01100031 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10443 BANDLEY DR 01100031
OWNER'S NAME: APPLICATION SUB DATE
DEVCON ASSOCIATES XVI 10/04/2001
PHONE: SANITARY NO. CONTROL NO.
O ecZ ARHITETEGINEER: BUILDING PERMIT INFO
O
BLDG ELECT PLUMB MECH
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y a LICENSED CONTRACTOR'S DECLARATION Job Description
SZ Iherebyaffirm ,, Iorolicensed under provisionsofns Code9(commencing
mem with Section]OW)of Division3 of the Busine sena Professions Code.and my license TENANT IMPROVEMENT.
Sms� ismrmlfareean a eat..r (T-BAR CEILING & CARPET)
a Licen Class Lia.
O a O Dam Contmaor
µ0 QHITECT'S DECLARA'f{MN
c .a I vndc...and my plans shall be used as public mcafds F I Iii.nom lana E D
2
u p O Licensed Professional '
o� OWNER-exempt R m the CATION 2001
1 hereby affirm that 1 a.1. exempt from the C stone is License law,for the N U U U 5
Z a fallowing ressoa permit
t ]031.5.Business and Professions Ca de:Any city or county
F o wh h 9 issuance,also
t t alt improve,hproaddemolish or repair ed structure -. _ __
F3 m .p to its smseld p el req Neininsapplicant f rs ch pens n Licenfile se
Law
(Chrome t - - - - - -
°' _ (commencing
ith anul0)ofDivision of theBusinsCc PmSiw(Chpte9 -- ,5 $q:-FtlFloorArea,� Valuation
or
mheiscwithS eonomanof Division the BusinessmMi6m Any
Code) y. 'e, r0. 6 ,4i inb.,1.M1.). ..
or that he is exempt any apom'and the basis for the subjects
ed efempn6o Any violationrv� I
of Section 7031.5 v any hundred
ont fora permit subjects the applicant a civil penalty
Ior at maln,nan eve nandrtd aoliars lssdm. APN Number i� .. : Occupancy Type
01,.owner of do,property.or my employees with wages as their sole compensation,
will do Oa workand the swcmrt is not intended or i ffened for sole(Sec.7044,
Business'and'Pmfessions Cole:The Comnaor's License Law does no,apply to an 102 - PIERS Required Inspections' "
ownv of property Who builds or improves domain,and who does such work himself 103 - UFER
o thin h❑ n employees provided that such Improvements arc not intended or t
;co ted f ule owner-builder
the buddm un -improvement n sold within one ild of104 - --- - - - "
completion the owner Wdder win have the buof proving the,he did not year
or - REBAR
impmvefmpmpaseafsale). 105 - ANCHOR BOLTS a
It I m "rWrodauipoputy,am Buss e 1 ,main with licensede Com mrs,o -
SEWER &: WATER
Licewa ae ors n Isco.roan,Beninese and Professions caacr)The vestmrson, 2 02 - UNDERFLOOR PLUMBING
License law does not apply men owner of property who builds se improves thereon,
and who es License
for such Projects wont a aontmmoas>.uaen d pursuant ro me. 203 - UNDERFLOOR MECHANICAL
ContmctoPs Lirense Lew..
❑I am exempt under Sec. ' ;9,&PC for his reason 204 - UNDERFLOOR-"FRAME It'''
owMr ' "oma 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
I hereby affirrin under pnal�y orcel ry r{ne ranowing aealamnona: 302 _ TUB & OR SHOWER
❑ I have and will maintain a Cenificarc of Consent m self-imine for Worker's 3 03 ROUGH MECHANICAL
Compcnsmion, ns provided for by Section 3700 of the Labor Code, for the
performance of the work far which this gem it,is issued. 304 - ROUGH ELECTRICAL
❑I have and will indiction Worker's Compensatiali Iliouraticc,ai required by Section 3 05 - FRAME
37M of the Labor t ' ICER Cade for the performance of On work for which this perm t a 3 0 6 HOLDOWNS
I d My W ,r,,,.,fns e c nd P l y a
2� n7 307.: INSULATION;'.
calrlm nF,EzemyNONPRowq •, .j, ' 'ra G 308,. to,
t. .
