02060083t4
iM
CITY OF CUPERTINO
BUILDING DIVISION PER*
--
CONTRACTOR INF!131R N:,
BUILDING ADDRESS:
PERMIT N0,
10001 N DE ANZA BLVD
02060083
NAME:
APPLICATION SUB DATE
FOWNER'S
,ENERAL BANK
06/13/2002
PHONE:
SANITARY NO. CONTROL NO. a
z ARCHITELT/ENGINEER:
0BUILDING
PERMIT INTO
BLDG ELECT PLUMB MECH
Z LICENSED CONTRACTOR'S DECLARATION
o of
a)ofD""iX3om that I am fenudunder
Job Description
Cfiom7 sandPions
sionsC¢r9(comm<cense
m in 3nnneBaafneasandProeasiOnsenacartam license
—i is full force and cffcct,� y
TENANT IMPROVEMENT (MOVE INTERIOR WALL)
License Class Lic.0 C.i
ce
Data J4a—C�—T.3�S
H S.111-mr
ARCf�CI"5 DECLAR 1
1 understartd my plans shall be usad as public records
OLic<nxd Profesnonal
OWNER -BUILDER DECLARATION
1 M1crcby arfrm that 11. exempt from the Contrns License Law for the
/
Co
< following rcuoa. (Section ]omani Business and Professions Coda Any city or county
which requires a permit re conswn, almn improve, demolish, orrepair"sig any ewcmm
$3000
Prior to its issuance, also requires the applicant for such permit m fle a signed statement
— that he is licensed pursuant to the provisions of the Convenors Littnu Taw (Chapter 9
'
(commenting with Section 7000) of Division 3 of the Bisinessind Professions Code)
:32S�3F (�r a'. a, Valuation
or total he is exempt therefrom and the basis for the alleged exemption. Any violation
t +
of Section ]031.5 by any applicant for a permit subjects the applicant to a civil penalty
.ofnotmorethanfivehundreddollars(S50o).
pyo
101APN � CATION
Occupancy Type
01, as owner of the property, or my employees with wages as their sole compensation,
I Q2—
PIERS
will do the work, and the structure is not intended or offered for sale (Sec ]044,
10 3 —
UFER Required Inspections
Business and Professions Coda The Convenor i License Law does not apply to an
owner of property Who builds or improves thereon, and who does such work himself
or through his own employees. provided that such improvements are not intended or
104 —
REBAR
offered for side. If, however, the building or infpowement is sold within one year of
eompledon, the owner -builder will have the burden of proving that he did not build or
105 —
ANCHOR BOLTS
improve far Purpose of.re.y
106 —
SEWER & WATER
01. as owner of tha prolart,am exclusively e°n6aedog with, rttnxd c°ntractom to
construct the project ISce 1044, Business and Professions Code) The Conuaaor's
202 —
UNDERFLOOR PLUMBING '
Licanxlawdoes a. apply 10 to--<rnfpropenywho Wild. orimprovather<on,
andwho emtttans.r°r a" pr°i«ta.wim r°i«ta.wima conttactnrts> u<enxa pnrsnant to me
203 —
UNDERFLOOR MECHANICAL
cinbaaxaorch,
's Llmnu U.
❑dun exempt nnaer see. - this reaann
' 2 04 —
UNDERFLOOR- FRAME- -
.Rapefar
205 —
UNDERFLOOR INSULATION
CI Dat`
WORKER'S COMPENSATION DECLARATION
301 —
ROUGH PLUMBING -
IherebyaRemunderpenahyofterjur,one of the following declarations:
302 —
TUB & OR SHOWER
11 0 1 have and will maintain a Certificate of Conunt m sclGinsom for wnrker'a
3 03 —
ROUGH MECHANICAL
I Compensation ns provided rot by Section 3100 or toe Labor code, for the
304 —
ROUGH ELECTRICAL
_ performance or the work for which this perms is issued.
305 —
FRAME
c: I havi, and will maintain Workar's Compensation Insurance. as ncitaired by Section
3700 of the Lne, Code, for the performance of the work for which this is
306 —
HOLDOWNS
permit
�avae.MyWorkeracomisamati°nmant. an«earrierandPoheynumberare:
307 —
INSULATION
camera. �. Pena, No.: ...
