01100009OFFICE -- ' "---
CITY OF CUPERTINO .
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIC T NO.
10300 DE ANZA BLVD
INTERIOR SYSTEMS AND SER
CE 1100009
OWNER'S NAME:
CITY OF CUPERTINO
180 LEWIS RD
APPLICATION SUB DATE
10/01/2001
PHONE'.
(408) 227-0237
SANITARY NO. CONTROL NO.
• eez
i O O
ARCHITECT'/ENGINEER:.
BUILDING PERMIT INFO
o
t to
ELECT PLUMB MECH
v i
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm mm 1 am licensed under pm.isiorrs of Chapter 9l commencing
! Job Descri IIOn
p
F•
l with Section 7000) of Di 3 ofthe Business and Prolosiona Cole, andmy license
� TENANT IMPROVEMENT.
,ea_
<
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V
fanroroeana<«, �z7�e�7
at e lass Lic. a _-
'ale �('�--i—U/ Cnn,raclof 2N x4�^�?
(FINANCE OFFICE)
1
. 1 ARCHITECT'S DECLARATION
1
i r4
1 undersand my plum shall be u.ad as public records
p p
.licensed Professional
1
DECLARATION
UN'NEin exempt
1 ti r
alarm on I am exempt from the Contractor's
Any
C
T
F Q
o
masa a city
Code: Any city sr county
county
following massa. (section 7031.5, Business and improve.
which requires a to improve, demollvh,
d
•
/
permit rons,ma, al¢q rml or repair any structure
t3 m_pnorme'suancal.mrcq
N
S . Floor Area
tf,jN iJ, q'e y•jL�I,,e4„yx�lrt2Va-it FL. Valuation
isiammfor Cormanniurla
mmba i kdpu a.7"pN omnshe Ca Probe LcenscfeyCWpmr9
msacromrmm fD'isimarm,.11 usieutd Pmf ys,Crude)Imim
or than
or Nos he s sacrcfrom anJ box, for the alleged exemption. Any violin on
-of 31.5 b on
by any applicant fora Permit subjects me avplicanuoacivil penalty
no,Mnahan
'nrauemnrtmanBtienanareaaonarsasan
APNNumber r.. Occupancy Type
O 1, as owner orsM pmpany, or my employees with .,axas their sole compeer anionINDATTON
'will da; thr'oMk; and the structure is not amended or offered for sale (Sec. 7031.-
'
' Bbshmis'and Pinfcssrons Cede: The Commcror s License Law does not apply to M
102 - PIERS Required Inspections'"'
...at or propcny Who Wilds or improves maroon, and who does such work himself
of m ere no inteone ear or
h' mvl y . provided tout wch mpent
10 3 - UFER
for
offeredf sale, If nes m building or,mpmvemenr year or
s sola
is sol one
-- . _ ':-.T._... -
104 - REBAR
completion, the ownerbuilder will have the burden of proving that he did not W Id or
he did
� ....:, .+
tmProve far neon of sale.).
_
105 ANCHOR BOLTS
0 Laaowner efmcProperty. amexclusively contracting with licensed
- SEWER -'&--WATER-
ITheC.maorsrn
conswel ,rte project IS«. L144, Busies• mM property
.cense Law doeswhtooe Chea The improves
not apply m an owner of propenr woo builds or improve. tnerenn.
th m on,
,a
202 - UNDERFLOOR PLUMBING ` . .'... .
a
'<:.
ane who comment, rot sacs projects with a cnmromml,l seen>ed.purstiam.m.me_
ceavacmrsucena<L,w_ ,,.
_203 - UNDERFLOOR-MECHANICAL----
D.:----...._._...--
� �
lameaempind"Svb: il'&PCfar 'his owso"
.. ...
204 - UNDERFLOOR`'FRAME'r'
”
Owner..• .. .: Date,, .> .. ..
'
205 - UNDERFLOOR INSULATION
WORKF.R'SCOMPENSATIONDECLARATION
_
''
301 - ROUGH PLUMBING
Incmby arrm, undo,. vp�eltypr ariary;oae onM1e n,llawmg eccmmnnns:
302 - TUB & OR SHOWER
D l naJ6'and wiir Maintain 'a CentBcamor consent to s<lf-insure for Workers
Compesm
nion, as Provided for by Section 3700 of the Labor Code. for the
303 - ROUGH MECHANICAL
xeomeeermewn rurwmmha ppniiisitsmaI
304 - ROUGH ELECTRICAL
Llibr< end will ma nt Worker's Cpmpe t tl ante eq ,icer by Section
3 05 - FRAME
_
3700 of the Labor Cod (a, the Performance of she wtor, for- which this pcnn.r is
issued. My worker; Compensationlnimince<atrierandPaigynumber Me:"
.._.
