01030057 CITY OF CUPERTINO
'B
BUILDING
'. CONT'RACOR NFORM
ON .]
o . PERMIT
UILDINGADDRESS
PERMIT NO. -
.10341 BUBB RD SOUTHBAY CONSTRUC I ON 01030057
OWNER'S NAME: „ APPLICATION SUB DACE t
2.
ONE: . .'t SANITARY NO. CONTROL NO.
r Q O O ARCHrrEcPHNGINF.F.R: r + _n BUILDING PF.RMFF INFO
¢�❑ - ', - •v. BLDG ELECT,{.�`,PLUMB, MECH
NzN
11--rn Z LICENSE UCONTRACTOR S DECLARATION
" - Job Deseri tion ,
ZOen Ihereby affrn,i tl' olicensed J p t' be IChapter 9l commI an, P• '
CW whlS a 7030).1 D' 3 ❑he B, n nd❑ fvsom Cnde,.Nn fume
fall fand s a -
W 3 a,F .lot or
1 16 O, ARCII I I CTS IJI RAft Q1
ludinkard.o, tonsshllh d Ustauddic records '�(M• • Y�
ke 03 Le dP f FINAI_EM..
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OWNER BUILDER DECLARATION � ,
Ihereby B read1 pf the Contractor 1cense I for the AUG (�� t ����ffF��"���"' .
C, a fou 6 (S , 70315 8 . dl f ' :Code:Any 1t may 'AUG 0 6 2001,
5 O -h h entries r'arrm,to at,duar, p dien.li,lin,repre, y daurdic . ,t -
3 . Pio , , l 4 theapplicantl hpermit I IIsignedstatement
'- Valuation
thin licensed p it)
the p f h C t License Law ChapterY. Area
Cn g with Section n I Petition i d B . J Profession,Code) Bul�gdg&
-
. .
,rthat h exempt therefrom and the basis ror the allegedexemption Any violation
ofSecret 703 1 5 h pet b3 , the a a pplt to a penalty
ern t m I y 1 3 applicant d o f.-(asdB1 APN Number - Ocou ane Type
°I a .1 the pasTeety,or,v coldo,or,with wages a,th p abet -, 7201;409 00 �Tllv
wiH it ,h k I th t , tintended offered f (S 7044'
Me, -
Business anu f:r Cod Tn L t t L La a ,,Iplytoan - - Required,Inspections
o.vrofwopom,Who aides to tanner,lh is and b d h weekl .oll - ,
ro gh Is employee,,provided ea,: n l ' p intendedea, 1:01 FOUNDATION ' .` .
orderedI aide.11 t building' improvementi W ih oncar of _
onpl,rn the lu lderwillhaveth n J of,awidgmitneddno,buildor 1'02 .PIERS .
inpr of rpt yosuttnde) - _ _
' ❑I as owner of the properly an exclusively cmnmmtng a i,h liunsed contractors to 103' — UFER'
t thep ( ,(son 7044.Holmes, tad Profess un,Code) ed Contractors 1
Lee la d ,a apply l of property who bull. to -p tl q .414 — REPAR
and who cordilleral hproject,wd,a nmrharr(a>I sed.ptrstmn „the ., ,105'-- ANCHOR;:.BOLTS '
`Convamorx Electric Law. • � ",
ElIamexempt inme,Sce. B&Pe]or hhrea,nm 1.06 —: SEWER & WATER
Owner Date .202 b 7 _UNDERFLOOR PI_UMBING
WORKERS COMPENSATION DECLARATION 203 "' UNDERFLOOR 'MECHANICAL1
1 hemby allin r under penalty of perjury one of,he following dednnaion®
204 UNDERFLOOR' FRAME
I la d will t ' Certificate f C e, 1 Iffor Worker's
-Cmnpe : t' s p e 1 f by Ser 3700 f the 'Labor Cede, far the _ 205 — UNDERFL,OOR INSULATION'
perf mannoffewokforwhich, is
h ,shoul's ked, e `
301 ROUGH PLUMBING
El l have and willn;.irrad Worker's Compecaallon lnsnranet,as rettored by Section 30c' — TLIP & OR SHOWER
371()of,he Labor Code,far the perfnnance of,he work for which this permit Is
is I,My r ',Cpen, imtlm��Go,oheymm�heram: 303, - ,ROUGH, MECHANICAL
«: Y�YfO� PoreyNo: _A
C17KI'IFICATI ON OF EX �..� �•�1 304 ROUGH ELECTRICAL
F.MP n ON FBOM1 O 5' • ,
COMPENSATIONINSURANCE _ 305 FRAMEx'w. y
r' (Til sector neednm be n„uple,e l if,he p td le fill one h,rami,dollars —
(Slan net,.) 306 '— HOLD014NS f
1 nenlfy that in the perf meume of the work u,r whim this permit is bmu d,1' 30,7_ I NSULAT TON, .