308 -
309 ='
,5HEETROCK -
EXTERIOR •LATH'
• ' CERnnCATION OF EXEMPTION FROM WORKERS"
COMPENSATION INSURANCE
lltis union nod not be complacd if the permit is for one hundred dollars
_ _
3.1.0.....
-INTERIOR LATH — — ......_..._.--.._. _...._ -. ._ .
(sloo)°"azo.)
311 —
SCRATCH COAT
Iscarify that in the perfoirmnce of the work tar which thrs patent is issued, T
313 —
ROOF NAIL — - -
than not employ any person in any manner so to o b' ct td the Workers
Compensation laws cf9mj ale .IL`s. a'`f�r `" a-�
501 —
FINAL ELECTRICAL ENERGY
AppliNOTICE
502 —
FINAL-PLUM13ING ENERGY
NOTICE TO Al, CA Tr efigr_mpp2tg this Certificate of Exemption, you should
become sabjcct to the Worker's Co pematern provisions mine laWrcode, you must
forltwimcomply with sn<hprovisions °rthis hall bedeemed
503 —
FINAL MECHANICAL ENERGY
penrit.
nev.1old,CONST
504 —
FINAL BUILDING ENERGY.
1 hereby butdreRUCTIONLENDINGAGENCY
that there iss construction lending for the pWomtarae
505 —
FINAL ELECTRICAL
for shishaffirm
of the work for'which this permit is issued (Sec. 3091, Civ. C.)
v C )
Lender's Name
506 —
TEST
Under'
507 —
_GAS
FINAL PLUMBING
1 cenify Nat 1 have read this application and state that the above information is
cmiett 1 agree m comply with all city and county ordinances
508 —
FINAL MECHANICAL
and stare laws relating
to Wilding commission, and hereby •uthodae repmsenmrs tivof this city m emer'
ur,
509 —
FINAL GRADE
jthe above-mentioned property for inspersion purposes.
agree m vve, indemnify and keep harmless the Ciry of CLperdno against
510 —
FINAL PLANNING
es. j
liabilities, judgments, costs and expenses which may m any way aecme against said
City in consequence of the granting of this peromi
514 —
FINAL PUB I C WORKS
SOPLICANTUI.DERSTAND MPLYWrn3ALL ON -POINT
souRcelxEcuLAnons. -41-C
Issued by:
6 0
Re -roofs
Date
Signature of Appliwnt/ConvanHAZARDOUor Dam
S MATE SCLOSURE
' NII the applicant or forMuni Wilding occupant more or cidhandle heurtlous rrSa l
as dedined!See by the Cupertino Municipal Code, Chapter 9.13. and the Hnith and Safcry
Type of Roof .
Coda Section 2553I(s)?
_
-
OYes 0 N ,• •
cam the applicantntamirants lit
•
All, roofs. shall be -inspected prior to any roofing, material. being installed.
a during by due Bay Ana Air Qucou
it hvardous ter contaminants az defined by the Bay Area Air Quality Management
Management
If a roof is installed
without first obtaining an inspection, I agree to remove
IDerrial?
❑Yea ❑rvn
all new materials for inspection. Applicant understands and will comply with
I
all non -point source
regulations.
have rad the hazardous materials 505, 2 533 a under Chapter 6.95 d thelifornia Health„Safny Code.Sectionson,
andsponsi 1uy'.
tht itis motlrhes
he Wilding does' not currently have a anent, that it is my responsibility to ratify the
occupant of the rcquircm xr be con proor to issuance a ficam
of
jf
b
Signature of Applicant
Date
All roof coverings to be Class "B” or better
ownerar.ath.-a. agent Dare
vrrwt
d
- i
APPROVED j
IN ACCORDANCE WITH THE CITY 09
CUPERTINO CODES AND CRDINANCES
DATE r
3�GNED ,.
?his set et p zns ; d ;, c,;—;;; -n
s mosr
be kept o '_. ._ T s l. --d it is un
lawful to c.. _, :,ea or a:,e.aiiLns
rn so.�a rs...
.be bu, d-- _ — -- —
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