02060067I
C
OFFICE
CITY OF CUPERTINO
BUILDING DIVISION
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cCiNTRACTOR
INFORMATION
PERMIT
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BUILDING ADDRESS:
PERMIT NO,
10001 N DE ANZA VD
02060067
OWNER'S NAME:
APPLICATION SUB DATE
SANDHILL PROPERTY CO.
06/12/2002
PHONE:
SANITARY NO. CONTROL NO.
D
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i
LICENSED CONTRACTOR'S DECLARATION
I hereby affimnhat 1 am licensed under provisions of Charter 9 (commencing
Job Description
p
J
with gcctinn7W(I)afDivisinn3otlhcBuinetsand Pm&ssomm,Code, and mylicense
I ante and cn.
TENANT IMPROVEMENT
IVLicen
lass c.a
Daa
(RATION
R❑i��6 C �®
rR TECrsomma
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1 undcrhanJ my plans shall be umJ as public record.,
`
5�? 1 2 2002
O Licensed Probe xxlonal
f,OWNER-BUILDER DECLARATION
to
1 hereby uRrm that 1 ren exempt from the Contractor's License Law for the
e
following reason. (Section 7031S, Business and Professions Code: Any city or countyp
which requires a permit to ronstrvct, alter, improve, dcmolixh, nr repair any structure
I /�
B� $]6 3O,p;6A
prior to its issuance, also requires the applicant for such permit to file a signed statement
–
that he is licensed lourguant to the pomistons of the Contractors License Law (Chapter 9
(commencing with Section 7") or Division 3 of the Business and Profession; Cale)
fr �]OO Valuation .
G� F( O yi r
or that he is exempt therefrom mal the basis far the allegpl a iemppon. Any violation
32h
o oF�iea
of Section 7831.3 by anyapplic:na for a permit subjects the applicant to a civil penalty
of not nnro than fie hundred dollars (ge00).
N�.7Dm6ly _
Occupancy Type
APN[Pbi
❑ I, as owner of the properly. or my employees with wages as their sole compensation,
101
N�SAT I ON
will do the work, :red me structure is not intended or offeree for sale (See. 7064.
1:82
PIER
Business and Profession, Cale: The Contmclo, x License Law does tett apply to an
103 -
UFER Required Inspections
owner of propeny Who builds or improves thereon. and who does such work himself
or through his own employees, provided that such improvements arc not intcndeJ or
104 —
REBAR
,bared for vole. If, however, the building Lir improvnnan is sold within one yew of
completion, the ownernbmildcr will have the burden or proving that he did not build or
1 0 5 –
ANCHOR BOLTS
improve for parpom of gale.).
106 —
SEWER & WATER
❑Lwowhe of he Inerrant. ai.B.1inevdy contracting wphncensedemmoctoaso
se thy project Iger. sx and
Cale:) The Contractor's ueedse
202 —
UNDERFLOOR PLUMBING
ice to togne, b, ,hob
Law does sat appy to an asses nr pmpery who baddx m in,proxes merend•
and Ma, c
dna wlm commms for ,sen projects wire a wmrwmr(p li«nsd pursuant m the
203 —
UNDERFLOOR MECHANICAL
License taw.
❑ I am exempt under S«. .9&PC for tillsrcwm
2 04 -
UNDERFLOOR FRAME
205 -
UNDERFLOOR INSULATION
Owner – Data
WORKER'S COMPENSATION DECLARATION
301 —
ROUGH PLUMBING
I hereby affirm under Penalty of perjary one of following declarations:
302 —
TUB & OR SHOWER
O I have and will namnid a Cenireme of Consent m,elf-imaR for Worker's
3 03 —
ROUGH MECHANICAL
Compensation, as provided for by Section 37W ad he Labor Cale, for the
304 —
ROUGH ELECTRICAL
perrormamee nr me was far wmm� tats permit is issued.
