10030109CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10200 S DE ANZA BLVD
CONTRACTOR: CEE GEE PARKING LOT
PERMIT NO: 10030109
STRIPING
OWAR'S NAME: SYMANTEC CORPORATION
1287 PEGGY AVE DATE ISSUED: 03/30/2010
OWNER'S PHONE: 6509193350
CAMPBELL, CA 95008 PHONE NO: (408)370-3478
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG r ELECT r– PLUMB
License Class Lic. #
MECH [_ RESIDENTIAL f- COMMERCIAL
Contractor Date
JOB DESCRIPTION: RE -STRIPING OF EXSTNG UNDRGRND PARKING
I hereby affirm that I am licensed under the provisions of Chapter 9
GARAGE.
(commencing with Section 7000) of Division 3 of the Business & Professions
LEVEL 1:STALL CONVERSION, LEVEL 4:CHG TO ONE-WAY
Code and that my license is in full force and effect.
CIRCULATION. STRIPE FOR PARALLEL & ANGLED PARKING
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
Valuation: $1895
permit is issued.
Sq. Ft Floor Area:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
arc Occu Type:
APN Number: 36901035.00 Occupancy YP :
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
180 DAYS FROM LAST CALLED INSPECTION.
9
Date: 73o`lo
Signature Date
Issued bp.
OWNER -BUILDER DECLARATION
t9
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
1, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044,
inspection.
Business & Professions Code)
Signature of Applicant: Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should I store or handle hazardous material.
permit is issued.
I that in the performance of the work for which this permit is issued, I shall
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
certify
not employ any person in any manner so as to become subject to the Worker's
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
O er or author'
forthwith comply with such provisions or this permit shall be deemed revoked.
Date--
ate:-APPLICANT
APPLICANTCERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of work's
11. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
ding construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Lender's Address
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
9.18.
r j
ADate
1 understand my plans shall be used as public records.
Signature C
Licensed Professional �