01080135A
CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
23500 CRISTO RAY DR
RAM BUILDING CO
01080135
OWNER'S NAME:
APPLICATION SUB DATE
THE FORUM CORPORATION
1097 RIDGELEY DR
08/28/2001
°HONE:
SANITARY NO. CONTROL NO.
(408)879-9756
• ARCHITECT`ENGINEER:
i
BUILDING PERMIT INFO
'
BLDG ELECT PLUMB MECH
i
o o u r_
7 LICENSED CONTRACTOR'S DECLARATION
hereby
Job Description DescriptionI
p
affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Sectl°n'taro)ofDi.isloa3ofheBusme„andPores,mrsCole and myom,a
1 is in force
OFFICE ADDITION 510 SQ. FT.
full and effect.
t Lianx Class Lic.g
• Date Contract.,
ARCHITECT'S DECLARATION
I understand my plans shall M used as public Reards
> Licensed Professional
OWNER -BUILDER DECLARATION
I 1 hereby by aRrthat 1 exempt from m< Costner•, License Law for the
following reams (Section ]831.1. 5,r. al e. and Professions Code: Any city or roomy a
o which requires a permit to consumer. alley. improve, demolish, or repsir any structure
$75000
swhpbrminoicees
••priorm hsiuusdpurnintto
soffor
she provisions Law(ch¢menl•
Bei bayou Mein, it pursues to the prf Divisii of the die Bra ors License law (CTnpter 9
thr gra grprAny vi crab)
(<Rnt,Keaigg with wherefrom
basis
f� l� `� "� f3 �LF • �ogriard�rZy i 1 F) ii:`•
: Valuation
or t and he
is and the apes for d,od
far alleged betas Any violation
ube
Se
Section 31e5 by any to
of Section ]831'.5 by any hundred ll for p %y. subjects the applicant to a civil Penalty
of not m.Rban five Wnartaa.hay(ssun
PN N❑���
Occupancy Type
owner or the ,.r my employees with wage as their sole kempenation,
516 FINA� BUILDIN
oral do the work, and he swnurt's no,
d andhe intended br oRfred for sale (Sc. ]844,
'Baynes, and Professions Code: The Contractor's License Law docs not apply to an
Required Inspectionsy”' `• " \ Ir
owner of propeny Who Wilds or improves member, and who does such work N.If
or trough born employes. ded that such improvement am not intended or
cHered for ale. If, however, the
.1 buildingem is that one Year of
'
1 e
completion,l have
me owner-WilderI.),wall rove tbc When of
ampeproving mm he did not Wald or
he did
tin far
prove far Oury.a of she.).
E
. aserwner or am withB
p(See The
APR 1-5-2002, -... __.. .__ ....._... _.. .
I ,.
7,
news the m (See ]844, BusinisJy d ProfessionsC.m yoto
and Pr h:)
Cod<0 The Cosset,•,
Chaise Ivo does no owners y who
not apply w an owner of ptperty who Wilds or improves
: t '
mo
and.whl mmrvces.f°r such prolay wit ommnor(s) IiccnsW.punuam to mo-
l to the
Convenor' arse
- BUILDING
°la spt .nate ,B&PCfo thismason
,.fti` E •. ` r;,•tq
Ow
RKn'S COMPENSATION DECLARATION
-
"' I hereby affirm under paralty of perjury one of the following decimations:
k7omI have and will 'malntun d'&e .freak of Consent m uhf -insure for Worker's
pepsalot, as provided for by Section 37W of the labor Coda for the
performance of the wort for which this pemm is issued.
° 1 have and will mpiriain Worker's Compenatioo lml ranee, as required by Section
37W'of he Labor eoa<: for the perfernunce of the walk for which this permit is
issued. My Wohcrs Compensation Ituura oa canter and Policy..me;
-
�• s i
policy No.:
1
t CERt'IFlCATIONOFSATIONn
...... .e...
Cox A•. 1�_ 9 \ /'i-' 1.• `J - L\
_ - 1-.tf,t Jfi .'\s 1.'./+• ..�.1 la-/• s.
SURANCWORKER$
:- COMPENSATION INSU ..
.• -..7
•11
__._____—_._.
.,. :.r.
(This aectionnecdnoe W completed if me permNCEf
p wore huMrtd dollars
._...... .._...__.._......_._.._..-._.. _. ._....... ....
,"� __ •P, .t ..__
($10B coless.)
• 1 e fy IM1m a the perfilmearree of me work for which this pe a l'i ;sued,, l
"-
shall temploy- y person n Y manner on as to become subject to me Worker%
1' Ct , L' 1 ♦ . , �'h;}.
Compensation Laws of California, Dat
Pp n .
NOTICE TO APPLICANT: IL after m i '
eking this of o mind
- - .__...
i. ,'.ht .
baomeh m the Workers Compensation perm l
visio s of me Labor d .you
Code, you must
om hoof
fonhwith comply wit sorb provisions or tis permit hall be deemed invoked.
_. ,mad
,
CONST"RUCTION LENDING AGENCY
9 hereby affirm that more consuirctioulendinga'8en<Y for he arf.om.. a..n. <e
thii work hien 'his Parody is issued (Sec. 309], CivC.) '
Cender's Name... — •_- ., _ .:.. ..
Lender's Addinss; '
• , rvl
., n •'I cenffy than 1 have Rad this application and .,.to that the above ;n earmaion is
correct. I agree to comply with all city mad coumy ordinances and state laws relating
to Wilding construction, and hereby sanatoria repinscmaelves of this city to enter upon
the above-mentioned property for inspection purposes
I (We) agree to save, indemnify and kap harmles, the City of cupenino against
liabilities, judgments, cosy and apeases which may in any way, accrue against said
Ciey it onscqucync fth/yggru ding of thix mit:
f EG7 G'-- A• W CONPLYWITHALL ON- INT'
Issued by: Date
6 /0 o
,Nivgn t RarA h nvc w t " D le'
.�' HAZARDOUS MATERIALS DISCLOSURE j,n
Re -roofs .
.. Will the appl cane or future Wilding n< psi, ata or aatmle hLardmt minimal
as defined by the Cupertino Municipal
Type Roof of Rf -
Cod Dopier 9.12. and the Health and Safety
Cade 255320)
- -
�i� -'
�Y ❑No 4a's1 s' r
S
a •At I :'. L $''Ss'r '%•� t;
.
All roofs.shall be inspected.prior-to.any roofing material -being installed.
. -Will m applicant flat.. building pant me equlpme e devices which
emit heamd r om nmsasa fined by me Bay Arm Q J ryM agement
If a roof is installed'without first obtaining an inspeehon' I'agree.to irmove
District?'_ - _
Y °No
all new materials for inspection Applicant understands and well comply with
P.y_.
It
all non -point source regulations.._(,
' I have mad me ha=aNss materials ria,mements umcr Chapter 6 95'of me
California Heald, & Safety'Code. Sections 25505; 25533 and 25534. .1 underamnd Nat
if the building docs notcurrently have a to., mat m rcspo sibyl ey eco notify the
miau
aW daresat y c us, n o re f OenificaR of
Signature of Applicant Date
All roof coverings to be Class "B" of better
IFT waarnnaae gent r - '" `. qme
_ .
OFFICE -