07120147 CITY OF CUPERTINO x ' t £ '' +•r+ r »;r �ma. r.�•;`
BuaDING DIVISION PERMIT TRACkFOR
PERMIT NO.
BUILplryri,5 VESkEVENS CREEK BLVD JOSHUA CONSTRUCTION & 07120147
10613 GASCOIGNE DR 02/01/2008
SANITARY N0, CONTROL NO.
(408) 725-3692
ARCHITI C(ENGINEER: BLULDING PERMIT INFO
BLDG ELECT PLUMB MECH
uoo LICENSED CONTRACTOR'S DECLARATION Job Description
hereby 011m Wt 1 m licensed under Prvioeons of Chapter 9(commencing
with section 7000)of Division 3 ofthe Businua and Professions Code.and my license is T. I . -RELOCATE LIGHTS,MECHANICAL DUCT WORK FOR 4 A
in full
asaindoRtat
Lkg DAY CARE & SPECIALIZED SCHOOL.
Date Contractor
e t� ARCHITECTS DECLARATION
I undcrwnd my plans NJI M used as public records
b8�
h Liceued Professional
OatNEmBUILDER DECLARATION
E a 1 ... affirm on 11. ,B sine from the Contractor',License Low r for ly
71 a o following moon. emit t TID L5, t.Business and Professions Code:Any city or county
z$tai which requires•issuance,also re emuwet alar.improve,demolish, fie pair any.traetam
_Z�n pat hor e its ensetleentin res the applicant of forsuch the Conaretoiuo BleasLwd rtatemem
ppss< ,(commitcing wit Pursuant7the")previsions of the Contrwmra Llmnoe Taw(ChapterCode)or
Sq.Ft. Floor Area Valuation
yl-9 (eat he I.cnSwiNSenficam ndth India
ofr the
theeged asmdon.Anynvi Cade)err 5500
Q .. Nat he I..em pt Wcmfro.and the aura for the alleged eanmant to Any l Penson of
Sermon 703L5.acy applicant for permit anbjmu the applkanna.civil Penalty of 316250425 Number Occupancy Type
nm more then Bw hundred dallm(SSW). '
0 1,u owner of the property m my employe.with wage.at their sole compensative,
willdathewmk,andtheauucwreknot(nwr daroRemdfonele(Sec.•1 .B"new Required Inspections
and Profeaslons Cade:The Contru mr.License Law does.01 apply m an awns e ns of q P
Property who Wads Or imgave.thmem.,nd sewdoeaawb v.rk himself.tluo talo his
own employe.,provided Nn mch improvements am nor intended err oRewel for Ws.If.
however,the building or hnpmvemrat tsanld within ane year of completion,the owner-
builder will have the hurden of proving That W did not Wild Or improve for purpose of
hle.).
0 1.an owwr a the property..exclusively'"bruc lis with licensed contracmn to
construct the project(Sec.7014,Bush..and Professions Code:)The Cosmactof.U.
more law daes not apply in an owner of property who Wilda or improves thereon.red.
who conn ors for such p.jem with•eonuamos(s)limmsed purs.nt or the OmI acmf.
Licuua law. .
❑I not uempr underSo-
{• .B&PSC fair u
Lr
ver YYf?'/
Data 1 '?G
W KER' OMPENSATTON DECLARATION
Thereby&J T.under penslry of perjury arc of tint(ollwing dtalarW""^
[ham and will maintain aCeniOmu ofConwnt to elf-aurum for Worker's Compere
all=.u provided for by Section 3700 of the labor Code.for the perfamanm of the
work for which this permit is.sued.
0 1 have and will maintain Worker's Compensation Insurance,as required by Semon
3700of cite Labor Code•for the per(ormuoee of the wart for which this pernit is issued.
My Worker's CmepenaWon Income..rrier and Pulley number ace:
Cartier. Policy No.:
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
COtis wctlan wed not be com plead lithe permit I.far arc hundred doom($100)
or Tera)
1 cool that In thc performance of the.,it for which Nis permit in issued,1 shall am
cmployanypcna many wrap, mbecomeanbjecuatW Wrice 'Co pmudon
Laws of Califomi N.
ApPlkutt •//
NOTICE TO APP
Certificate of Exemption,you should
become subject m the Worker's Compensation provisions of the labor,Code,you mute
.,0 forthwith comply with such provisions or this Permit shall W domeed revoked.
ti CONmucnON LENDING AGENCY
IWmhy affirm that Vert la a construction lending agency for the performance of
ai > the were for which this permit is issued(See 3097,Civ.C.)
alander.Name
Z Landers Address
U O 1 verify that 1 haVC road I.M.application and Shue that do aWw informative k
!' cprtecL 1 agree m comply with all city and county aNinanaa and sue laws reading m
C) Wilding construction,and hereby mthodm mpresuiulm ofthu city m muoupnn dte
WW a Ww-mudowd p.peny fm inspection purpue.
IWe)agree m an.indco nify W Total,harmless the City of Cognition against
f/I liabilid.,judimens.cam and..perste which may In any way.mace against said City
U Z in cowegwwe of the granting of this pemtit L%
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued
Sigwurt of Appli.11y ZZRact Date
HAZARD S MATERIALS DISCLOSURE Type of Roof
00511 the applicant err feu re Wilding rccopantmrt or haMk hamdow material
u de0ned by the Cupertino Municipal Cade.Chapter 9.13.and the Health and Safety
.Section 25533()7 All roofs shall be inspected prior to any roofing material being installed.
DY.
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed-without first obtaining an inspection,.I agree to remove
:mit hnardous cif contaminants as dcGned by the Bay Area Air Quality Management all new materialsfor inspection.
MaricO
0r'. u
1 have mW doe hundtwmauri.ts mquircmenu under Chapter 6.95 ofthe Califim.
nu H.Ith&Safety Cade.Scnlans25505,25533 and 25534.1 undimmed thin lfthe Wilding
docs not currently haw a meant,duo It is my rtsponslhllity m oil' the occupant of Ne
rei.i. which 7and0armissu.M.Tmcc ' oOc money. SignatureofApplicant Date
� � c
All roof coverings to be Class"B"or better
Owner r Dam'