07110119 CITY OF CUPERTINO �
BUILDING DIVISION PERNIIT ��'���������������
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BUII,DING ADDRESS: PERMIT NO.
10600 N DE ANZA BLVD 1ST FLR NOVO CCNSTRUCTION 07110119 .
PERMI'f ISSUE DATE
OWNER'S NAME:
SOBRATO DEVELOPMENT COMPANY 1042 HF.MILTON CT � 11/20/2007
SAMTARY NO. CONTROL NO.
�NE:
(650)7C1-1500
BUICDING PERMIT INFO
ARCHITEC[/ENGiNEER:
HLDG ELECT PLUMB MECH
� � � �
u p p LICENSED CONTRACTOR'S DECLARATION JOU DeSCTlpt1011
V� I hcrcyy afficm Wat I am lixnscd unckr provisions oC Chaptcr 9(commencing
�z� withSccUon7000)ofDivision3of�hcBusincssandProfcssionsCodc TEMP PF;RMIT—DRYWALL � T—BAR � FLORRING TEMP PERMIT �
�< a in full foree and effect.
;�z LicenacClass ��.�► GOOD Or�LY 30 DAYS, EXPIRES DEC. 2 0, 0 7. N O F I N A L
: F ' � Da � ARCHITECI'S DECLARA7'ION ON TH I: i PERM I T
��� I undersund my plans shall be uscd u public rccords
�yU
`� y Licensed Prufcuionai
y � OWNER-BUILDER DECI.ARATION
� I hcrcby affirm iha� 1 am raccmpt from thc Convaaors Liccnsc L.aw far �hc
� p O following reuon. (SccGon 7031.5, Busincss and Rofcssions Ca1c: Any ciry or counry
y$ Pi which requices a permit to cnnswct, aitcr. improvc. dcmolish. nr repair any swcwre
prior 10 i�s issuance, also requires �he appiicant (or such permit �o file a signnl sulement F't Floor Area � O Valuation
� _ � thu hc is IicenscJ pursuant lo thc p�ovisions of thc Conuactor's License f�w (Chaptcr 9 S�] •
Y t- (commcncing with Sccdon 7000) of Division 3 of thc Busincss and Profcssions Codc) ur
y�� that he ia racempt therefmm and tAe buis [or �e alleged exempdon. My violatiun ot
Section 7031.3 by airy applicant fw a pecmit subjecu the applicant W a civil penatty of 316 0 21 c) 3'�� Number Occupaney Type
not mme �han fiw 6undred dollars (5500)•
❑ 1, u owner oC Uu pcnperty, ar my employces with wages at the'v solc compensadon,
will do the work and i6e strucwre is notintended or of[ered for sale (Sec. 7044, Businesa Required Inspections
and Professions Code: The Conuactor's Lianse Law does not appty to sn owner ot
property who builds or improves thercon, and who does such worlc himself ar through his
own employces, provided �at such improvements are not imm�ded or otlbred for saie. lf,
however, the building or improvemenl ia sold within om yar of complcGon, the ownu-
builder will have �he burden o[ proving that he did nat huild or impcovc for pu�pose of
sakJ. . .
0 I. u owner of the propeny. am wcclusively conuacting with licensed conuactors w
constnut the p�njett (Sec. 7044. Business and Profcssions Code:)'ff�e Conuactur's Li-
cense Law does not apply to an owner of propeny who builds or improves Ihemon. �nd ,
who conuacu for such projects with a conuactor(s) licensed pursuanl w �he Convacror's T���r ��� Pe=
A tp1Y
License Law. . .
❑ I am exempt undu Sec. . B& P C for this reason �
� _�. _,.�. ��..,r1e�Ofl
Owner Date '
_-sue
WORKER'S COMPENSATION DECLARATION Cont � �!ete
1 hercby �rm under penalty o[ perjury one o[ the following decluations:
( hsae and will mainuin a CeniGcam of Consent w ulf-insurc for Workers Compen- rp,5 � "�
sation, as providcd far by Section 3700 of �he Labor Code, far the perfarmancc ot thc •
work tor which this permit is issued. dm �
❑ I havc and wiU munitin Workcls Compensauon Insunncc, u requircd by Section • r.Or
3700 ot the I.�bar Code. Cw ihc per(ormance of �he work for which this permit is issued. V
My Worlcers CompensaGon Insucance cartier and Poliry number ue: �pr ; i
!c
�v
C�� Poliry No.:
CEKI'IFICA'[E OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANC6 f r`' ���, V
(This scction need no[ be canpieted if the permit is Cor anc hundred dollus (51001
or Icss.) � , /�� j �/ ' t /
I cenify that in t6c perfortnance of thc work for which ihis permit is issucd. ! shall not S� � l� �e v i�v '�/ /1 (/`� -
employ any pecsan i� any manner so u W become subject to �he Workcrs' Compensauon
Laws of Califomia Date /� y
Applican� t�. L / --
NOTICE TO APPLICANT: If, after making this CertiGca�e of Excmption, you should
bccane subject to the Worker's Compcnsadon ptovisions af ihc Latwr Codc, you muu
�,'� for[hwi�h comply wi�h sueh provisions or this permil shall bc dccmcd revoked.
O CONSTRUCTION LENDING AGENCY
(� r.�r I hercby �rtn ihat thcre is a consuuctinn Icnding agcncy for thc perCurmance of .
p�„ � ihe work for which this permit is iuucd (Scc. 3097, Civ. C.)
W A Lendefs Namc
? � L.cnder's Address
V � 1 cectifY �hat I have rwd �his application and staic ihat �he abovc informaGun i:
w F co�a. 1 agrce w comply with all city and county oedinarkes and suk laws celating w
0 U buildin6 consuucdon, and hereby authoria reprcxntaGvcs of this city to cn�er upnn ihc
w alwve-mcndo�d pmperty for inspenion pur�ases
�a (Wc) agree to save, indcmni(y and keep harmless the Ci�y o[ Cupertino against
�,� � liabilitiu, judgmcn�s, cosLS and expenscs which may in any way acc[uc againsl said City
V z in consequencc of �Ac granting of Ihis permi� Date
� APPLICANT UNDERSTANDS AND W1LL COMPLY W1TH ALL NON-POIM Issued b ":
SOURCE REGULAT(ONS.
Re-roofs
Signature of ApplicanUConvacwr �8� T of ]toof
HAZARDOUS MA7'ERIALS D[SCLOSURE }��
Will the appliant or future building acupant storc or handlc ha•rardous ma�crial
az defincd by �he Cupenino Municipal Codc. Chap�cr 9.12. and �he Hcalth and SaCcty
c� Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑ Ycs ❑ No
wll thc applicant or future buiiding occupant usc cquipmcnt or dcviccs which
If a roof is installed without first obtaining an inspection, I agree to remove
harardous air conuminan�t az ckfincd by the Bay Area Air Quslity Managcmcm all new r laterials for inspection.
�.,����
Q Ycs Q Nu
1 havc rcad �he ha�aM�ws materials requircmcn�s undcr Chaptcr 6.95 of ihc Cali(or-
nia Flcalih & Safcty Codc, Sectio�s 25505.25533 anJ 25534.1 undcrs�vid ihat iCthc building
docs nol curtcntly havc a mnan4 ihat it is my responsibiliry w notify Uic occupant af Ne
rcyuiremcn�s which muu bc me� prior a issuancc of a Ccnificatc of Occvpancy. S(gngtUi�' of Appl icant Date
p �� _ All roof coverings to be Class "B" or better
Owner or authari�cd agcnl