01070027 CI OBUILDING DIVC'ISSIIONNO :PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10300 BUBB RD. SOUTHBAY CONSTRUCTION 01070027
O
E. APPLICTIONS BDATE
IPV�ff 511 DIVISION STREET 07/10 2001
PHONE: SANITARY NO. CONTROL NO.
(408) 379-0400
eco z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
U
z Ti-P �J
DG ELECT PLUMB MECH
< �-� L� LJ I-1 CJ
8
LICENSED CONTRACTOR'S DECLARATION
p o,H G I hereby atom Division
1 nm licensed under provisions of Chapter 9lcormeming job Deseripti ❑
F:Fw with full have
and effect. on3ofthe Buninexsand Professions Code,and mylicense TI (1421 SQ.FT.
z y
is in full force and effect.
c 6 License Class Lic.g
a 3 a h Dare Contractor
A TECr'5 DECLARATION
O e e used as public records •t t
6 License P f stinal
sod se OWN -BUILDER DECLARATION
.0 - I emby affirm that 1 am exempt form the Contractors License Law for the
h z< following reason.(Section 7031.5.Business and Professions Cade:Any city or co my 1 943
atD which requires a permit to contused,iter,improve,demolish,or minor any structure
w-m
_prior to issuance.also requires the applicant for such perm to file a signed statement - -- -- - -
a3- 'hat beslicensed pursuant the p visions of Ne Contractors License law(Chapmr9 Valuation
(c tong with Section 70881f Division 3 of the Business and Prafassmrm Code) "f) rr Si )E.4 t,4i19 t�° •
or that he is exempt therefrom and the basis for the allegrd eaimpdoh.Any violation `
of Section 7031.5 by any applicant for a permit subjects the.....cant to a civil penalty r�.,�
of notmore than five hundred dollars(5588). 1O1APN'}�,DV` kJLVDAT I ON Occupancy Type
❑I,as owner of the property.or my employees with wages as their sole compensation, 102 - PIERS _
will do the'wors;and the structure,is not intendedofoffered for sale(Ser.7044. 103 - UFER Required Inspections
Business and Professions Code:The Contractor's License Law does am apply to an q p
owner of property Who builds or improves thereon,and who does such work himself 104 - REBAR _
or through his own employees.provided that such improvements are not intended or _ ,-,..
offered for sale:If,however,the bulldGq or improvement is soldwithinone year of -105 -mANCHOR_..BOLTS
completion,the owner,Wilder will have the burden of proving,n he did not build art
improve far propose of sale.). 106 - SEWER & WATER
i;a:awned;ter mepap�Y:am:.m:wdr contracting witnR sea anti a to -202--=-UNDERFLOOR-PLUMBING-
0 -
construct the pmject(Sec.7D41.Business and Professions Code:)The Contractor's 203 - UNDERFLOOR MECHANICAL
License Law does not apply tp na owner,of property who builds or improves he...
f .-and who conuacu.for.such.projeces with a connactor(a).ficarsed pursuant to.om _. -204- - UNDERFLOOR FRAME - -- "- - - - --- '- -----
Com
tmexemptcenselSec. 205 - UNDERFLOOR -INSULATION
Clam Licenser Sec. ,B&PCfor this reason
Owner Date301 - ROUGH PLUMBING
1
WORKER'SCOMPENSATION DECLARATION 302 - TUB & OR SHOWER
Ihereby arrr undarperaltyofpejurycone ofthe following declamdarx: 303 - ROUGH MECHANICAL
`• 0 1 hlie and will maintain a Cenificam of Conserv to self-iname for Worker'. 304 - ROUGH ELECTRICAL
_ - Coexpewtion, as provided for by Section 3700 of the labor Code, far the
performance of the work far which this permit is issue, 305 - FRAME
❑ `
1 have and will.;intern Worker's Compensation Insurance,as required by Section 306 - HOEDOWNS
3700 of the labra Code.for the performance of to work fee which this p tmft is 307 - INSULATION
is etl My Workers Compensat nn Insu a c er and Polio number arc,
308 - SHEETROCK _ .._
_.. .. . .
t..r:
- J CERTIFICATION OF EXEMPTION FROM WORKERS t ' 1 1 3 O 9 °-'xEXTERSOR -L'ATH' :
COMPENSATION INSURANCE '- ~
- - --
-3 10 -:- -INTERIOR--LATH—,..____.._...i 11, --- - ._...
