08060126 CITY OF CUPERTINO � ^
BUILDING DIVISION PERNIIT �CCINNTRAGTQR�INPORMA.TIO.N
BUIIDI G ORPSS: PERMIT NO.
1U DE ANZA BLVD TBD — TO BE DETERMINED 08060126
W NER'S NAME: v PERMR ISSUE DATE
CATHAY BANK 06/18/2008
PHONE: SANrfARY NO. CONTROL N0.
ARCHI'IECf/ENGINEER: BURRING PERMIT INFO
-BLDG ELECT PLUMB MECH
flotaLICENSED CONTRACTOR'S DECLARATION
CmF 1 Wmby alfirm that I am licensed under provinionsol'Chaprer 9(commencing Job Description
e2t�r
vimS==70M)of Division3ofNCBusrw Profensiom Code.uldmylic—ie COMM'L TI DEMO WLLS&DRS,WL INFILLS@E DOOR
<n. in ful folie and effceL
ucemt am Llc.9 OPNINGS, RLOC OF DRS&SNK,ADD NEW FLRSNK RLOCT
Dam.Contractor
ARCHr1ECI'SDECLARATION WTRHTR RPLC .FLR FINSHES, MINR CEILNG TILE RPR NEW
I understand my plans Stull Ise used as public records
g a. Licensed Prufcaai...I
5 OWNER-BUILDER DECLARATION
iE 1 hereby alTtsm Net 1 am exempt from me Contractors license Law for the
p O following mason.(Section 7031.3.Business and Professions Code:Any city or county
5_ which requites a permit to conswcL alter,improv.demol'W,m septir any smetum
-ZN pdorwiBM1UaMC.WSOl Uimel)ICappliCanlforbUChpeMillOGlCafignWSUNmcol
FF < thuleWicc=dpnl,rantmlhepmvieiemafd Con=. sU==tAw(Chapmr9 Sq.Ft.Floor Area Valuation
(commencing with Section 7000)of Division 3 ofthc Business and Professions Code)or $55000
Wthat he I,eaunPt Ihemfrom and the buss for the alleged......pd.0 My vWlm;osa Of
Seeaon 7031.5 by any applicant far a permit subjects the applicant lO a Civil penalty Of
MNumber Occupancy Type
l mart Na five hundred dollus(5300). 3 6 9 4 0 014
❑1.an owner of the property,or my employees with wage as Heb sok compensation,
will W the wort.and W suneture W.1 incomes or oRereE for sok(Sec.7044.Bumus
and Protestant Code:The COmhacmh Liame Law does not apply in an owner of Required Inspections
Property who Wilde wicaprowthveon.and wW daessuNwort himself.thrometh his
two employees,provided that such impmvemeats are not intended oromred for tale.R.
however,the Wilding or Wprowmem Is sold within one year of c.epleuce.the owner-
Wilder MR have the burden of proving,that M did an,Wild.improv for purpose of
sale .
1.u owner Of the property,am uclmivcly contracting with licensed cuumme ars to
construct the Mica(Sec.7044.Business sed Profetitm Code)The Connotations U-
cenen law does not apply an an owner of property who Wilds or improves NemOn•and,
who concocts f.such Projects with a eonmentorta)licensed pursusnl he the Contracmrs
License law.
❑Ions"am",
on .B d P C for us lesson
net flees/ Dain
ORKER'S C PE SATION DECUB Date
1 hereby amen under pemlty of perjury arc of the following declarations:
❑Ihew and will mainuine CeniOoie olCOnntuself-WimfarWerttrsCompen-
setion,as provided f.by Section 37M of dm labor Code.fm the performance of the
work for which this Permit is issued.
❑i hew and will main n Wortrrs Compensation Imuran,as required by Saxon
3700 of the lahor Code'for Ne performance of use wort f.which this Permit is intend
My Workers Compensation Insuranrc carrier and Policy number me
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
muisseemem recd mt W compleed if the Permit Is Intone hundred dollar($100)
.lux)
1 certify that in the performance of the work f.which this permll u iwed.I sail not
employ any person in my..=W-!ecpmpmbcc)5V6Wor1mry Compcmxmm
Laws of Califfmr t1/�Ca /_7F�fel'IJV
APPliesol09 / l�
NOTICE TO AfeEfCh?;PT AbWaldiffoWCertificam,of Exemption,you shOW
become subject in the Workers Compensation pmvions of the labor Code.you muss
.,Q forthwith comply with such provisions or mu Permit shall W deemed muted.
z" CONSTRUCnON LENDING AGENCY
(~ koeby whamrm Permit
ieecnnswcti0lending agency for the lorfonnan of
E
the wort f.which this permit W issued(See.]09'I,Civ.C.)
QLenders Name
O z Leader's Address
V O 1 certify that I haw mad this application and sole dem cot shmc huomadw k
!` erect.l agree ed comply with a0 city and county ordinances and aunt laws misting to
C)SV^ Wilding construction,and hereby authorim mpsmmldt of mu city to enter upon no
W aWw-mC1140Md property,f.inspection Pwpmti
CL (We)agree W ace,indemnify and keep l umlm it.City Of Cupertino against
Nd liabilitks•judgments.cents end expcmu which may in any way steres against said City
V Z in consequence of the gu.ing Of this permit.
^ APPLICANT UNDERSTANDS W WILL COMPLY WITH ALL NOryryry-POINT Issued by: Date �•/
SOURC v// C)-3
0 Re-roofs /
Stgnazm
uo pplicanUContraclor
xnznOUS MATERIALS DlsaosuRE Type Of Roof
Will the a Cupertino
or future ipal Co e.Chart rumor fundic Healtum.aerial
u de0ned by the Cupertino Mumnpal Cade.Chagcr 9.13,ane the Health and Safely
Section 35333(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yen LPN�O
Will the applicant or fugue Wilding occupant iso equipmerrt.devices which If a roof is installed without first obtaining an inspection,I agree to remove
District�us azr conumim m as unlined by the Bay Area Air Quality Management all new materials for inspection.
❑Yen 6Q/
I haw read the hasud.0 maleriMsmquirenunu under Chmm,6.95ofde Calif.-
riaHrul"Sal.yCWc.SecdaunM3,25533 and255M41 undcrsumd thazifthe Wilding
tires rot curmnuy v a u^•^c Il'u my respamiWlity u MtifY do occupant of the
nNunumenls met issuvueOF.CeNfceuofQ,,a� Signature of Applicant Date
�� r 5, All roof coverings to be Class'%{"or better
Owner Or ser frixcd agent ere