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CIBUlLDING OF
DPER�ONN0 PERMIT
itCON,TR CTOR INFO]k AWIOT��.
BUILDING ADDRESS:
PERMITNO.05070184
20330 STEVENS CREEK BLVD
R'S NAME:
PERMIT LSSUE DATE
SYMANTEC
07/28/2005
PHONE:
SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I Wroby affrrn Nu 1 am I coned under provisions of Chapter 9 (commencing
with Section 70(X1) of Division 3 of the Business and Forkwion, Code, and my license is
in fun (Coca and crfe
DEMOLITION OF EXISTING OFFICES
T/J
License CI Lie. X
Dome CO.L.101
D121,ARAnObl
Vhamons �—�pARCHMECT'S
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1CH
b+aL
rofcs;onY
OWNER -BUILDER DECLARATION
I hereby affirm Not I am eacmpl form the Cmmracnel Licenx Law for the
following mason. (Scctiun 703 1.5. Business and Foreswear Code: Any city Cor county
which ¢quina a permit to consumer. alter, imporw, demolish, or repair any structure
$20000
prior to m, issuance. also mQuim1 the applicant for such Permit to file a signed statement
that W is licensed pursuant o Nc pmvinknu of Oc Conlruwr's License UW (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Div'sion 3 of Ne Business and Professions Code) or
that be u exempt fmfmm and the basis for Its, alleged exemption. Any violation of
r
Occupancy Type
3Lhan
Saurianor Rb by�dmdlydcaronfrapwrotwbfccudeeapplicantcoacivilPenallyOf
ollars
1, m owner niche propcny, or my employca with wages as duir sale compensation,
will do Ne work, end the{buctum is not intended croRmeA forulc (Sec. 7004, Business
Required Inspections
and Professions Code: The Comatemrs License taw does rot appy N an mother of
property who builds orimpmsrs thercen. and who doessuch workhimnelfor Wough his
own eer.mea,previdr Narsuch improwm arene n,
wtcou
year fompletied
i the mral,
builder Nebuilding orimprowmenlishathwithinoro Wild of completion, the owner
builder will hew On burden of proving that he did not Wild or improve for purpose of
plc
I, as Owner Of NC poc.704 am suras and contrPrefeserlmg with rat, d umVxbR i-
1.
construct Nm project (Sec. Wino Business and v Code:) The amon.
rty who u d fid
cemx Iso dors not apply ts owner of properly who Wilds or improves thereon, and,
/
e
whocontractsLacs for such projeeu with a contrxmr(s) licensed pursuanuo ted Convumr'sLica
v
JW.
01 wo
❑ 1 am esempl under See . B & P C for his recon
Dare
WORKERS COMPENSATION DECLARATION
I hereby am. under penalty of perjury one of Ne following deddmiom:
0 tinware! will rommuin • Certificatemf Consent m self-Imwn, fm Wmkcracampen-
sarion, as provided for by Section 3700 of the Isbor Code, for, the performance of Ne
work for which this permit is issued.
0 1 have and will maintain Wmker's Compensation Inamance, az roquimd by Section
37W of Oc labor Code, for the performance of the work for which this permit is issued.
My WmrkcYs Came oration Ins coma ca 'm and Policy num11 Wr are:
Cartier. Policy Nm.:
CERTIFICA OFFS ON FROM WORKERS'
COMPENSAT NINSURANCE
(Thu action need not W completed Btbe permit is for one hundred dollars ($100)
or ess.)
1 certify that in me performance of the work for which this permit is issued, l still not
employ any town in my manner so az in become subject on he Workeri Compcnption
Laws of California. Dau
Applicant
NOTICE TO APPLICANT: If, arm, making this Certifiam of Exmpti. , you should
became subject to the Worker's Compensation provisions of the Labor Code, you mus,
forthwith comply with such ronaiaas or this permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby aRrm Nat them is a comtmclion lending agency for tic performance of
Ne work for which this permit u owed (See. 3097. Civ. CJ
Undoes Name
-
Londee. Address
1 comfy that I have read this application and sum Nd the shout information is
coram. I agree to comply with all city and county on inances and also, laws relating in
building conswction, and hereby wounim mprexnmiws of Nis city to corm upon du
aMve-menudgm pony for on terpowhich
(We) agree to sore, indemnify and keep har pled Ne cry of Cupertino against
..p.
ms
judgments, cora and expcnsa which may in any way umce against pin City
oabiliva,
moon cncc mf Negcoming of Ni 't.
FP UUEROSTA 5 0014 iC MPLY WITH ALL NON -POINT
Issued by: Date
S CER
Re -roofs
R orApplican Dossers Date
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant ter lunum Wilding acupantstom or handle harmonious material
az defined by the Cupertino Municipal Code. Chapter 9.12, and the HeaBh and Safety
e. OYon tion25s3z(a)1
, O
All roofs shall be inspected prior to any roofing material being installed.
�r
Will the applicant furore building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit havardous air contaminanu ss dc0ned by the Bay Arca Air Quality Management
all new materials for inspection.
DiwicR \1
No
0 Yes g
I haw read the hapnlommaudals requiremcnu under Chapmr6.95 ofthe Califor-
niaHcalN&SafctyC0dc,Secuom 5505. J3 anJ 5534/I undersund that if Nc Wilding
macs u nlly have a,mnann, Na 't i m Rspo ibility u noul'y the oceoPan of the
aqui uwhic " i team a fi am of Occupancy.
�gnature of Applicant Date
All roof coverings to be Class "B" or better
neem uthonacdagent Dam