02090002 CITY OF CUPERTINO �' -
BUILDING DIVISION PERMIT ' CONTRACTOR INFORMATION.--
Bln Es NMSBPCSLDHB GRANUM PARTN } TN02090002
'gKSaPCSLDHB GRANUM PARTNERS APPLICATIgIe99yPO)Y)t2002
PHONE: SANITARY NO. CONTROL NO.
ARCHITECfIENGINEER: BUILD]NO PERMIT INTO
BLDGELECT PLUMB MECH
❑ed, 0 M t�
�0o LICENSED CONTRACTOR'S DECLARATION p,�,
<Ln lnclehyrmrmmadamlicenseduntiesprowislonsofChapmr9lcnmmencing TENANT IMPROVLMRTc"'fT & 2ND FL. )
wish Section)0107 of Division 3 of be Businem and Professions Cale.and my license is
in lull force and effect.
OZi License Close Contr
�4 Date Lie.#VV -
ARCHITECT'S DECLARATION
0,U IundcrslenJ my plans shall Mused es public rccnNs �.
FLLuiO
Licensed Pmfessinnal
m
OWNER-BUILDER DE CLARATION A U I U
u� I MrcbyAffirm than 11. exemptfroms an the Cunlnctnrs License Law for the 112177
�u—p0 whichfollowingrcas a(Semon 7031.5. alter, mrPre,deoli Code:Any city InCounty __ fill L�
sae_$ which leyuircs a permit re nims the.alter,impose,h@ermitt fie a sig ed structure
CO pllnr In ll4155uanCC.a1aI1IC11Yilns the for aaCh pCmllt In tlC.slgnCJ 5laM111C111
that he is licensed pursuant In the provisions of the Contractor's License Luw(Corer H 3�6C�9H1(Sb6A1@8 Valuation
F$ (commencing with Section70g0 of Division]of the Business and Professions Code)or
..
that M is exempt therefrom and the basis for One alleged exemption.Any violation of
Section]031.5 by any applicml for a permit subjects the applicant 1o.Civil penally of PN`NFjPRqiTDA I Occupancy Type
not more than five handled dollars(SSo07. 102 — PIERS
❑ I,a owner of the property,or my employees with wages ass their axle compensation, 16B TJFER
will Jo the work,and IM suvchlm is not intended or offered for sale(Sec.7W,Business
and Professions Code:The Convectors License Law docs not apply to an owner of 104 - REBAR Required Inspections
property who builds or improvee thereon,and who doessuch work himself or through his
own employees,provided that such improvements mo nor intended or offered fm sale.If. 105 — ANCHOR BOLTS
however.the building or improvement is sold within one year of COMPlction,the owner- 106 — SEWER & WATER
builder will hon the burden of prising that he did not build or improve for purpose of
surk.). 202 - UNDERFLOOR PLUMBING
K.a Owner of the propeny.am exclusively contracting with licensed emanations to 203 - UNDERFLOOR MECHANICAL
aram the project(sec.70,14.Business and Professions Code:)The Connectors Li.
cense law does not apply to an owner f property who builds or improves themon.and 204 - UNDERFLOOR FRAME
who conferees for such projects with a contramorfs)licensed pursuant o the Contractor's
Lieease Law 205 - UNDERFLOOR INSULATION
1val
ex maiB&PCforehisleamn 301 - ROUGH PLUMBING
302 - TUB & OR SHOWER
WORKER'S COMPENSATION DECLARAT 303 - ROUGH MECHANICAL
I Emby affirm under Penalty or perjury one of the following declarations: 304 - ROUGH ELECTRICAL
❑I have and will maintain a CeniOcam of Consent to self-insure for Worker'sCompcm 3O5 — FRAME
Poll
az provided for by Section 37W of the Labor Codc,for the performance of the
work ler which this permit is issued. 306 - HOLDOWNS
❑ I have and will maintain Workers Compensation Insurance.M required by section 3 07 - INSULATION
370)of the Latin,Code,for Ne performance of be work for which Nis permit is issued.
My Worker's Compensation lmuculce,carrier and Policy number M: 308 — SHEETROCK
Carver: Policy Nn: 309 - EXTERIOR LATH
CERTIFICATE
COMPENSATION INSURANCE ORKERS' 310 — INTERIOR LATH
mosscction nccJmnMcnmplcredif,M pmndisfo,mic hundoodollass(510) 311 - SCRATCH COAT
or IBS''') 313 - ROOF NAIL
1 cari fy Ohm in the PCI! c of the work far which this permit is issucd.1 shall not 501 - FINAL ELECTRICAL ENERGY
cmpbyanyno,
I ymap unjcmm NC WnhcriC rap vdon
Lawsof E �� s� 502 - FINAL PLUMBING ENERGY
APPI' A4 C41
N TO APPLICANT:If,afro making this Cri i leetc of Exempting led should 5 03 - FINAL MECHANICAL ENERGY
become subject tube Worker's Com,mmenion Provisions of the I-mor Cade.you mus 504 - FINAL BUILDING ENERGY
zOforthwith Comply with such provisions orthis Permit shall Mdeemed rcvnked. SOS — FINAL ELECTRICAL
a0.. CONSTRUCTION LENDING AGENCY —
(r IMrehyaRrmthatthereis.Commotionlendingagoicylivtheltokimsaneenf 506 GAS TEST
Ra 7 the writ for which this Friend isissued(See.3060.Civ.C.) 507 - FINAL PLUMBING
gis W^p IandersLender's Aame Address 508 - FINAL MECHANICAL
U O 1 certify that 1 have read this application end sate that thc above infmmatiun is 509 - FINAL GRADE
0 U comet.1 agree to comply with all city and county ordinances and state laws relating In
building Construction,and hereby mitharroe nFicarroativer Of door City In enter upon the 5 FINAL PLANNING
above mentioned properly fur inspection purposes. 5,14 FIN LIC W RKS
( .glee to save,i ad expense end keep harmless he Cityof Culcnino against \
y liebiliri ,j C01 costs ad spswhich may in any way accrue against aid City
U 7 i can 4ue ce NQ gr of loisDWie.
�7 PP CA UNq T NDS AND WILL COMPLY WITH ALL NO�NsPpINT Issued by: Date
C EG L T N `I
Re-roofs
mturc-fA,p,CmtJCd6mC,.r Dom
HAZARDOUSMATERIAISDISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle bvuduus material
defined by the Cupertino Municipal Code,Chapter 9.12.and IM Health and Safety
C.section 25532(.)'! All roofs shall be inspected prior to any roofing material being installed.
❑Yes Nu
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit ha taus air ulntaminanu s dcI d by the Bay Arca Air Quality Management all new materials for inspection.
Disci ?
0 Nu
Iha m the Mr usmareneh ym menuundcrChaplcrfi95ufthcCalifor-
me I 5 �adc u 5, 5J 125534.Iunderslaillhas he building
currently ave an Nal, responsibilitym unify ebe Occupant of the
q Ones which Mm pnorto sum f Cmdricme af0ceap Signature of Applicant Date
644
Owner nr mffi ioed agent D m All roof coverings to be Class 'Bo or better