305 -
FRAME
❑ I have and will maintain workers Compensation Insurance, as mandm l by Sectio"
3701 of the Luhor Core. fur the perrnmmnce of rhe work for which this permit is
3 0 6 -
HOEDOWNS
issued. My Workers Campcnsmion Insurance art y( a Policy nanberare:
ounne"�'%1/n?170/
307 -
INSULATION
c
308 -
SHEETROCK
CL F EXEMPTION FROM WORKER— 3T`—'—
F C N� COMPENSA ON INS NCE )
/ �rTseetioOn(dlonl�pvmh�c°;��FovycaJon,m
309 -
310 -
EXTERIOR LATH
INTERIOR LATH
alopinleccj
311. -
SCRATCH COAT
I comfy that in the performance of the work for which this permit is issued, 1
313 -
ROOF NAIL
k
shall not employ any Anon in any manner so as m hcome subject m the WnBxen.'
Compenmi employan oferson inan Dom
501 —
FINAL ELECTRICAL ENERGY
pipiki
NOTICnt
NOTICE TO APPLICANT: If, aper making this Cemhnof rf EsemptCod you utmost
502
FINAL PLUMBING ENERGY
7
be thwith b;emmmthsuchrxcnn,iaorionpromi, hvonhelern«cvoked, mast
forthwith ronydy with such provisinnx onM1ix pemrix hall be deemed revoked.
_
503
FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
5 04 —
FINAL BUILDING ENERGY
I hereby affirm mw mere is a ronswaion lending ngenry for theper/onna«e
505 —
FINAL ELECTRI CAL
a
of the workfor which his .it is issued (Set, 3897, Civ. C.,
Under's Name
506 —
GAS TEST
=
Le°°`'.,Arturo'th
507 —
FINAL PLUMBING
1 certify that I have read this application and state that the above information is
c I agree to comply with all city and county mdutives s and law., relining
508 —
FINAL MECHANICAL
.vette
build and modby of mixciy menmr upon
the
509 —
FINAL GRADE
a
above-mentioned purpose.
the aboxn-aagree Ou pmpeny for inspection and keep Cityor Cupertino against
(s,judgrec to.xave, indemnifyandwhich
510 —
FINAL PLANNING
7
liabilities, judgments, coxa and expenses which may in any way accrue aguinss said
may
gmming
City in CANTO
of be
514 -
FINAL WORKS
I
AP LICANTUNce
DERSTc D WI Lt. O
NDSAN D N'ILI,COMPI,Y N'IT L ON -POINT
s u Ecu •
T;
Issued by: �
/
(`) 6`/'/�/_`LJ�
l� `V
G-"--'�_-__ Date
^ O
rgnmure orb am nnsract« Date
cHAZARDO ATERIALS DISCLOSURE
Re -roofs
Will theoppllcamsnrunre Wildingoocapam scuermhondle hazardous fine) ow Out
de
Type Of Roof
as by the Cupxnino Municipal Cale. Chapter 9.12. and the Health and Safety
Cale, Section Z5532Io1'
oyes IDNo
Will
All roofs shall be inspected prior to any roofing material being installed.
the applicantorfuture holding «cupamuttequipmenordevices which
umit hm.allous iii,a,mammm�s as defined bye ay rca Am Quality Management
'hBA
If a roof is installed
without first obtaining an inspection, I agree to remove
ihaer.
❑Yes ielgx
(
all new materials
for inspection. Applicant understands and will comply with
all non -point source
regulations.
T have read the u.s materials odder 6 9 of the
Safety Cull 505, 25 33 a 4. 1 understand
f the uil Hg ithdo s balmy Calc,Sections25585. itis and 25534. un der hand thm
ifcubuilding does not currently have a,nnbendo, itix respnnsihilixyI. the
oramify
occupant of the ¢ esu which must be rents prior m issuance nr a Cenificam of
1.
oampamy.
.. f.Q
Signature of Applicant
Date
All roof coverings to be Class "B" or better
weer n e
n,in•A regnt one
OFFICE