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08030159Boa i<a .�H r rr/�Z i )yU .0 N ..d cl0 emCi ego 0z z0 Ct. Q az UO LL. H OU CITY OF CUPERTINO "= BUILDING DIVISION PERMIT CONTU CTOR 1106 aufLTTo�gR ORANGE AVE BLDG B TBD - TO BE DETERMINED PERMrr NO. 08030159 OWNER'S NAME PERMIT ISSUE DATE MARCI PROPERTIES LLC 09/05/2008 PHONE SANITARY NO. CONTROL NO. ARCHITEC IFNGiNEEiL BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION licensed Chapter 9 Job Description 1 hereby affirm that I am under provisions of (commencing with Section 7000) of Division 3 of the Business and Professloms Code, and my license is SFDWL- 2 , 4 3 3 ' IN MULTI -USE BLDG B in full force and effect License Class Lie. N Date Contractor ARCHr1F.C7-S DECLARATION - I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 703 M, Business and Professions Code: Any city or county which requires a permit to corsuve, alter, improve, demolish, or repair any suveturc prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed to the of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation pursuant provisions 3 1 6 2 9 0 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $. that he is exempt therefrom and the basis for the alleged exemption. Any violation of �p,7�,�7 umber 3 5 717 0 5 8 Occupancy T P Y Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars M500)- .` iC t51� 1, as owner of the property, or my employes with wages as their sole compensation. . Required Inspections will do the work, and the structure Is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves theeon, 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, die owner - builder will him the burden of proving that he did not build or improve for purpose of sal I Z .. owner of the property, am exclusively contracting with licensed contractors to ,'construct the project (Sec 70". Business and Professions Code:) The Contractor's Li. ce se Law does not apply to in owner of property who builds or improves thereon, and who contracts for such projects with a contnetor(s) Grznxd pursuant to the Contractor's License w- cre i pt an Sec , B& P C f n nee Dare ORKER'S COMO SAIL N ECIA TION 1 hereby affirm under penalty of pcujury one of the following declarations. 1 hive and will maintain a Certificate of Consent to self -insure for Workers Compen- sation, is provided far 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 Worker's Compensation Insurance carrier and Policy number am: Carrier. Policy No. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE . (This section need not be completed If the permit is for one hundred dollars (S 100) or loss.) I certify that in the performance of the work for which this permit is issued. I shall not employ any person N any manner o bec - cci to the Workcrd Compensation Laws of Californrn��.. Date Applicant �7`tn,4 NOTICE Tb<PKLrCA. If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be derrned revoked. — CONSTRUC-nON LENDING AGENCY I hereby affirm that thane is at construction lending agency for the performance of the work for which this permit is Issued (Sec. 3097, Civ. C-) Lender's Name Lender's Address I certify that 1 have read this application arid state that the above information is correct I agree to comply with all City and county ordinances and state lam rolating 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, costs and expenses which may In any way accrue against said City 9 in consequence of the granting of this permlL APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date � �A� SOURCE-REEZUMONS. ! Re -roofs / Type of Roof '�7 07 / t / 5'�J�,6 �� Sign of plicaHAZArDO i"� HAZARDOUS MATERIALS DISCLOSURE WIII 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 core, scales 2.5532(a)7 Yea �No All roofs shall be inspected prior to any roofing material being installed. an P If a roof is installed without first obtaininginspection, I agree to remove Will the applicant or future building occupant use equipm=L or devices which emit hazardous air contaminants defined by the Bay Area Air Quality Management all new -materials for inspection. District? ❑ Yes I have mad the hazardous materials requirements under Chapter &95 of the Califor- nia Health & Safety Cade, Sections 25505. 25533 and 25534,1 understand Chat if the building does not�nyve a tenon That It b my responsibility to notify the occupant of the requi ust be et prior to issuance of a certificate of Octy ancy. Signature of Applicant Date �� All roof coverings to be Class 'xj" or better Own' Date m au orimd agent CITY OF CUPERTINO BUILDING PE!= BUILDING ADDRESS: 10048 ORANGE AVE BLDG B CONTRACTOR: MIRAGE 30159 CONSTRUCTION OWNER'S NAME: MARCI PROPERTIES LLC 400 REED ST DATE ISSUED: 09/05/2008 OWNER'S PHONE: 4087778720 SANTA CLARA, CA 95050 PHONE NO: (408)496-0159 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL LJ License Class Lic. N 5/5/10-REVISION N 1 REVISE DRAWINGS TO ELIMINATE B OCCUPANCY IN BASEMENT & CHANGE TO R3. ELIMINATING ADDRESS 10050 ORANGE Contractor Date AVE, WILL BECOME PART OF 10048 ORANGE AVE. I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions SFDWL-2,433' IN MULTI -USE BLDG B-COMMERCIAL Code and that my license is in full force and effect. BEING I hereby affirm under penalty of perjury one of the following two declarations: ELIMINATED & TURNED INTO RESIDENTIAL. 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 Sq. Ft Floor Area: Valuation: $316290 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 APN Number: 35717058.R48B Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. OWNER -BUILDER DECLARATION Signature of Applicant: Date: [ hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, wiI I do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contracjprs to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). .1( �n/(j I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and 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 the ealth & Safety Code, Sections 25505, 25533, and 25534. Owner - r r- o permit is issued. or authorized agent: DateL I 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 Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. 1 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9. 18. Signature ly Date