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08080201:09Z 00 I UZZr i<a 7N N i ;0 ry . 00 0 m 3-H �Zt �F0 C L-I r-i C4 C �Dz UO OV 0. UZ CITY OF CUPERTINO BUILDING DIVISION PERMIT Y ✓ ' Xid;s.:nkYT_ au1 WOLFE ADDRESS: & HOMESTEAD RD TBD — TO BE DETERMINED` PERMIT NO, 08080201 OWNER'S NAME: PERMIT ISSUE DATE KIMCO 10/08/2008 PHONE: SANITARY NO. CONTROL NO, ARCHI=/ENGINEER: BUILDING PER -Ma INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION hereby I licensed Chapter 9 Job Description I affirm that am under provisions of (commencing with Section 7000) of Division 3 of the Business and Professions Cc&, and my license is ADD ROOF TO 2 EXISTING TRASH ENCLOSURES —ONE in full force and effect ,r 2L License Gass Lie.• •S Date Comracinr 75, cn, r OPP,, -- BEHIND ARCHIIECrSDECLARA]ON RANCH 99—THE OTHER BY THE APT SIDE. 1 understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contactors License Law for the following reason. (Section 7031.5, Business and Profession Code: Any city or county which requires a permit to canslruct. alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the previsions or the contractor's Liens Law (Chapter 9 Sq. Ft. floor Area Valuation (commencing with Section 70DO) of Division 3 of the Business and PCode) or 3 Orofessions 0 0 0 that he is exempt therefrom and the basis for the alleged exemption Any violation of � p.� 316 0 5 0 5 2 Occupancy TyPe Section 7031.5 by any applicant for a permit subjects the applicant to a Civil penally of not more than five hundred dollars (s30D). ."i'ttd At1�tuber ❑ L as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work and the mucttue is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does 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.). ❑ 1. as owner of the property. am exclusively contacting with licensed conllaerolE to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- . cone 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 Contactors License Law. 71 1 am except under Sec B & P C for this reason Owner Date WORKERS COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, far the performance of the work for which this permit is issued. 71 1 have and will maintain Worlceis Compptaation lasurance, as mquireQby Sect on 3700 of the Libor Code, for the performance of the work for which the permit is issued. ' My Worker'sJCoompensat/eyn_ insurance carrier and Policy number am: Cartier. tom, 1 FlaPolicy No.: e % /!lU '� OU I r CERTIFICATE OF EXEMP'ITON FROM WORKERS' COMPENSATION INSURANCE 01iis section need not be completed if the permit Is for one hundred dollars ($100) or less.) 1 certify that In the performance or the work for which this permit Ls Issued, 1 shall not employ any person In any mannerso as to become subject to the Wortcrs' Compensation Laws of California. Dam Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Codc, you must forthwith comply with such provisions or this permit shall be deemed evoked. , CONSTRUCTION LENDING AGENCY I hereby affirm that there is a, construction lending agency for the performance of the work for which this permit is issued (Sec- 3097. Civ. C.) Lenders Name Lnder's Address 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws elating to building construction, and hereby authorize representatives of this city to cnicir upon the above -mentioned property for Inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against Iiabilides,judgments, costs and expenses which may In any way acme against said City in consequence of rho granting of This permit h ANT UNDER AN WILL COMPLY WITH ALL N��INN'1 DINT Issued by: Date 3 SOURCE Gl1LA ,S� / /� / ,L/.// Re -roofs Type of Roof Si ure of Applicant/Conusemr Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building oavpant store or handle hazardous material as defined by the Cupertino Municipal Code, Cbaptcr 9.12, and the Health and Safety Cade, Section 25532(a)7 ❑ Yes (yam N`n/o All roofs shall be inspected prior to any roofing material being installed. V If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air cons unfiru as defined by the Bay Area Air Quality Management all new materials for inspection. District? Yes No I have road the hazardous materials requirements under Chapter 6.95 of the Califor- nia sty Code, Section 25505, 25533 and 25534.1 understand that if the bwldtng 'dots not Curren Svc a Ten that my responsibility to notify the pant ear requirements whit east et or I a of a CrntiRae pf Ocnr ry. Signature of Applicant Date All roof coverings to be Class'n" or better Date Ow r authoriird agent S."Im CITY OF CUPEkTINO CITY OF CUPERTINO TENANT IMPROVEMENT PERMIT APPLICATION FORM I Ok6k-024 D t— �,�r— Date: Cth- [71-3/(P 'Buil('. ,R Adore= - Ve- !�iailing`Address (if different from building address): MO-1�c S rZAJL AN r>e-A4--ts c G A - Tenant (If tenant please provide a letter from the building owner ap roving the tenant improvement.) Building Owner ❑ Tenant/Building Owner's Name: c a Phone #: L i ►'�rJ �.'` 92j�) r o Contractor: Phone #: C Fax M Contractor License #: Cupertino Business License M Contact: Phone #: Fax #: Alternate Contact: Phone #: Fax M Valuation (cost of project): e a� 1 Job Description (be specific): AV 3S' 7ryr� �. Tenant Improvement Includes Re -Roof: Yes ❑ Naf�J<If yes, number of squares Tenant Improvement Includes Structural YesR-No ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V-B P. Project Size: ExpresAM Standard LJ Large 11 Major Green Building: Please complete Leed for commercial interiors checklist & attach it to the application or if applicable, include in plans & sheet index LEED Points Achieved -,&� *** For Office Use Only*** Over The Counter ❑ Revised 8/08/08 City of Cupertino �"I � Basemap Labels Abc Street Names Address Freeway Basemap Easements a Street Centerline County Freeways County Major Roads Right -of -Way Parcels ® City Boundary SCALE 1 : 4,547 200 0 200 400 600 FEET http://gissvr/cupertinointranet/home/mapFile.aspx Monday, August 25, 2008 4:24 PM