hall ton employ eny persm,in any mance,.c a a, ,,bee he icier,In the worker: 308 . — SHEET ROCK
Compensmion Laws of California Daae
Applicant 309' - EX.TERIOR ,.LATH '
NOTICE TO APPLICANT I If,aftennaking this Cenihcmc of Excerption,you should
Z become hubjectt the H ker s Compensation provisitax cone Labor Code yot most ” 310 — INTERIOR LATH
'O mann th'comply suchProvisions orraPe t:hal l be deemed revoked.
�. 311 —':SCRATCHe;COAT
E"t V] ,CONSTRUCTION LENDING AGENCY
4 e
C I hereby of rn d ,d c construction lending age cy far pialf i na 31.3 ROOF 'NAIL'. .
RIA I I ,
.ofth weekf rwhsh,h p 1
n1 'sa oil(See 3197,Civ C.) y — '
z pd1eS 501". - 'FINAL ELECTRICAL ENERGY',:
V,O . - '502 —' FINAL_ PLUMBING .ENERGY `
a. I n'fyhtlh ,1',,illn f stateLthattl b, oformation
F J
erply With ll city a countyvernacularsm
tat I Ming 5 FINALa,e HANICAL ENERGY.'
O U mbuilding egnstrecrn. alherenyaumu zerepesenta,ves of this city to enter upon -
the abovelo," 'n e l '
p,mt.t pro„sty for mapemke pmpnses. 405
F I hlRl_ 1 I LD I dG
(w) s tn,a 1 mm'Iy�nLk-ego- t l::the City rcnp rn ag itt,l C ENERGY
� m City if l ague I: a p :, n h nayinacy y ne t�,,,,n�tl INAL' -LE'CTRICRL• ;'
G Z City' c sequence of th g mitg of shim l ' _ '
_il
'AP CANTUNDERSTANDS !D WI L COMPLY W7y'HALL I( POI I'• S
S UI CE •GULATIONS, / Issued by: Date. ' -Gt "
5pplcanUCoo act,,. _ N� Dtne Re-roofs'.. ' a
HAZARDOUS MATERIALS DISCLOSURE . . 08"- FINAL_ MECHANICAL -
W'll the applicant Bit Indian,omr,am s,t v or handle h 1 teem e Of Roof
defaultbythciar M ill C de Copula 9.12.a ad to H lib dStan, Typ 509 —r FIllGRADE , 7 P
CJ Section 25532O yy T pI pn T IS1�; '
°Y - °N - All roofs shall be Sp cted i'A [y��}}�jLll pr tlt i Rlmial beim mstalled. -
w'll o ppm o , f t building nanupact use egmp t, l .whim If a roof is installed i irimp `sTt�6t�in�nT -i pec �` gree to remove
mi,lu aNnusanonr tots as refined by lie Bay AreaA rQ,'I;y MuchWeed
Lsmere all new materials for inspection. Applicant understands'and will.comply with
El Yea °"° all non-point'source regulations. '
I h d,1 hazardous t I q t:and Chapter 6,95 of II e
Calf H ahl kSafety CJ Sections 25505 25539 d25534 1 J . dlh t ' e
.'finch ld yJ : t tly h' ,e I ,h', t : y p h1'tyt rfY the 3'
an, f,h 1 ns ch nuyT , sal f a C r ria f - t
y fill,
Signature of Applicant Date -
iminamed age a - ase All roof coverings to be Class "B" or better
Y.
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OFFICE'
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