01060079 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10261 RURB ROAD MAT INDUSTRIES INC _0innnn79
OWNER'S NAME: APPLICATION SUB DATE
_06/1 -�/20ni
` PHONE: SANITARY NO. CONTROL NO.
o ARCHITECT/ENGINEER' BUILD PERMIT
U— BL ELE P E
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17—e
z S v=Ni z LICENSED CONTRACTOR'S DECLARATION Job Description
'
O Z_ I hearth, m Na
thy affir1 am licensed under provisions of Cnm
apter 9(commencing Job
pmh- with Section 7000)of Division 3 of the B alines.,and P fission;Cade deny liana
<m S full rose and effe y
05 <..eaaas uc.a — TENANT IMPROVEMENT
X a a., n¢ camm<mr
ARCHITECT'S DECLARATION
z 2
0< I understandilly plans sM1all be used as public records
w21
p Licensed Professional
°'a= OWNER-BUILDER DECLARATION
I hereby aRnn that 1 mm exempt from the Ccutme ors License Law far the JUL 2 0 2001
(allowing recon.(Section 703 1.5,Business and Professions Come:Any city or county
Ix which requires a permit to conswer,alter,improve,demobsh,or repair any stmc,.m
uYtPrior.ill "L131111.11111 mopalelficilnuicam.l cl pecounitto tl xg dmorment.
'bar be isl 3 puldimat tbth Iarovisicn,offln,Cornatmr,l I Ca 9 S I'P filum Qrel WL0ft06I
or g with tSectiontgin a !Div J f tl ld i mess and Professions Cale) (_ i (� e I+ s .:1v1' h7 LJ7 Uallon
or that Section
s demur th rcfrom and the basis for the alleged p mpunn Any l Pennon s, '
of Scetion]831.5 by any applicant for a permit subjects the applicant m a civil Penalty
of not more than five handfed dollar.(s50fi. 357 N 1 Occupancy Type
❑I,as owner of the propely,or my employees wim wages as their sole comperam;oo, _
.I do the.,it,and the saucture is not intended or offered far side(Sec.78,14,
Basmezz and Professions Cale:The Contractors License Law does not apply to an 101 - FOUNDATI sired Inspections -
owner of property Who builds or improves thereon,and who does such work himself
or end for his own employees.provide]that such vement mens ate not;menden a 102 — - PIERS- -.
.
',cHcrtd for sale. wnectmf. vcr.shell buildingtheburden of Prov n sold he did not build
of -
Icompletion,me awnenbadde,will naso me burden or proving that he dm not bairn or 10 3 — UFER
mprove for purgsse of sale). �
— ... . ..
❑Las owner a(1.mep pct � cactus ly cote ci gwthl<ensW t Taste 104 REBAR-
-
constract the protect(Sec.70ul Business in J Professions coo )The Contractor's 105 - ANCHOR BOLTS - 1.
License Law does amt apply to an mama,of property who builds or tmpmves mecum. -
' - , _and wnm cataracts far Wich.p,mje<ts.with a.commcdc,$).Gansed pdusuam m-me. _ .-1'06 - -SEWER -.&..WATER......_ . _..... .. .
Commam's License Ina. -
❑lamc.cnptunJerSee + ;g&PCforflm,.n202 - UNDERFLOOR' PLUMBING
°tamer Dor 203 - UNDERFLOOR MECHANICAL
WORKER'S COMPENSATION DECLARATION
'r 204 - UNDERFLOOR FRAME
re ad.reby afrrmawer aCemficate of Cosentteoosawingd,for or 205 UNDERFLOOR INSULATION
❑ 1 hrsati and will ro sided 5 Certificate Seceaf 3700 o m ted Labor for Worker's[tis
Comrmanc of the
provided for Section J7W ml the Labor cote. for cite 301 - ROUGH PLUMBING
a,ramamee'ormewa to which i.,pgmhisiss, 302 - TUB & OR SHOWER.
