02120012 CITY OF CUPERTINO 1, 'fir '
BUILDING DIVISION PERMIT %,,CONTRACTOR4NFORMATION ,
BUILDING ADDR as PERMIT NO.
10260 DE ANZA BLVD 02120012
ER'S NAME: APPLICATION SUB DATE
WELLS FARGO 12/03/2002
PHONE SANITARY NO. CONTROL NO,
ARCHITECTICNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
m I bomb ff
LICENSED I I.ONTRd TORunder S DECLARATION Job Description
y a rut that 1 am officered under provisions of sCode. 9(commencing p
with Section 71XXp of Division t office Business and Pndcssions Codc,and my license is
in 1.11fnm,and elfect. REVISION--IN HOUSE USE ONLY
20"v�� License Class Lic.as
BNF❑ oaf Commelm ORIG. 402090174 , NO NEW PERMIT ISSUED
ARCHITECTS DECLARATION
< 1 understand my plans shall he used as public records
u�3du
r LL G g Licensed Profcxsinnal
OWNER-BUILDER fr DECLARATION
w n$ I naso affirm 1 am exempt from the Contractor's o License Law for me
ris ii as O o which rg reason a (Sectiont703IS.Business and Icc.de i demolish.
COde:Any city nr county (�
m=� whim im isss a e.31BO to construct.the
applialter.cant
improve,demolish.nr repair any structure V
totprior m its censed e,also requites the applicant lar soon Permit mice s signed Chamem
reommencingwitpSectio 7In 00KBolDivision3ofeCu usines'andPrsetaw(Chapm,l Sq. Ft. Floor Area Valuation
¢� (commencing with Section 7lNXq of Division Sof the Business and Professions Code)of
i 3$ Wm he is exempt therefrom add On basis for the alleged exemption.Any violation of $5000
Section 7031.5 by any applicant for a Permit subjects the applicant m a civil penalty of APN Number
not more than Eve hundred dollars($500). Occupancy Type
❑ 1.air owner of due propeartY,or my employers with wages ad thdr sole ciampedradion, 36940004 . 00
will do the work,and the swclnte is not intended or offered for sale IScc.7144,Business
and Professions Code:The Commctor's License law does not apply to an owner of 101 - FOUNDAfff *ed Inspections
property who builds or improves thereon,and who docssuch work himsclforthrough his
Own employees,provided Nat such improvemems are not intended or offered formic.If, 102 — PIERS
however,the building or improvement is sold within one year of completion.the owner
builder will have the burden or proving thm be did not laud or improve for purpose of 10 3 - UFER
441e). 104 — REBAR
❑1,as owner of the property,am exclusively connecting with liccn.ted mnramrs to 10 5 — ANCHOR BOLTS
consonant did project(Sec 7644.Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an Owner of property who builds or improves thereon.and 106 — SEWER & WATER
License iaw�forsucn projecuwith aconvactor(alliwmseapnnuam to the comrazmrs' 202 — UNDERFLOOR PLUMBING
❑ 11.exempt under Sec. ,B&PCfor this reason 203 — UNDERFLOOR MECHANICAL
fr Data 204 — UNDERFLOOR FRAME
WORKERunder Penalty
DECLARATION 205 — UNDERFLOOR INSULATION
Ihereby
andwillanion
maintain a penapyof perjmyionoflhe insure
ricclaraWorkerts Co 301 — ROUGH PLUMBING
1 have end will maintain Section
3700 of Cnmrem rstiff Code sure fur Worker's Cnmpen-
utirin,as provmed for by se,Bam 37tH Or me un,r code.for me penotmamm of the 302 — TUB & OR SHOWER
wfrkforwhichthisPermitisissued. 303 — ROUGH MECHANICAL
❑1 have and will maintain Worker's Compensation Insurance,as required by Second 3 04 — ROUGH ELECTRICAL
3701 of the LuMf Code,for the performance of thpermit
e work for which this is issued.
My Workers Compenaam,n Insurance carrier and Policy number are: 305 - FRAME
canner: Policy No.: 306 — HOLDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 307 — INSULATION
(Tris section need not be cnmplctctl iRlr permit is for he hundred dollars IS 100) 308 — SHEETROCK
nrlf9) 309 — EXTERIOR LATH
employ
enry that er the performance of the work for which this permit is issued.I shall not 310 — INTERIOR LATH
p yanyfmm,I inany manner soasmbecome suhjttumhc WorkersCnmpensminn
Lawlicant rOfnia.Da'c 311 — SCRATCH COAT
Applicant
NOTICE TO APPLICANT':11;after making this Cerilicam of Exemption,you should 313 - ROOF NAIL
become subject to the Worker's Compensation provisions of the laps Calc,you must
c) Z Nmrwithcomply wimsucbprovisions orthis Permit shallbedeemed revoker. 501 — FINAL ELECTRICAL ENERGY
Z OCONSTRUCTION LENDING AGENCY 502 — FINAL PLUMBING ENERGY
[- � I hereby allirm that Wer,is a construction lending agency for the perlinmance u( 503 — FINAL MECHANICAL ENERGY
E
th,work for which this Permit is issued(See 3097.Civ.C.)
p Lender's Name 504 — FINAL BUILDING ENERGY
]z lsmdersAddrom 505 - FINAL ELECTRICAL
U O I fenny But I have read this application and.,tate that the shrive informadrin is 5 0 6 — GAS TEST
0U conrcng eorfcmcn,plyand hireallodifiticuumyntatives of and sure
toentrelating upon the
� V huilding amswaion,and hereby authonvc representatives of this city to corer upon the 5 FINAL PLUMG
r above (we)agree
in saw lindemnify an keep ca. O 8 — FIN
yhamidess against against WIIN L
liabitom. abov ities,me judgmboned procosts rtyfor aKetios which may in any way accmc egging sail City 5 NU Z APPLI AliT U DEREthe ting of ANDSthiND WItIssued by51 Date
^� APPLICANT UNDERSTANDS AND WII.f.COMPLY WITH ALL NON-POINT
SOURCE REGULATIONS.
Re-roofs
Signature ofApplicaHAZARDOUS MATERIALS DISCLOSURE Data Type of Roof
Will We applicant of future building occupant store of handle hafardo s mamrial
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safely
nlc.Section 25532(a)'!
C]yea ❑No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment ordcvims which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air contaminants m defined by the Bay Arca Air Quality Managcmem all new materials for inspection.
Distill'? P
0 Y 0 N
I haul read dm hafallous marerialsfequiremems under Chapmr 6.95 of the Califor.
ria IIeaW&Safety G,dc,Section 255115.25533 and 25534.1 understand that if Wf holding
docs not currently have a tenant,that it is my responsibility to madly tic occupm of Bac
requirements which mug he met Poor In issuance of a Ccnifcam of Odcupancy Signature of Applicant Bate
Own,ro,ombiagvO, Dat, All roof coverings to be Class "B" or better