07090161 -77;777777777=-
CITY OF CUPERTINO
BUILDING DIVISION PERMIT �� TQ IRMTI�N
PERMIT NO.
""TUM"N':"N': DE ANZA BLVD NOVO CONSTRUCTION 07090161
PERMIT ISSUE DATE
OWNER'S NAME:
SOBRATO DEVELOPMENT COMPANY 1042 HA11ILTON CT 09/24/2007
SANITARY NO. CONTROL NO.
)NE:
(650) 70:.-1500
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
p Q LICENSED CONTRACTOR'S DECLARATION Job Description
Vp I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z w with Section 7000)of Division 3 of the Business and Profons Code,and my license is INTERIOR DEMO ONLY
a y t -11102 in full force and effeccssi1
License Clan Co t
F p Date Contractor—
UJ
actor
j ARCHITECTS DECLARATION
i a< I understand my plans shall be used as public records
)CLIU
a.H Licensed Professional
O a
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law for the
jp O 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 structure
—'� prior m its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation
a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 �q $6000
is O (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
L that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3160210 3 ttl�': Number
not more than five hundred dollars($500}
❑I,as owner of the property.or my employees with wages as their sole compensation,
will do the work,and the structure isnot intended oroffered for awe(Sec.70",Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or 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 not build or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's)-
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 Cont actoes
License Law.
❑I am exempt under Sec. B&P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Worker sCompen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's 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 insurance carr. and Policy number are:
CarrierV�k1 C�/r� ~f-Ilr olicyNo.: 15201"o
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or Icss.)
1 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 Compensation provisions of the Labor Codc,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
p4> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
aZ Lender's Address
U C) I certify that I have read this application and state that the above information is
u.I—, correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
(We)agree to save,indemnif armless the City of Cupertino against
„F,,,t) liabilities,judgments,costs an x nses which y in any way accrue against said City
U Z in consequence of the g g o is permit
►-t APPLICANT UNDER AN AND WIL COMPLY WITH ALL NON POINT
Issued b): ate
SO REG) S. 1?/-2 /J
( _7( Re-roofs
Signature of Applic C Date Type of Roof
MATERIALS DISCLOSURE yp
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Cl Yes
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection.
District? ,�-
❑Yes twm
1 have read the hazardouumaterials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sec 5.25533 and 25534.1 understand that if the,building
does not currently have ate t tit is my responsibility to notify the occupant of the
rte nus which m be t or to u ce of a Certificate of orfupaV. Signature•of Applicant Date
` All roof coverings to be Class'B" or better
O er or authorized Date