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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
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PERMIT N0.
STEVENS CREEK BLVD
TBD - TO BE DETERMINED
08030070
W NlER''S NAME'
PERMIT ISSUE DATE
KCR DEVELOPMENT
06/27/2008
HONE:
SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Chapter
o
lb Description
1 hereby affirm Nde 9 (commencing
at I ate licensed unr premiums of
Milt Section 7")of Division 3 of the Busioeu and Profession Code. aM my license is
-
DEFERRED SUBMITTAL -TRASH ENCLOSURE
in full roue and effccL
License Class Lk. k
Dab Contractor
ARCHITECTS DECLARATION
I undemonnd my plana Nall be used as public ecords
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby wiire out I am exempt Imro the Cmmriemr. Liana law for the
following ewon. (Section 7031.5. Business and Pmfescom Code: Any city or county
which mquires a Permit or construc4 alter, improve, demolub, or repair any sbuctum
! poor to its icswnce,,lsu requires the applicant for such permit to flea signed statement
he i, licewed to ft ofdb Contranmrs Uccnao Law (Chapter 9
Sq. Ft. Floor AreaValuation
that purmant provisions
(commencing with Section 7") of Division 3 of the Busineuand PmrruCodc) or
$40000iow
! that be is eumpt theref oro and the bwis for the alleged exemption. Any violation of
Occupancy
Secdan 7031.5 by my applicant for a permit subjects the applicant to a coil penalty ofNumber
not more dm fiw hundred dolim($5W).
36906008.TYpe
❑ I,uawne mf the property,ocmy employee with wallassdse'v sole compnuadon.
Required Inspections
will da tW wo& and the structure u notinueodc l or offered forsak(Sce. 7000,11usinas
and Profe.tiow Code: The Coromeme, Lice. law doe rot appy b m owner of
property who builds or i mprowa thereon, and who docs such wart himul f or through h u
awn employ., provided Nu inch improsemmte see not intended oroRered foraale, if.
Immomr, the Wilding or improvement is sold within one Year of caopkdm. the ownm-
Wilder will haw the Innocent of proving that he did Out Wild or improve for Fortune of
sat.)..
t] 1, as owner of the properly am aciuuwly contracting with licensed wmraega b
construct the pmjco (See. 7000. Bummn and Professions Code:) The Contractors U.
cewe Law dons nm apply at an owner of property who Wlbs. improves thereon. and
who contracts five such projects with a eonuutar(s) lice ned pmmant in the Conuum'.
License law.
ire eaemp, untln See B 6: P C for this moon
Dam
Fee"1
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury rine of the fallowing decimation
❑ 1 hire and will maintain aCeruftamof Coroentto self-iwurt for WorkersCmmprn.
,anon, an pmvided for by Section 37W of the labor Code, for the pothormene, of the
wort for which On. permit is issued.
❑ 1 haw and will maintain Workers Compewation I.... as mquited by section
37W of the LaWr Code. (Or the pertmm r cc of the work for which this Permit is luted.
My Workers Compewabm insurance amu and Policy number see:
Carver. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Ibis seed. ted m, W compkmA Bede permit Is formic hundred donna ($100)
or less)
1 ouni that in the performance of the work for which Nis Permit u imm,d, l shall no,
employ any potion in any m um%7as to the Workers' Compewti.
Laws of California. D. �66Wpmt�subject
GGffii/f ZZ �f
Applicant
NOTICE TO APP Co : If. after making this Cerdbwm of Emmmi., you sbould
become auhjec, b Ne rkers Compcwtion provisions of the labor Code, you muse
faMwith comply with such ProAimme - this Permit aha116e decmW evoked.
CONSTRUCTION LENDING AGENCY
1 hereby aRm this there U. cawtruN. kndiog agency for db perfamaue of
dre work for which this permit is ummul (See. 3W7, Civ. C.)
lender's Name
Lender. Adores
-
1 certify that I haw mad this application and sub d u the aWw information u
cmmcn. I agme to comply with all city and county ordinances and auto laws relating m
Wilding convection, and hereby authorise repumate s of this city m over upon the
tlloYe-mentidned pmpCM1Y rm iwPeNmO purpowhich
(We) agree to sew. Indemnify and keep hamlets the City of Cupertino agaiwt
coati and expernoter a
which may in My way amue,guwttend City
inconseqencejudgments,
in conugwmc of the granting of this permit.
N
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCEREGULA NS.
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G67/1-9
Re -roofs
Date
SignommolAppli=US
AT
MATERIALS DISCLOSURE
_
of Roof
WIOyteCupmtsur (Muni Wildinge hnd hrurdousmaterial
��—
n tleBned Chaptr9.1m
the Cupertino Municipal Codc. Chapter 9.12 roti the Health roti Safety
.
cede. Section 255324n?
❑Ya ErN.
All roofs shall be inspected prior to any roofing material being installed.
Will the spplicnot or future Wilding occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit bacmh w airconuminanu to defined by the Bay Area Air Quality Management
all new materials for inspection.
DimicR �
D sec. ❑ Nu
1 haw mal the h»ardonsmabriau equimments under Chapbr6.95 of the Califon.
iia HalNkSeI yCade,Seevau25505.2533md25534.Iund dNuifthe Wilding
doa not cumndy haw a tenant. that it u my rapomthiloy b.dlY tW a¢upant of db
rtquirtmcnt mwlW tprimrbintrmamracenifiabafQr7r2:7kA
l(/11 (o
Signature of Applicant Date
All roof coverings to be Class 'W' or better
Owner or,mthnri> gem b