05010017 ;i'�IFMING
TYOF CUPERTINOBUILDING'DIVISION PERMIT ADDRESS: TRITON CONSTRUCTION CO. PERMITNb5010017R'S NAME: PERMRLSSUEDATE
SYMATEC" (2ND/3RD FL) 1948 MT DIABLO RLIM
E: - SANITARY 440. '-_• CONTROL NO. -
(925) 946-9648
ARCHnECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+�oa LICENSED CONTRACTOR'S RATION. �.' - + _
Z �Imby arcrm Nattxm llmneed umkr pmvwam esti tp�9(canmexmg Job Descrlf/u yuf� 8 ({ L -' - -- -"
<< n7IXXD afDivl 7ofma Budreu and ProfeWom Code.and myllcenwb �IUp1���V`,fNy19/gr-.�\K
err mcewdercec S !]- DEMO (2ND/3RD FL. )
n'�z LIcenw Clan Lk.d '.. - MAR ..._ _
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�i t�`Sge' Y�aGWJ my phm Ntll be unJ upublic - �U05 -
3 Lm
fcesionul - _ -
58� OWNER-BURDERDECLARATION - q'y A:,
<y I WrehyafRon that 1 am eamps from me Connuctoru License Law for the
p, ry.p"e- -
C C o followingwon.(Section 7131.5.Business and Profesdan Codi:An cit m roOnlyv �l 1�' ,„f
I$ which requires a permit to eonatmil, Mer.improve,demolish,or repair.any structure
1-.4^ 'prior w lso its issue=,arequires de applicant for such permit w file a signed summer
< tMtheiemmnwdpuManttnmcpmvigionl Offt CQnLmwr's LimnwUw(Chapwg - Sq.Ft.Floor Area . .-.-. Valuation - ..
(commencing with Section 70001 of Divnon3 of de Budnessand Pramsslov Code)or
1.- that M is exempt therefrom and the butt(or the alleged exemption.Any violation of
Section 7031.5 by any applicant far a permit subjects W applicant in a civil penalty of 3 6604114620=0 0 OCCU anCy=Outmremanfivehundreddolln +pa
,.
0I.uwmeraf0apropeny.mmyet6playmwWwaguu0ahwlc o pemdm. .
willdo themek and theswcture is not inm akdmaffered forsele(Sec.7044,Bairn
-' and Professions Cade:The Conrramors License Law dm sea apply m w o-xrcr of Required'Inspections
property who builds or improves themon,andwha dmuuchmak himselfor through his - - -' — - - .7.
-
.. awn employees,provided thin such improvemmu ere onlinmMed moQered fmtale If.
however,the building or improvement Is mid within or year of mmpledon,Ne owner- -
builder will have rhe Wrdon of proving most he did rt Wild Or improve fm purpose of
sal.).
❑1,As axon of the property,am exclusively contracting with fianwd comraclma m
mruwet the pmjca(Sec.7044,Business and Profession Cade:)Tla Contrecmru Ll-
..Law dean am apply in A.new.
-avelawdonsnmapplymA.new.of property be Wild,At impoem thereon.And. - - - -
who contracts for such projects with a cominclorts)licensed pursuant to the Contractors .,. .,
License law. .. -.
❑I am exempt under See, BA,P C for this
Owner Data _ _ -
. WORKER'SCOMPENSATIONDECLARATION - --- - -_' "' - - -
1 hereby aam under penalty of perjury,one of the following declsndovi
I have and will maintain a Ccnficam of Constantin self-insum for Wmbera Compaq-
Milan,As provldM for by Secdan 3700 of the labor Code,far me performance of the
work for which Nu pmnit is issued. ... .. ..
❑i have and will maintain Workers Compensation Inauwce,ss .red by SeNon - - -
37Wofth her Code,for the pofmaraec of die work for w nTemit is issued.
We (Ca pen�a[d�pn�Inwryn��caner and Poiiry Tae:. -
Ca `va`r vJ Poliry Na.: 101147. ,
CERTIFICATE OF EKEMTON FROM WORKER ..
COMPENSATION INSURANCE
(7hm vectionretlnm Wcompletad lithe Permit lsforonc hundred dollars($100) - - - -.
or m+a)
1 cerlify that in the performance of the wart for which this Permit Is issued,l boll not
ernploy any person in my mannerw as in became subject to the Workers''Compensation
Laws of California.Dam
Applicant ..
NOTICE TO APPLICANT,IL after making this Cenilicam of Exemption,you should
became subject m the Worker's Compensation provisions of the Labor Code,you most
OO forthwith comply with such provisions"is Permit shall be deemed rooked. -
CONSTRUCTION LENDING AGENCY
(~4 Thereby offine Our Nem is a construction lending agency,for the performance of
ai> the work for which thin permit is Issued(Sec.3097,Co,C.) -
W Q Landes Name
z Landers Addiess
[)Q 1 certify mat 1 love read this application and sum mat the above info made,Is
Iy F
Ono.I agroe in comply with all city and county ordinances and mm laws misting m
Q U Wilding construction,and hereby authorise representatives of this city tomw upon the /
W above-mcmianed proinny for ivpecton purpmes
a (We)as=to Mve,indemnify and kap Mumma,the City of Collection again,
W liabilities.judgments,coats and expenses which may in any way moms against said City.
fJ`,LIn consequence of the Starting of this peril
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by; Dat//Z�r/
SOURCE REOU TIONS.
O� Re-roofs
` Sig uncol'ApUliftuComrsefter,li Daw If{I OOf ROOF
HAZARDOUS MATERIALS DISCLOSURE •J p
Will de applicant or future Wilding occupwtswao or handle huardous malarial .
u defined by the Cupertino Municipal Coda,Chapter 9.12,and the Health and Safety
aJn.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yea Xi
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hmAnus air comenciants As defend by the Bay Awa Air Quality Management all new materials for inspection.
District? /�
❑Yea r rru
I have read the hanrdun�44sn u cria4 requimmenu under Chapter 6,95 of the Calirm.
nh Health&Safety Cade,Sections 25305,25533 aha 25534.1 tru ersmed that ifthc building
Jots not currently have a wnane est it u my resWnsibill.y w entry the oecupam of de
tyipimmcnuw ich muu`W'tne rwiuuawe oh CertiOcem of Occu wry Signature of Applicant Date
V t a�
owner ar oath m.a a art Dam All roof coverings to be Class "B"or better