03030134 CITY OF CUPERTINO +. as '�'�"' '"
BUILDING mvlsloN PERMIT CONTRACTOR IlVFORMATIQN:
J0>h ; - _;�oxo
BUILDINGADDRESS: VENTURE BUILDERS PERMIT NO.
AB'S NAME: 1509 INDUSTRIAL RD PERMD'LSS B A .
P E: (650) 598-3999 SANRARY NO. CONTROL NO.
ARCHT=- IENGINEER: - BUILDING PERMIT INFO
' BLDG ELECT PLUMB MECH .
�oo LICENSED CONTRACTOR'S DECLARATION lob Desc i mita
u� 1 heoby.fOrm that I am licensed under provisions of Chapter 9(commencing p n
"� with Smdon]IXX))of DlWdon Sof the Bud Profeidons Code,mtlm Ikenseh �o�,t{++t�'} ED
Llfmlro an etrxsf7 Llc.« �7�y5 TENANT IMPROVEMENT-BORLAND
Lie C.° J —c°"`° STH & 7TH FLOORS ONLY JUL. � 2003
ARCHITRCTSD RATION
✓y linsM hsea
euaruhricmenNs FEES PAID ON #03030093
=ori LkenseJPafesdan.I BUILDING
OWN UILDER DECLARATION
1 hereby affirm LMI I a exempt From me Conlon Co License taw for the '
0 D fallowing mason.(Section R .5.Buairteu and Rofessiar Cods:Any city or county
a$ which inquires a permit to construct,alter.Improve,demolish,Of repolr any summon
prior In its issuance,also requires the applicant for such permit to file a signed statement
Fp< that heiallceno dpuauanttotheprovisionanftheComract.e.Lkcnse Law(Chapter 9 Sq.Ft. Floor Area Valuation
d$ (commencing with Section 7")of Division of the fiddncssond Profusions Conk)or
Nat he is exempt lFsrtform and the basis for da alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penally of 1 EPsggMy Top
not...than five hundred dollars(M).
APN Number �` 1tY' �7 e
❑1,as owner of the property,or my employees with wages as d¢iraole compensation, -
willdsthework,and theswctumisnot lmmmdcdoroffered Russia(Sec.7044,Business 36901029 . 00
and Pmfaad.Cods:The Canuactor's License Law does not apply to an owner of Required Inspections,
propeny who builds or improves thereon,and who doeuuch work himsehf or through his
own employ=,provided that such Improvements arc nothnanded croffmad for sale.11, 101 — FOUNDATION
however,the building or Improvement is sold within one year of mmpledon,me owner.
oulmes will hove the burden of proving that he did MI balm or Improve for purpose of - 102 - PIERS
. .
"I.J.
❑L.&owner of the property,am exclusively,contracting with licensed contractors to 103 — UFER
construct dm project(See.7044,Business and Profusions Code:)The Contractor's U. 104 REBAR
cense law does not apply to an owner of propeny who builds or improves thereon.and, POS ANCHOR BOLTS
who contacts for such projects with scontractor(O licensed pursuant to the Contractors
License lam, 106 - SEWER & WATER
❑lanexemptunder Sec ,Bit PCforthiswon
202 - UNDERFLOOR PLUMBING
Date
e WORKER'S COMPENSATIONDECLARATION 203 - UNDERFLOOR MECHANICAL
I hereby aRrm under penalty of perjury one of the following decimations: 204 — UNDERFLOOR FRAME
l haw and will maintain a Certificate of Consent toself-Insure for Worker's Compen. 205 - UNDERFLOOR. INSULATION
sedan,as provided for by Section 3700 of the Labor Code.for the performance of the 301 - ROUGH PLUMBING
'
work for which this permit is issued. '
❑1 ham and will maintain Workers Compensation Imunnce,as ins uimd by Seelion 302 — TUB & OR SHOWER -
37W ofthe labor Code.for the performance"r the wnrgfor which this pcmm0 is issued. � 303 — ROUGH MECHANICAL _
My Worknr��a Compenudonlrunna caprrrier and Polkyy�'uTmMre�� .� 304 - .ROUGH ELECTRICAL '
CanlerYJw.lC.7dT20'�f7't PyyIIcD No/: �y Z II�_
CERTIFICATE OF EXEMPnbA'F4lOM WORKERS' 305 — FRAME
COMPENSATION INSURANCE 306 HOLDOWNS - .
mless.)(nnssecOm neednotl ecompletad if the Permit is for one hundred dollars(g100) 307 INSULATION '
1 mnify that In the pe r...Re of the work for which this permit is Issued.I shall not 308 SHE ETROCK _
employ any person in any manner an as in become subjecuo the Workers'Compenuuon 309 — EXTERIOR LATH
LawsApplicant nt California,Date 310 - INTERIOR LATH
Laws ofoam
NOTICE TO APPLICANT:If.after making this CenlBcatc of Exemption,you shnulJ 311 — .SCRATCH' COAT.
become subject to the Warier's Compensation provisions of the lahor Codc,you most
C)0 forthwith comply with such pmadem
ma or this permit 0.11 he deed revoked.. 313 — ROOF NAIL .
'Z0 - CONSTIUCDONLENDING AGENCY 501 - FINAL ELECTRICAL ENERGY
�—m4 Iherby aRrm inn them its crnstmOlino lending agency for the performance of 502 - FINAL PLUMBING ENERGY .
lY. 7 the work for which this permit is issued(Sm.3097,CO.CJ
WqLender'sAa
Lenders Address me 503 FINAL .MECHANICAL ENERGY_
V0. .
o I certify that I haw read this application and state that the noon information is 504' — FINAL BUILDING ENERGY
LT. correct.I agree to comply with all city and county ordinances and state laws misting to 505 - FINAL ELECTRICAL
O V building construction,and hereby authorize mpreentstims or this city to enter upon the GAS EST
.hove-mentionad property for impeetlan purposes.
(We)agree to on.Indemnify and keep harmless the City of Cupertino against 0 7 FI
In
liabilities,judgments,costs and expenses which may in any way =me against said City
U 2 in consequence of the granting or this permit. 5 ICAL
G PPI,ICANT UNDERSTANDS AND WILL COMPLY WITH L NON-POINT Issued by:Cj Date `
S R E R G A ONS.
23 Re-roofs 510 NAL PLANNING
Signnumof ApplicanUCor to Dam ��4 - FINAL PUBLIC WORKS
H= SMATERIAISDISCLOSURE Type ofRo
Will the applicant Or future building aceupsm store or handle hamdous material
as&caned by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Jc,Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea; '(1
Will the applicant or future temporal If a roof is installed without first obtainingan inspection,I agree to remove
Ins 6 W equipment or devices which p g
emit hanrdnus air contaminants m defined by the Boy Ara Air Quality Management all new materials for inspection.
D'ank17
❑Yes Nn
I have read the hmrs, s ateials requirements under,Chepset 6.95 of the Califor.
nleHcul"Safety Cade,Suctions 25515,25533 and 23534,1 understand mel if the building - - -
does not currently hum a mnanL that It ts my m.porlhility n dfy IM occupant M the
m mcu is unbemetpdormisaoance eCCYiI. IOccupany. Signature of Applicant Date
Ownerunuthomadapent o m All roof coverings to be Class"B"or better