06050062 CITY OF CUPERTINO
BUILDING DIVISION PERMIT +C� ' `RA TOR14.1:6
BUILDING ADDRESS: TURNER CONSTRUCTION CO PERMIT NO.0 6 050062
20955 STEVENS CREEK BLVD
OWNER'S NAME: PERMIT ISSUE DATE
TRU110 WEST SANTA CLARA ST 05/08/2006
IE: SANITARY NO. CONTROL NO.
(408) 295-7598
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i p Z LICENSED CONTRACTOR'S DECLARATION Job Description
V I hereby affirm that I am licensed under provisions of Chapter 9(commencing
?Z with Section 70(0)of Division 3 of the Business and Professions Code.and my license is
;`y in full force and effect TEMPORARY PERMIT FOR FOUNDATION ONLY
)M? License Class Lie.B F EXPIRES 06/08/2006
m Date Contractor
ARCHITECTS DECLARATION
a< 1 understand my plans shall be used as public records
�qri
U.yLicensed Professional
y OWNER-BUILDER DECLARATION !!
I hereby affirm that 1 am exempt from the Contractor's License Law for the
LZ O following reason.(Section 7031.5,Business and Professions Code:Any city or county x
<0 0! which requires a permit to construct,alter,improve,demob h,or repair any structure
13;0„ prior to its issuance,also requires the applicant for such permit to file a signed statement
_< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
F- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or _X0,00
L that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofp 6310 NUrt-t beL 0 0 Occupancy Type
3
not more than five hundred dollars(S500). *� 1 �0
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of Ll P
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
cdtstmct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law docs not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a conuactor(s)licensed pursuant to the Contractor's
License Law.
C3 I amuempt err Se ,B dt P C for this reason
AWVOwner
R1 ?R'S C015NSATION DECLARAMON
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insuc for Workers Compen-
sation,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 required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workees Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
z
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of thc work for which this permit is issued,I shall not
employ any person in any I L as to become su 'ect o Workers'Compensation
Laws of Cali
Applicant
NOTICE TO APPLICA ,after makiriffLfCedificate of Exemption,you should
become subject to the Worker's Compensation revisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed rcvokcd.
Z► CONSTRUCTION LENDING AGENCY
[�V) I hereby affirm that there is a construction lending agency for the performance of
(Yi> the work for which this permit is issued(Sec.3097,Civ.C.)
WCI.Q Lender's Name
►7 Z Lender's Address
V 0 I certify that I have read this application and state that the above information is
Lr."I correct.I agree to comply with all city and county ordinances and state laws relating to
C U building construction,and hereby authorize representatives of this city to enter upon the
a above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against -�
p"C,) liabilities,judgments•costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date _ej
►r APPLICANT UN ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: —v
SOU CER L TI
Re-roofs
Signaturi-ol'Xp--pliVilConu-ackrIDato
HAZARDOLTS MATERIALS DISCLOSURE Type of Roof
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.
❑Yes 16JJo
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
.It hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
C]Yes �W
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Cade,Sections 25505,25533 and 25534.1 understand that if the building
docs not currently have a tenant.that it is my responsibility to notify the occupant of the
rc ire a whir must be met 'or to i�suan/ce�,ofa Ccnificatc of Occu Signature of Applicant Date
M 6 haft, � t - All roof coverings to be Class"B"or better
Owner or auth rized agent Date