy number aa:
'er./7rttawalt S�,d)G MNS Pica'' , We-590363
CERTIFICATE OF EXEMPn OM WORKERS'
COMPENSATION INSURANCE
(TMs section need notbecomplemd if IM permit is for one hundad dollars(SIBBI
or Icss.)
1 cenify Nat in the pnformmm of the work for which its Permit is issued,l shall not
employ any perm my manner m as to Woman subject to NC Workers Compensation
Laws of California.
Applicant
NOTICE TO APPLICANT:If,after making this Ccnifiote of Exemption,you should
become subject to the Worker's Compenanion provisions or the Labor Code.you mum
.,2 forthwith comply with such provisions or this permit shall W doomed revoked. /
z CONSTRUCTION
d(Sm.3 7.Ct,AGENCY
,L .N. 1 hereby aITrm Nat Vert is a convection lending agency for He performance of
IY� the work for which Nu permit is issued(Sm.J097,Civ.C.)
Iz]
Louts
D.
Z Lendeia Address
U
V O 1 certify Nat I pars read this application and too:that theand
sWw information is
0 f-' comply and hith all rebyauty m0 countyoNinanccs and etsa lawsenter upon
the
�O above mentionedou,md hertbyectonprposes. tiwaof this city menterupon the
�[Id ahovamcmagrd to portysave forinspectionpurposes.
CL (Wc)agree to save,indemnify and keep hay in an IM City nc Cupertino against
U Z incoiseque consequence
the mstsmdOfthisuConit. may in my way attmc againstmid City
C)z APLICANT NDERanti N of this permit
APPLICANT UNDERSTAN BAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
__ Re-roofs �
Sag AypRc FR OUSMATFRIALSO CLOSURE Da Type of Roof
Will On appl'=I serf wa W ildiag occupm smrc or handle havardous material
as dcOncd by He Cupen"m Mumm al Code.Cha r 9.12,and Nc Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
t]Ya M.
Will the applicant or(alure holding occupaart use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hanal us air conuminants as trained by due Bay Area Air Quality Management all new materials for inspection.
DimimB
❑Yes 0
1 have mad the baallous materialsrequlrements under Chapter 6.95 of On Califor-
niaHo7th&SafnyCode,Sections 255(15,25533 and 25534.1 undemtend Nat iflM Wilding
dont not Currently haw a mnam.Nat its my respomihility m fury Of occupant of Nc
requirements whichmu,IMmmpnorwi oreceni0eateortxapan Signature of Applicant Date
Owner or aaHonrc asen .Date All roof coverings to be Class "B"or better