❑IM1mv<hc'L.blriulmainor thepefomancea at the as required by Section 303 - ROUGH MECHANICAL
,1'100 of the'Ldbur C&le,for the performance
al'the'wornu for which this permit;z
is. d.'My Warkels Compen9anccarri
ion Insurae er and Policy num care
304 —ROUGH ELECTRICAL -
mcrl s RTIFICATION OF EXEMPTION FROM WORKERS! 4. 131).5 --PFRAMEI:,!',, �j,i,4i 51s•;;
"COMPENSATIONINSURANCE
._...HOLDOWNS--...---- — - ' _
151001
"Cut,'
it..need not be completed+!the permit is(or can,hundred dollars 307 - INSULATION
308-'- 'SHEETROCK-
C.m1cellflatht th pin trtl ki h M1u ctissued,)
anal of"Play y pe any mama to bccom sublet m me Workers' 309 - EXTERIOR LATH -
Co pout an Laws ofC l'fmm a:D4@ '
r+aricero nrrucnNT a -nor m,k gm crtB 310 INTERIOR -LATH -
becomesubjectio,heWake,sCom care of Exemption,you hould t _
O Z forthwith comply with such pens'+ties permit shall the LaMa code,you man 311 - SCRATCH COAT
pywi p rsionza th permit shall he,dimmest rooked.
C
CONSTRUCTION LENDING AGENCY
ROOF - -
- -
�' In hr ziffiaromtm c.n,,.rtioa leading agency for the peramarem 501 — FINALELECTRICAL ' ENERGYthe work for which this permt is issued(Sec 3Civ.C.) --
502 - FINAL- PLUMBING -'ENERGY'
ag,sAJartss
: U 503 - FINAL MECHANICAL` ENERGY
� , 1 certify tha 1 M1aoe read this applicamn and.,tete then the above inPormaion iz
C+ p^ comet.1 agree,.comply with all city and county ordinances and state laws rewting 504 - FINAL BUILDING ENERGY
L) I-hi constra,l.a.and hereby uumainn,resmunivel oflh,,city,.enter upon
,7yz W the above-mentioned property formspenionpu,p..les 505 - FINAL ELECTRICAL
4 esjacgrcemsave,indemnify and keep hamJess the City of Cupertino against.
Vt liabilities, udgments,mors and es,a, witch may in any way accme against said 506 - GAS TEST
U Z .Cirymconsequenceofthe_gruntingg'o 'It permit. -
S URCANT,UNDEION DS N sfLLC0AIPLY WITHALLNON-POI.Nnf 1)7
- URCE CATION + Issued
gnaw Dan '. Re-roctgg9 - FINAL GRADE
Coddid
set on 25332
tan - g
HA D S ATEft1ALS DISCLOSURE
W lira p lb t f u e Id' cupanrms haalle k'nmda s mace I
r e pen a 1 cele I cit me 91> nam H lin as rely. -. Typo 4 F0of- FINAL -PLANNING ... .. _ _. . ... .-. ..—_ --. .
❑vs 3at ❑ri +. '( 551'4"'=r'FINAL'•PU1 LIC •WOPKS
- All roofs shall,beinspected pnor.to any roo inn material being installed.
is Bm it co t Ionic ti fing < p t seea equipment Maraevareh n If a roof is installed without first obtaining an inspection, I agree ro'remove
emit h rnrJ i u nt defined by theB y Area A r Qual ty Manan te t
D"' ' ova . ,-- all new materials for inspection. Applicant understands and will comply with
❑v PP.-
t all non-point source regulations.. -
have mail the hazard....materials requhcinems under Chapter 6.95 of the
Cist..'a Health Safety Code Se<' 8505.15533and25534. lunderoandmat
if the building does stmt carnallyM1atenant,-mat it's my razponsibiliri to'natify the
occupanr'of the mgbiremenwmu I so
ust be m met prior wma ice of mcenilicme of
'
!. Occupant � ,
_. / o -. - Signature of Applicant _ Date
Q.v rsum roli a t- Date All roof coverings to be Class `B" or better
•rl - . . .OFFICE