306 - HOLDOWNS
..,...Y. _...-_
c.� Sri+rE: FuA D'1PatyN
307 kl tINSULATION-
' l `, ; .3'0,8 r T_ l•SHEETROCK i :: sti vnL I r 1
CERGIT
TION
FICACOM OF ION
FIC WORKERS `
COMPENSATION , :,,
„'
l
-EXTERIOR ... LATH. _,._._...._.
ieaneeantne<<omPnoNINSURANCE''ne309":�
or ane hundred dollars
' :.1 ',� /);•Cpl , \ lin,:
rslm) le j
310 - INTERIOR LATH
" 'Ieenrymramepeno:ma ane r-honth.pe,-t. weal
-__ 31.1 ---SCRATCH- COAT — ._.___.
_(,1--
:hon t employ any: pc m any manse to becoma Syb ort m the Wmi,em
-
313 - ROOF NAIL 1., " , 1-yifl�.
Compc t nL fClf Dt',-
Appl ' - --
NOTICE TO APPLICANT II ft ak, eh Cen'fc e f E en pt y should
-501 - FINAL -ELECTRICAL ..ENERGY... -'- --
z
bo=om b/at m wrker c penes, p s,on,rudeLal«Cadyou a.
formxnh comply with such
502 - FINAL PLUMBING ENERGY
provisions or thin Permit shall hed mns!maaed _
_ - 503_.-r__FINAL-.MECHANICAL._ENERGY._._,___
+�
' `'CONSTRUCTION LENmncacsl.cY
I h mby afT,m that them .ery tiM, iiirdin, ii,imry lim, the' perf nance
-- --- _
504 - FINAL BUILDING ENERGY
,.,
arm urn, nenm a �.saeals-' Ci,_c.) ',-�
505 - ELECTRICAL...
Tend Name - -
_FINAL
, z
z
I<de rs Ada .. '.".. � ..
506 - GAS TEST" -- .-_ ... ___.. .. _ ..
• 1 c nee thin I have read alts application and emm ale he above saws
t•rr :�
507 - FINAL PLUMBING "
=[..
tobuce1acmetrcomplyxashall,atrtandcoilresedinanceaand ralmi g
to
ntioned aectione.epresenmsive,s of ihii
508 - FINAL MECHANIC
w
citymenmr upon
above-meng citylawseruion
ropcoM1 for i
meabn(We)rimptosaivx
509 - FINAL GRADE
,L
i demifyandknpnrpmsee.,,
Iwo)egrcc'N save:ine<mnify and keep harmless me City of Cupertino against
-rp
liabilities, judgmegts, costs d expenses which on -0- any way recruit is unit said
'f
510 - FINAL PLANN
.z
'•'
Cityin ca quenc<oft a arcing mis'permix' ' - ' ; ,' '
APP TUNOER, A DS :A 'ILLC ]rP 'WffN'ALLNON-POINT°
••''
SL - NA P RKS p
s GuEAn Ns r —U�-6
Issued by: Date
s gnat of Appl'C. t t , " D "'
Re -roofs
HA RDOUSMATERIALSDISCLOSURE ! - n
'- W ll me iiplicarl'or future bidding repant side or handle haaardoss material
of Rf
Type Roof --
m defed by the Cpcm Mumcp lCsd chapter 9.12.ad the HeaHealthand SafeY
_
- ^•- _..._ _ ___ __
- -
Code SLIbon DYa 2553 fa)') 3 DN 1[.v ,SV f-
t rl .5 'I'd ' I'j'�!ki �n,• r i vt \ I: ,1'
a ",
__.All To shalLbe inspected prior, to any_ roofing. material being installed..._
i equipmentces which
eml Willthe aircintm nfumrc Wilding c Pam use equip t )yeti«,ar a,
If
t h ll contaminants a d fond by B y Arta Q I ry ev
a roof is irisialle'dIWithout first obtaining an'inspection; I'agre@.to'remove
Di,n,el . ' "
Dist oY - •• ❑No
_all new materials for inspection, _Applicant understands and will comply with
'non
a
all -point source regulations.,
,. rtad'me hasnNs mate Is q ent, under Ch pee 695 f ,ha
, l , tic°, rt• s'.
Calf Health & 5 rely C Section, 25505:25533 and 25534 n alitio l Nat
:
ifs buldingdesnotcunemly have a tenant. they it is my responnbinry wnoil,ti
up b forare an! am, which mutt he pH. tr osuance'of i Cenifiume of
• -
T: D b i D
Signature of Applicant Date
All roof coverings to be Class "B" or hewer
morm..m'.ed age t • •, ., Data
OFFICE -- ' "---