COMPENSATIONI Able .,,,.........._.
309'(-kEXTERIOR''LATH _
rnlsseetmn need'not necomplciad lnhe permits mr ane hundred dollars 310 - INTERIOR LATH l
(s100) kss) .
soon not an performance eof the
- 311 SCRATCH 'COAT '. ."
1 n f that the ormance f the wo'Ili for wh h this Permit is issued 1 +. l��.i
. employ y P= any ar to became bin{to the.Workers 313 ROOF NAIL` -. .
Compensation Laws felt a.Date 501 FINAL ELECTRICAL ENERGY
..Appl m - ...... ..... ..
i NOTICE TO APPLICANT If,after making thisCertificate f Exemption,you should "
z broomeSubject tothe Worker's Conformation pro isionsattheLaborCode-you must 502 - FINAL PLUMBING ENERGY'
with nP provisions this Permit deemed aka FINAL MECHANICAL .O _ . . l .. _ ... . . . .
rt I comply
F f"�" •' CONSTROCTIONLENDiNCAGENCY 504 - FINAL BUILDING ENERGY,- ',i `y'
In by affirm that there is a construction lending agency forthe performanc
'A :'y ofth wokmf'wh=hmsp mtisissm dIs
3097 Cis c) 505 - _ FINAL ELECTRICAL
W;:Z Land sNa i..,.:;:. 506 - GAS TEST .. . . .. . .. . .. .. .. . .
z L,na Add:
t - -
VQ I mfythat lhave mad this application and shinthat the above information is 507 - FINAL PLUMBING
:ei.j(✓ ware.I agree to comply with all,city and county,ordinances and state laws relating 508 - FINAL MECHANI CAL
to building construction,and hereby au Ow re senmtives of this city to enter upon
the above-mentioned pro for inspection nes. 509 - FINAL GRADE
(We)hgrce m save,indemnify and P harmless the City of cupenlno against
F m liabilities,judgments,costs and excen hien may in any way aceme against said 510 - FINAL L I NG
C. inconuquenceofthegrand. rspermit.; 14 NA WORKS
LICANTUNDERSTANDS .D ILLCOMPLY ITHALL NON-POINT
oURCE REG s. +- "'I° ,y Issued y: Date
STIonatmeof Ap .factor Dam RC roofs
HAZARDOUS MATERIALS DISCLOSURE - 61-
�,. Will the appl cant r future build g p t tine or handle hLardous notterial .. .,.. -
as deft d by the Calamine Municipal Code Chapter 9 12 and theHealth and safety n'Pe of Roofs .. _ -,- - ,-.;7 '-e
Code Section 255320
E]yes.
°" All roofs shall be inspected prior to any,roofing material being installed /_. .
Wlfl the applicant or fu,rebuilding.,.,.,at use ei pm nt in devices which If a roof is installed'without first obtaining an inspecuon;Tagi'ee'.to''remove
can t hamrdous an Count unions as deft rA by the Bay Area Air Quality Management
p D st m all new materials for inspection._Applicant understands and will comply with,.
O Namnal ovements der Cha ter 6 all non-point source regulations ...I) . ,
0
' I have
cti 5505;25533 end 25534.4 understandt _
Ys
read the 6ais.,de. m, p ta of the
Califomis Health&Safety Code,Se that _
if the building daesnotcutundy he hentq that it is my responsibility to notify the, _" - • "' "
occupant ohne lequ um nts is - u t be at prior to s once of a Certir trate of
Oce army. - _
�p.//;p` Signature,of Applicant Date.
KK
n Tor' agent'',' I Date All roof coverings to be Class B"or better
OFFICE . . .. . .