06070071C
CITY OF CUPERTINO
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> CON TRACT,0R4NF0RMATION 'W
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
-NOVO CONSTRUCTION
P"""N006070071
20400 STEVENS CRK BLD 3
OWNER'S NAME:
PERMIT ISSUE DATE
CHORDIANT
1042 HAMILTON COURT
08/02/2006
SANITARY NO. CONTROL NO.
(650)701-1500
ARCHITECT/ENGINEER:
BUILDING PERMMWO
BLDG ELECT PLUMB MEC"
LICENSED CONTRACTORS DECLARATION
Job Description
hereby affirm Nat 1 am licensed under Provisions of Chapter 9 (commencing
with Sectat7") of Division 3 ofde Business and ofe��y my license is
in full forte and effect. �`Z / ,�%Z
REVISION -MODIFY CEILING/ADD ELECTRICAL
Dae contractor 6v0 a r
ORIG PERMIT $(06060170 -NO NEW PERMIT
ARC11ECTs DECLARATION
I underwnd my plans shall W used u public mcc ds
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm Nat 1 son cs.mpt from Ne Contractors License law (or the
following mason. (Section NO 13, Business and Professions Cade: Any city or county
which mquim a permit in convect, almm improve, demnll h, lir top , any, structure
prior to its issuance. also mqui= flue applicant forsuch parmil to rile a signed statement
• of site Contractor's License Law chapter 9
he u licensed
Sq. Ft. Floor Area Valuation
thn Foremast to the provisions
I(commencing with Saction 7000) of Division 3 of the Business and Profusions Codc)or
• Nat be u exempt thetcfrom and de basis for site alleged exemption. Any violad,an or
Occupancy Type
Section 70313 by any applicant for. permit subjects the applicam to a rnil penalty of
twt mmc titan faw hundmd dollars (ISO().
077 VVV1V C
3 0 O
❑I,uawmro(Neptopmy.amywploycuwiNwaguuthehmlecam radon,
e ns
Required Inspections
will do the work. and the atmemm 4 maintenaa aalfeed krsale(See. 7W. Business
Cade: The Contrwrs License Law does trot apply w an awns of
and Prefesmons Cam
q P
Property who builds or improm thereon. and who doessuchwork himself car through his
awn ampkyses, provided can such impmsemems art rot intended aoffered fatale If,
howcwr, the building or improvement u sold within ane year ofmmpkdon theowmu,
improve for
builder will have the burden of pmving Nat he did not Wild or purpose of
sak.).
0 I, as Owner of the property, am eaclusiwly connecting with licensed convectors to
construct phe proje. (Sec. 7044. Business and Professions Code:) The Conmactari Li-
come Law does not apply to an owner of property who builds or improm thereon. and
who contracts for such projects with acontractnr(s) licensed pursuant to the Contractors
License law.
\
O lsmacmptunder Sec .BL.PCforshismason
\
Owner Date
WORKERS COMPENSATION DECLARATION
V1 hereby a firre under penalty of perjury, am aof the following declarations:
and will maintain it Cer likeeof Consent w self -inure fur Warkcrs Compere
section, . provided for by Section 3700 of the tabor Code, far the Mdse rami. of the
work for which this permit is issued.
0 1 haw and will maintain Worlmes Compenumon Insurance, as me uirtd by Section
3700.(0. labs Code, fa the perfamanee or the work for which this permit is lamed.
My Workers Compensation In.= ani. and Policy number art:
Cartier. Polity NO.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
.
(Thu seet1cm ius l wo be canplcmd if the awnit is faros hundred dollars (SIM)
or less)
I certify dist in the perfnrmmcc of the wah for which this Permit is isaad, I shall not
employ any person in any manncrm an to become subject to Or Worker3 Compensation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If, after making this Certificate o(Ex.mptian, you should
become Subject ta On Worker's Competuation provisions of the labor Cade you mus
' forthwith comply wish such provisions or this permit shall be dcemnd rooked.
j CONSTRUCTION
a conNLENDINGAGENCY
1 herebyich thi dist siert u a construction i30 ending agency for the Ferfamance of
' theLe work fur which dire permit u issued (Sec. X57, Civ, CJ
Nun.
Le.dcr's
Lcnmh Address
j i certify Nat 1 have read this application and sue shat she above infamtation is
' camel. l agree to comply with all city and county ordinances and state laws relating to
Wilding eonamuetion, and hereby au Noma mpmsentatim or Nis city to enter upon the
above-propcny for insperme; purposes.
cuoa
1
(We) agree to taw. indemnify and keep harmless the City of Cupertino against
j IiabiliOes.Judgmcnu.costs and expenses which may In any way at. agaiutslid City
imbibO .j.Irn
in consequence of the granting of this Permit.' APPLICA� ERSTANDS AND WILL COMPLY WITH ALL NON -POINT
0.CE GLA
Issued by: Date Z --e2_
0 0
Re -roofs
Signature of AppliamOVonuaanr one
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant car forum Wilding ocoupantstore or handle hanrdou material
u def ted by the Cupertino Municipal Code. Chapter 9.11. and the Health and Safety
Cans. Section 25532(a)7
❑Yaa
All roofs shall be inspected prior to any roofing material being installed.
Will thea Thant carr rmwm Wildin Occupant um whim
fN tequipment or
If a roof is installed without first obtainingan inspection, I agree to remove
P
n s air contaminants as defined by the Bay Area Air Quality Management
Mina
all new materials for inspection.
District?
Dismia?
0Yes Nu
1 have mad the hoorduusmaerols requirements under Chaper6.95 of the CARL.,
nu WAIO 6 Salcty Com• Sections 75505.25533 hod 15534.1 understand shuifNc Wilding
does not cu tenant, Nat it u my responsibility to notify the occupant Of she
rt mire cots wnkn mum pt pnia som af, CeniF, arOca
Signature of Applicant Date
All roof coverings to be Class "B" or better
owner.r.mIhn,.dag Dae