' '(Thissation need not be completed if the permit is for one hundred dollars 311 SCRATCH COAT
(SI00)oflexsJ
"i&cif �nai I.m�- rformnnce"ei t2 work Far which his . - .313 - ROOF NAIL
y, x pevniteWar"' 501 - FINAL ELECTRICAL''ENERGY
.hall not employ any person in any manner w as to become subjen w the Worker:
cpmpn4agpn awxarcarromia.gme unin
Appl .502. - .FINAL PLUMBING..ENERGY__
NOTICE TO APPLICANT If,afact making this Certificate of Exemption.you should 503 - FINAL MECHANICAL' ENERGY
become subject .,he Workers Compencatian provisions of the Lahr Cade,you man
O Z fohhwiNcomply with such pmrisionsorthispermitshaubedeemedrosoked, 504 - FINAL BUILDING ENERGY
- - ._
(A - r' " CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
I hemby i ffum that Nert is a cimoiunion lending agency for the performance
of Ne woekfar which Wilmot is&umdgcc3097,Ci..C:) 506 - GAS TEST
Under'sName- 507 - FINAL PLUMBING
Z der
./,
Lens Address
t�..0 508 - FINAL MECHANICAL'
1 certify Nat 1 have read this application and sum that the above information is -
comet,1 agree to comply wit all city and county,ordinances and state laws mixing 509 FINAL GRADE
O U I.Wilding construction.and hereby tutoriu re,examinnesothis city mcion,.oa 510 - FINAL PLANNING
�.� the above-mantioned property for inspection purposes. _
r✓ a (We)agree to son.indemnify and keep harnalcas the City of Cupertino against 514 - FINAL PUBLIC WORKS
Vi liabilities,judgments,casts Ind expenses which may in any way accrue again,said
V-Z City in co gene (the tingD W permit.'
APPL 4
ST 'AND WILL COMPLY WffHALLN-P IM (�
s Issued by: Date
Signamro f pplicMutconr mr f Data• Re-roofs
HAZA OUS MATERIALS DISCLOSU
11 due'ir lkam tatone building occupant Store m handle hrianlpns matedrl Type of Roof ,
as define by the Cupcmno Municipal Code Chapmr 9.IZ..J the Heath and Safety
Code3ection 25532(a)? .. - r. '•" I? ,4.-, ��; r .
ora Guo" 1.'i.' :`;i : _.All-roofs.shall.be inspected-prior to.any.roofing.material being.installed.
Will the applicant or future building weapon use equipment or devices which If a roof is insialled'without first obtaining an inspection, Pagree to remove
emitlawn, ous air contaminants as defined by the Bay Area Air Quality Mxnugement
District ' all new.materials for inspection. Applicant understands and will comply with
0Y. ❑No :- - - all non-point source regulations. „
I have read the Wors s materials recommend,under Chapter 6.95 of the
California Health&Safety Code,Sections 25505.25533 and 25534.I undemand tat -
iftebuildi doesnos cum seamrant.that it is my responsibility to notify the
occupant req ' e I ch muo be met prior to issuance of Can am of '
Oc
a 7 �_ Signature of Applicant Date
own ter ,o xe ag n[ Date All roof coverings to be Class "B" or better
7.
- - OFFICE -
r - -
� ���
� � ,o
CI OBUILDING DIVC'ISSIIONNO :PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10300 BUBB RD. SOUTHBAY CONSTRUCTION 01070027
O
E. APPLICTIONS BDATE
IPV�ff 511 DIVISION STREET 07/10 2001
PHONE: SANITARY NO. CONTROL NO.
(408) 379-0400
eco z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
U
z Ti-P �J
DG ELECT PLUMB MECH
< �-� L� LJ I-1 CJ
8
LICENSED CONTRACTOR'S DECLARATION
p o,H G I hereby atom Division
1 nm licensed under provisions of Chapter 9lcormeming job Deseripti ❑
F:Fw with full have
and effect. on3ofthe Buninexsand Professions Code,and mylicense TI (1421 SQ.FT.
z y
is in full force and effect.
c 6 License Class Lic.g
a 3 a h Dare Contractor
A TECr'5 DECLARATION
O e e used as public records •t t
6 License P f stinal
sod se OWN -BUILDER DECLARATION
.0 - I emby affirm that 1 am exempt form the Contractors License Law for the
h z< following reason.(Section 7031.5.Business and Professions Cade:Any city or co my 1 943
atD which requires a permit to contused,iter,improve,demolish,or minor any structure
w-m
_prior to issuance.also requires the applicant for such perm to file a signed statement - -- -- - -
a3- 'hat beslicensed pursuant the p visions of Ne Contractors License law(Chapmr9 Valuation
(c tong with Section 70881f Division 3 of the Business and Prafassmrm Code) "f) rr Si )E.4 t,4i19 t�° •
or that he is exempt therefrom and the basis for the allegrd eaimpdoh.Any violation `
of Section 7031.5 by any applicant for a permit subjects the.....cant to a civil penalty r�.,�
of notmore than five hundred dollars(5588). 1O1APN'}�,DV` kJLVDAT I ON Occupancy Type
❑I,as owner of the property.or my employees with wages as their sole compensation, 102 - PIERS _
will do the'wors;and the structure,is not intendedofoffered for sale(Ser.7044. 103 - UFER Required Inspections
Business and Professions Code:The Contractor's License Law does am apply to an q p
owner of property Who builds or improves thereon,and who does such work himself 104 - REBAR _
or through his own employees.provided that such improvements are not intended or _ ,-,..
