04080144 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR T14RO111Y1�TON
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BUILDING ADDRESS: DADE BEHRING PERMIT N%4080144
20400 MARTANT A17
OWNER'S NAME: PERMIT ISSUE DATE
DADE BEHRIN
IE:
SANITARY NO. CONTROL NO,
ARCHITECrfENGINEER: BUILDING PERMITINFO
BLDG ELECT' PLUMB MECH
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LICENSED CONnsed Um R'S DECLARATION -
YIn F 1 hereby affirm that 1 am IittnaM a visions of Chapter 9(commencing Job Description
`Z� willy5ecuon 1011lH nrniHsion Tor NC Bua"rdi mPmrestlolueade.,ne myliceveia
^SZ' m u rola aha effect. TI--OFFICE RENOVATION C/ S FT. )
n�Z �Class I,ic.tl
I, to C :tor �t-.•tier PHASE 1
ARCHITECT'SS DEG'IASATION
I uMcrstand pia shall roc tic recto
�V Ocu
;u t; Licensed O
103 OWNER-BUILDER DECLARATION C *f,
E 1 hereby alfifm that I em exempt from the Comnctor's License Law for the O(Q- �Ortsa
O O following moron.(Section 701.5,Business and Professions Code:Any city or county (/sMk
29 which requires a permit to consumer.ales improve,dcmroliah,or repair any structure
Uziprior in its issuance.also requires the applicant for such permit to File a signed statement
that he is licensed pursuant to the provisions of the Cantmcmr's License law(ChaPlm9 Sq.Ft. Floor Area Q V&hr¢ 32
C (commencing with Section 7100)of Division 3 or the Business and Professions Code)or �(] Y+
$ Out he u exempt therefrom,and the basis for the alleged exemption.Any violation of e,^..
Section 7071.5 by any applicant for a permit subjeces the applicant to a civil penalty of APN Number Occdpancy Type
not more Nan five hundred dollars($50M,
❑I.uowner of the property,or my employwwith wage u0ev role compcncotion, 31622018 . 00
will do she work and theawnune is notihuMed oro@tad forsalc(Sec.TOM.Business
and Professions Codc:Tito Contacloes License law docs Act apply in an owner of Required Inspections
property who builds or improma thereon.and who doea such work himmlf or through his
own cmptoyw,provided that such improvements are not imemdW orroQered parable.If.
however,Nc building or improvement iasold within.. .of completion.the owner.
builder will have the burden of Proving that he did nm build or improve for purpose of
coin.).
❑1.as owner of the property,am exclusively contracting with licensed contractora to
cpnstmct the project(Sec.7044,Business and Profession Crede:)The ConVumfi Li'
cense law docs Out apply to an owner of properly who builds or improves Merton,and
who enhances for such projects with a conamror(S)licensed pursuant to the Comaacrpls
Licasm law.
❑Iamexemptunder See .B&PCfor Nisrcason
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby aRhm under penalty of perjury one of the following declarations:
have and will maintain aCofificate of Consenuo self-iosufe for WorkeYsCompcn-
an,As provided for by Section 3700 of the labor Code,for Ne pmforenancc of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as lequircd by Section
37W of the labor Code,for the pmrormance of the work for which this permit is issued.
My Worker's Compensation Insurance partner and Policy number are:
Ca 'cr( Q Iii%i/�1h6/ POYcy No:
CERTIFlCATEOFEX PION FROM WORKERS
COMPENSAPON INSURANCE
(This section need ret he completed iron,permit isforome hundred dhllara($IQ))
or les.)
1 eer ify Not in the pc llo mance of the work for which this permit is issued I shell not
employ any person in any manner m as m become subject to Ole Workers'Compensation
LAWS of Califomis.Dau
Applicant
NOTICE TO APPLICANT:If,after making this CcniGnu of Exemption,you should
become subjceo to the Worker's Compensation provisions of the Labor Code,you must
.J,Z foMwilh comply with such provisions or this heron shall W deemed fcvmked.
'Z..'Q CONSTRUCf10N LENDING AGENCY
E
I bereby affirm that then is a consauctmb lending agency for the pefroor mm of
C' the work for which this permit is issued(Sec.3097,Civ.C.)
Q1<ndcts Namc
it z come,. Address
U O 1 anlry that I have read this application and stm,that the above information is
0 U cording 1 agree m comply with all city and county ordinances and sou laws r upon
to
e
0 V building-Aconswction,andhorebyauthonmrcptcsenesuvesmf this city in enter upon Oe
r C ahovc-(We)Agreedl
to sartyve.
for emnifyian keeses.
(We)agree to cove,indemm(y and tech A.R.Ota City of Cupertino against
h in
of One
gaga antl CXN=s which may in any way accmc againn said City is
O'er A APPLICANT
of thegranting of this per mit,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: CIO Date
SOURCE EGrULATIONy._ /zt�U�
S G Re-roofs
u
gnarc o(ApplicalrcanU omrse,HAZARDOUS MATERIALS DISCLOSURE Dau Type of Roof
Will the applicant or future building occupant store or handle hammmus maetlal
as defined by the Cupenino Municipal Code.Chapter 9.11,and One Health and Safety
Code.Section 15332(a)?
0Y All roofs shall be inspected prior to any roofing material being installed.
�No
Will the applicant or future building arupanr use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
'r lus.hiss air ci numinanu As defined by the Bay Area Air Quality Management all new materials for inspection.
mid?
F1 yea �N'u
1 have read the haaadous materials requirements undcrchaper 6.95 of thc Califoo-
nia RAshh&Sa(ety Cade,Sections 25505.25537 and 75534.1 unddaarM thatifNe building
dnes not Ily have a tenant Nal it u my¢aponsihility m tify IM occupant of the
coq=ire awns mesr be m= roiesaama nrac`' rg� (O,,apmcy. Signature of Applicant Date
owners n tnaaf'otiaed.ggnt + D,e All roof coverings to be Class"B"or better