02070031 CITYBUILDING DIIVISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10201 N DE ANZA BLVD 02070031
WNER'S NAME R APPLICATION SppDAT
ROBERT GRANUM 07/03/2002
s �, PHONEQ SANITARY NO. CONTROL NO.
Ore ZO AR44HITECDENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB ' MECH
l'-1
LICENSED CONTRACTOR'S DECLARATION
z = -1 Job DescCEpS-
.Il!m.7")rm that aftheedundes provisions Proansof,Chaode.an ommecense ) DEMO'HARDWALLS OFFICES ' FOR OPEN FL PLAN
Fye< with Sce[iorce and of Division J of Ne Business and Professions Code,and my license r
is in full forte and effect.
�'a'� License Class Lica
S:O a.V Dam ConbseO
3,LLO ARCHITECT'S DECLARATION Y,
t
N
g 1 undersmnd my plans shall be used as Public rec 1 t
'pc LittnuO Professional
e OWNER ese the TI
y I hereby
ffnn t o f th C p cm s tl n�- for e '
t-2 folio mg mason a ev Pmf no t y c ry - an - $105000
O wh cb qu rt crust e imp aro m lis rep ny s mm•
Pnarm iu ruse req uesN cansf uch perrtds ttpbrsl eduammenr
3--d1ntp$blcpngetl upn pp of t tr L�nu (Chamr9 _ ....._ _ _
?tf5, P ,mss �y,.h,(rss�r, Valuation
(co menti g ng and
)of fpe,J lost Pgaf PfeutonsCMU3, G"L1,3'Y V 1'(7 V`i.JY�.ilr'cl ld t.�
or that Re Is ea" pt refm,d anJ t britt'lSeY Ill mptwn Any violation "
-of Section 103115 by applicant f arms bjec,,the it,hesm so a civil peralry
mf an marethan 6. a 'S51)0). NO VW�M#LD INSPECT ONS': "" Occupancy Type
°Lasownerof Nepro u,,or rayernplo,ces with wages as their sole compenution,
will-do and Prk:and-the strucode:ureTh C n n intended ice eR aav foe sidenot apply
to an -R
'Rounds and Pny Who b Code The Contractor's License Law does not apply to an Required Inspections".'
owner of property Who bunds or improves thereon,and who does such work himself
or through his own employees.provided Nn[such improvements are not intended or _—.,__._:... ..„....,.._.....:_..___ _...
-"dRem3 far sale:If,hms5vere the l building dr amen f Prov r mIa'he did one yam of sty improve
thepurpose
ase of ale.).will have the buNen of proving that he did not build or '
improve for puryau of sale.).
�l er owncrohh propenYm xclasiely contmning with lee sed nuactdrsmLicense
i ens r theproject(S ]to a Business o d Professions Code)mp Convacmrs
and.w L d of apply t an net f property ur ) Id. improves thereon, //Vx
_and who animas far such prolecu with a, nvscmgs)Iccnud pursuant to,our _._ _--.
Co t e L cense L
1 p m er S � '' vr '� ,B'&P C.for this reason _ '
Darr (3�UZ l�
WOR(ER' COMPENSA Ory,pFl..LL�ARATION
t_. '•,- .l hereby affirm under pcnniry of po o o the follo wing declaretiom:
01 have and will minimum is Cenif¢me of Consent to scif-insure for Worker's — vL
Compensation, as provided far by Section 37W of the Labor Coun, for he
pertormanaedfN<wod forwhich.this permit is issued. � 4-1 ^ � v
i 4 C
r
°I hove and abo Calleiv Worker's fomance of Insurance,vs required by Seniors
3]00 . the Labor Code for the pertormnce of the dwork Poli i which this perm i s
t iss ed My Workers Compo sato insurance artier and Pohrymorticians
w L/
` Y'is CERTIPI$ATION OFCOMPEN COMPENSATION
INSURANMWORR�,RS ;. / �[�
COMPENSATION INSURANCE Y
is hand _.—
r' )or
sec7ion tied n0i be completed if the permit is for one hundred dollars
($1 1)0) leas)
1 Rrofy than in the performance of the work forwhich this Permit sx ❑ 1 ,
lhbll n t en lay any person r a� er sa.a�b Wcymg yyt tl[ the Workery
Compo w N(}d f mid. ` a7`V L
am
NOR E APPLICA f I aft rmalu gsh Certifcme of Exempt on y should
becomwt m the Wnikers Compcnsahon provisions of thelabor CWe,you must
z ell he dremed invoked.
y y`si CONSTRUCTION LENDINGA _- -- - _ -- _ ---- - -- -_ - - - _
O forthwith cam 1 with
such snorts or this wh
Ihie,v AGENCY.. a fo ..... ., ,
�l 1 work
affmn Nmpco iso construction lending agency for are performance
Untie work for which this'pxmit is iuuW(Sec.3119],Civ.C.)
LondeNme . . . . doll_. . .. . .. . ... .._._v.. .. _... ... .. . . _.. ...__. .._. _ ..
p Z Lender s Address _• . - 1 L
C.1 � 1 witify that 1 h e read this application nd stale that the bo information is -
k+-'rr canon I agree to comply with all city and counts ordinances and.tate la s relating
19 building c nsmllism' nd thereby audichle repreuntaride.,of flova city ser enter upon
[]] the above-romioned,pritpenY l ar inspection purposes.
Q. (We)agree touvc,indemnify a ail keep harmless the City of Cupertinnit, st
-Vl liabilities,judgmen¢.cast.,and expenses which may in any way recruitagainn said
U ,7^,. City n NT en tERST g Sin ofth yT'y I
APP ENRLTU' jEROSVSYD5p4DtfI1LcC0\`PLYIVITHALL NON-POINT
'O Issued by: r� D e o v
t t �JII�',loll ....
gwmre of Applican C t for aD`—p„ Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
wiI the apipli6anner fuume building occupant store or hundle Imudous material Type.of Roof.. . _ _:.......=z_ .._...._..�.��...
as defined by Ne C Peru o M re I Cod Ch pre,4 I .and the Health and Safety
CndeS mm�2553ZIa1a i .t.'Irt ,., �'. �j \ n st s. SJ
°Y �" All roofs shall be inspected prior to-any-roofing material-beim Installed.
F — . g.
Will the appllcout or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspeetiori,'I agree to remove
emir humid...air contaminants as defined by the Bay.Amir Quahty Management
District] all new materials for inspection. Applicant understands and will com 1 with
- °Yd - -.. - No t ..
all non-point source regulations. . PP ”"' Y'
1 have read the hazardous materials requirement under Chapter 6.95 of the
California Hcalth&Safesy Cede,Sec[iom 8505,25533 and 8534.1 andemmrd Nat
tf the Iding daes'nor cumntlY haveam ant that it i.rayresponsihlitywn ify the
oceu f th rc ircmcmiwhi must be met poor to issuance of a CenIifcam of
Signature of Applicant _ Date
er pr aathodxea ages[ ale All roof coverings to be Class,"B" or better
.OFFICE