offered for sale:If,however,the bulldGq or improvement is soldwithinone year of -105 -mANCHOR_..BOLTS
completion,the owner,Wilder will have the burden of proving,n he did not build art
improve far propose of sale.). 106 - SEWER & WATER
i;a:awned;ter mepap�Y:am:.m:wdr contracting witnR sea anti a to -202--=-UNDERFLOOR-PLUMBING-
0 -
construct the pmject(Sec.7D41.Business and Professions Code:)The Contractor's 203 - UNDERFLOOR MECHANICAL
License Law does not apply tp na owner,of property who builds or improves he...
f .-and who conuacu.for.such.projeces with a connactor(a).ficarsed pursuant to.om _. -204- - UNDERFLOOR FRAME - -- "- - - - --- '- -----
Com
tmexemptcenselSec. 205 - UNDERFLOOR -INSULATION
Clam Licenser Sec. ,B&PCfor this reason
Owner Date301 - ROUGH PLUMBING
1
WORKER'SCOMPENSATION DECLARATION 302 - TUB & OR SHOWER
Ihereby arrr undarperaltyofpejurycone ofthe following declamdarx: 303 - ROUGH MECHANICAL
`• 0 1 hlie and will maintain a Cenificam of Conserv to self-iname for Worker'. 304 - ROUGH ELECTRICAL
_ - Coexpewtion, as provided for by Section 3700 of the labor Code, far the
performance of the work far which this permit is issue, 305 - FRAME
❑ `
1 have and will.;intern Worker's Compensation Insurance,as required by Section 306 - HOEDOWNS
3700 of the labra Code.for the performance of to work fee which this p tmft is 307 - INSULATION
is etl My Workers Compensat nn Insu a c er and Polio number arc,
308 - SHEETROCK _ .._
_.. .. . .
t..r:
- J CERTIFICATION OF EXEMPTION FROM WORKERS t ' 1 1 3 O 9 °-'xEXTERSOR -L'ATH' :
COMPENSATION INSURANCE '- ~
- - --
-3 10 -:- -INTERIOR--LATH—,..____.._...i 11, --- - ._...
' '(Thissation need not be completed if the permit is for one hundred dollars 311 SCRATCH COAT
(SI00)oflexsJ
"i&cif �nai I.m�- rformnnce"ei t2 work Far which his . - .313 - ROOF NAIL
y, x P=RritheWa�r"' 501 - FINAL ELE6'TRICAL''ENERGY
.hall not employ any person in any manner w as to become subjen w the Worker:
cpmpn4agpn awxarcarromia.gme unin
Appl .502. - .FINAL PLUMBING..ENERGY__
NOTICE TO APPLICANT If,afact making this Certificate of Exemption.you should 503 - FINAL MECHANICAL' ENERGY
become subject .,he Workers Compencatian provisions of the Lahr Cade,you man
O Z fohhwiNcomply with such pmrisionsorthispermitshaubedeemedrosoked, 504 - FINAL BUILDING ENERGY
- - ._
(A - r' " CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
I hemby i ffum that Nert is a cimoiunion lending agency for the performance
of Ne woekfar which Wilmot is&umdgcc3097,Ci..C:) 506 - GAS TEST
Under'sName- 507 - FINAL PLUMBING
Z der
./,
Lens Address
t�..0 508 - FINAL MECHANICAL'
1 certify Nat 1 have read this application and sum that the above information is -
comet,1 agree to comply wit all city and county,ordinances and state laws mixing 509 FINAL GRADE
O U I.Wilding construction.and hereby tutoriu re,examinnesothis city mcion,.oa 510 - FINAL PLANNING
�.� the above-mantioned property for inspection purposes. _
r✓ a (We)agree to son.indemnify and keep harnalcas the City of Cupertino against 514 - FINAL PUBLIC WORKS
Vi liabilities,judgments,casts Ind expenses which may in any way accrue again,said
V-Z City in co gene (the tingD W permit.'
APPL 4
ST 'AND WILL COMPLY WffHALLN-P IM (�
s Issued by: Date
Signamro f pplicMutconr mr f Data• Re-roofs
HAZA OUS MATERIALS DISCLOSU
11 due'ir lkam tatone building occupant Store m handle hrianlpns matedrl Type of Roof ,
as define by the Cupcmno Municipal Code Chapmr 9.IZ..J the Heath and Safety
Code3ection 25532(a)? .. - r. '•" I? ,4.-, ��; r .
ora Guo" 1.'i.' :`;i : _.All-roofs.shall.be inspected-prior to.any.roofing.material being.installed.
Will the applicant or future building weapon use equipment or devices which If a roof is insialled'without first obtaining an inspection, Pagree to remove
emitlawn, ous air contaminants as defined by the Bay Area Air Quality Mxnugement
District ' all new.materials for inspection. Applicant understands and will comply with
0Y. ❑No :- - - all non-point source regulations. „
I have read the Wors s materials recommend,under Chapter 6.95 of the
California Health&Safety Code,Sections 25505.25533 and 25534.I undemand tat -
iftebuildi doesnos cum seamrant.that it is my responsibility to notify the
occupant req ' e I ch muo be met prior to issuance of Can am of '
Oc
a 7 �_ Signature of Applicant Date
own ter ,o xe ag n[ Date All roof coverings to be Class "B" or better
7.
- - OFFICE -
r - -
� ���
� � ,o