08020173 CITY OF
BUILDING DIVISION PERMIT EICUNT==R' 'Ur VF��t1'I TION:
BUILPERMRNO.
1qgUN
TANTAU AVE CUPERTINO ELECTRIC INC 08020173
.R'S NAME: PERAffI'L^EUB DATE
ERITAS PROPERTY MGT 1132 N 7TH ST 03/10/2008
PHONE: SANn7ARY NO. CONTROL NO.
(408) 991-1000
ARCHRECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
3Gj LICENSED CONTRACTORS DECLARATION 0 D O 0
QF 1 hereby affirm dot 1 am 14emnd under previsions of Chapter 9(commencing - Job Description
5Rwith Section 70(0)of Division 7 of the Business and Profession,Coda,md my liceveu SITE LIGHTNG UPGRADE, COMM'L BUS CTR
infullfame do �3
? ? License 1 r C. Lk.N
t Dau Contractor
A-"I IxCTs DECLARA ON
IuwcssunJ my plan-till be,,.-au Public mrools
ytrd Licensed Pmfeatianal
OWNER-BUILDER DECLARATION
9 I hereby a111m that I Am exempt from the Camnmars License Law for the
i O O following moon.(section 7031.5.Business and Profession Code:Any city or County
IRE! which aequima a permh he coruwet.aller.Impro e,demmlhh,or mPat,any rmmou
zs^ prior b its issuance,also mquima tho aPpliCUL for such permit to file a signed statement
gx< da Im h licmlmd puuuant to the provisions of the Conuacars Luarme Law(chapter 9 Sq.Ft. Floor Area Valuation
e;R (commencing with Section 7(1 of Division 3 ovum Business and Pmlrsioru Code)or - $134000
out W is exempt therefrom and the bait for that alleged exemption.Any Mallon of
Section 70315 by any appliam for a permit subjectsuta applicant to a civil Penalty ofNumber Occupancy
not mare Iran R.hundred daBars(&500). 31618035 Parc Y Type
Las owmr of tau property.or my employces with wage u uuh sole compemauon,
mite dPmfeeestlmo,c dee:The Ceratrcmi,roux 1 a mesfmmt appppiy a an owmer - Required Inspections
property who build,m improves thmecn.sw who don such work hlmatlf m throuh his
own employs,provided out such imper emenu am am intendol maRered fmaala If.
however•the building orlmprovement Is mid within arc your of compiet an,the oweer-
builder ,will lune W 4udert of proving that to did an,build or improve for purpose of
tau.).
❑1,as owner at the maperty,am ucludvely,Convecting with licensed contractors to
cmuuuct the pmjem(Sce.7044,Bout.and Profession Cada:)The Conuaemra Lb
cense Law ds not apply m an owner of Property who builds or Improves theme n,and
who conuacv for such pajecu with acanuecmr(s)licen,ed pmsuam m the O musetmt
License law.
❑1 am mu mpt under Sec. .B d P C fm thismoon
Data
WORKER'S COMPENSATION DECLARATION
I hereby LMm under penalty of perjury one of the following decluWor¢
1 haw and wBl maintain a CeniBau afConsent to self-Iuum fa Wortels Cmnpeo-
sadon,as provided for by section 37M of the lahm Code•for that PC,(..of the
work fm which this permit is hued.
❑1 have and will maintain Workers Compensation lmmm,u required by Section
37M of the labor Code.fm the performance of Ne work for which this permit is lad. '
My Workers Cmrp madon InsuuInsurancegrimanted Policy number
comer. 7A'r"J1 160-1a#0y Pal'Iq No.:
CERTIFICATE OF MEMPIION FROM WORKFIIS•
COMPENSATION INSURANCE
(Thbseminn mad trot Wcomplemd if Ile permit Is fmona hundred dollars($IIXO
or lna)
1 certify amt in the perfmmana of than work Ire which this permit Is Wool.l shill not
employ any Parma In any msmmr an u in become subject to the Workers'Conformation .
Laws of Califomla Dau
Applitm . .
NOTICE TO APPLICANT.if.after making this Certificate of Exemption.you should
become Subject to the Workers Compmwtion provisions of the laver Code•you a=
vJ O forthwith Comply with such provisions or this permit shall be deemed revoked. ,
Z" CONSTRUCTION LENDING'AGENCY
'ry 1 hereby affirm that there Is a consuucunn lending agency for the Performance of
C> the work for which this permit is blued(sec.3097.Cin.Q
144 Q Leader's Name
A.
A.Z Lew --.
Leaders Add
V Q 1 Certify that 1 have mad to.application and mm that the above Information is
IL Comm I agree he Comply with all city and county ordinances and aisle law,retailing an
(] Wilding construction,end hemby interim mprnenutives of this city to enter upon the -
show-meetiomd property for iupecuon purposes.
�•� gy (We)agree be ave,indemnify+cad keep hamleas he City of Cupertino against
IA liabilities,jndgmenu.count and expenses which may in any way acme Maim Wit City
V 7 in conacgwxe of the Swung of this Parrott,
a ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
RC 6 LATIO S.
$ /O a Re-roofs
sitnrureo Appllonunu
Cosctor p as
HAZARDOUSMATERIAM1333LL SURE Type of Roof -
WIB the suppliant m future building k.Chapter
mm mhawle Health m materiai
de0nol by the Cupertino Municipal Cook.Chapter 9.13,and the Health ams Safety
•Samoa n532(o7 r-� All roofs shall be inspected prior to any roofing material being installed.
❑You R1(
Will the applicant or future building occupant use equipment or dcvis which If a roof is installed without first obtaining an inspection,.I agree to remove
emit hanamnou tar conumin,nu as deRecd by the Bay Area Air Quaiily Management all new materials for inspection.
District?
yao
I have mrd the huanfausmatedalsmquimmenu under Chafam6.95 of the Califor- -
nuHcalth,kSafmy Cade.Seclimu755Q5.25533 aw25534.I umkrsuntl thstithe building
den riot cunemly haw•Mount.that It h my m,ponshilily to motify the occupant of the
newlamorp which muss met ryiarto Wamce aftcmiticate of0. Signature of Applicant Date
All roof coverings to be Class a%{a'Owner m mthornsd agent DAM
or better