02020077 CITY OF CUPERTINO - • -
' BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: " - PERMIT NO.
10,440 DE ANZA BLVD' : SOUTHBAY CONSTRUCTION CO INC 02020077
OWNER'S NAME: APPLICATION SUB DATE
DR. CHIU OFFICE 511 DIVISION STREET 02/21/2002
PHONE: SANITARY NO, CONTROL NO.
(408) 379-0400
O e0 o ARCHITECT/ENGINEER: BUILDING PERMIT INFO
v BLDG ELECT PLUMB MECH
iLICENSED CONTRACTOR'S DECLARATION,'
.SH � mmJob Description
IhembyafG6n that lam licensed'..do,provisions of Chapin,9(co
encing I3
ly_� with on 7000)of Division 3of,hL7Bas',y,,,{!sand Piofesiim,Cdde,and my license TENANT IMPROVEMENT.
j y E j min finfmce a effl'cl. ✓'
License Claxs_ Lis.M� -)'Ae t�< f��p
13- ; �"!g 10oL comrac•1ar/fes[{ FONALE®
ARCHITECT'S UECM�tA170N If""G C®9
`E'O,g 1 unJcrsmnd my plain shall be used a public mends
APR 2 6 2002
i a O Licensed Professional
X o - OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
C?,Q following Lemon.(Section 7(131'.5;Business and Pmfes.ions Code:Any city or county
Y F O which requires a permit m emtsuuc(Ater,improve,demolish,or repair any structure5 6 000
u°i3$ prix , mssuan also giro thepplcant rorsuch pcmal m file a signed statement.
Inaiye srcenwo"cc, ulM1p pro s onsarlhe Conimcmn Lcenu lawlChapmr9 �`q,F F7�ar t.'v Valuation
(comm cog Ih Secti 7000) f D' ilio"3 of the Bustpest arta Profesimns Code) t,-x" f 3•Pl,'lY b(7 T` ,'V U"'i`r 1,
or thin he R exam t Iherefaom and Ne nasi.ror.the all ed exam mn.An
P a8 w iv violation '
-vPSemion9031.5 by
any aPPlicam for v permit subjects rhe vpplicam to.civil peachy
of not mare than Bve.humbed aanox ls5W7.' 10]APN ''ltlUfxlDAT I ON ;;i-! i ^ t 'Occupancy Type
oCas°wael.fthe pm,.,,ur m,employees with wages as their salecompensation. .. ... -
will,dWlhpeox�otkT nod-Ihe'someone is at imended or offered for late(See:7044:
m -- -- -- - --- -
._ �Busess'and'Professions Code:The Contractor s License Law does not apply m an 103 - UFER Required Inspections'•.. - -
owner r of pen,who builds or improves thereon,sad who does such work himself
or throughhis own employees provided Ihw such iinprovnnenis are not intended or 104 - REBAR __ '
".offered missile.If,h°wevd:the building or improvement is.sold wiihiri one Yeti of -' - --"—--'-""'_""'""'_ '- ff --"'—"-'- '
105 - ANCHOR BOLTS
` omplAioq the ownenbuilJcr will have the burden of Proving that he did not build or
� '�^• '�• '�• �•�-
mprovemrpmPaseafsale.). 106 - SEWER & WATER
.. _---._._.— Business -- ' -_.----- -- -- ___
DI;axewm;anhept°p.,sine:emsivelyremainingwitnransedcimandsrsI. - 202 - UNDERFLOOR PLUMBING-- -
oact the project(See.7044.B and Pmfcsxionx came:)The Commeror's "
License L"w does not apply to an owner of property who wilds or improves thereon, 203 - UNDERFLOOR MECHANICAL'--
::? '. ..and wlm.comracer.for.suhprojeta with a,cenbectors).lceosed.pursuantm.che. . --------
204-`- UNDERFLOOR FRAMEComa t 1 ensaL - ' -
DI am exempaunit,,1 c' d 1 - �' IP B it,PCfar this feasont
205 - UNDERFLR OO •INSULATION
"'t'""nlet' 301 - ROUGH PLUMBING
;•', WORKER'S COMPENSATION DECLARATION - 302 - TUB & OR SHOWER
M1erebya n mderpair ty,ofperjriiyohe,of,he{auowiagdeclarations: 303 - ROUGH MECHANICAL
S./ ❑ 1 hale seed'LIOM aroimain a Cer{ific-se of Consem'to self-insure far worker', 3 04 - ROUGH EliECTRI CAL
4'✓ Compensation, asprovidedfor by Section 37W of the Labor Code, for the
- _ performance anise work to wmen this permit is issued,.,. 3 OS - FRAME
_ 01 have odd will mainuin Worker;x Compensation losuoance,as requhcd by,Settion 3 OG - HOLDOWNS
37W of lheLabor Cod,,for the performance of the work for which this permit,is 3 0 7 - INSULATION
ssii d My Worker's'Co pe u I sure �j d Poli y ar
be
Inp¢nlnrtP$hana✓ D3t222 off 3 08 = SHE) TROCK
f CERTI EXEMPTIONFROKWORKERS �{ I�'•. Jnr_ 'i, ii C'•
COMPENSATION IUSURANCE•m 309 - 'EXTERI'OR 'LATH.
31'0.-.-I,NT RT OR' liATH' -' - - '•-___
anion need not ne'c°m lewd f the i .. _. ..._,...
(51 W)or less.) p permit is for one hundred dollars _ e ? S+•Ci'!i;;(IC
311 SCRATCH COAT
_ 313-'_ ROOF-NAIL.. ..
k<mfy ih I in IM1e pe fo ce of the "k f r hick Ih perm t i;xneJ 1 - - - - -_
xnmi ' inployanyperson ym...it t 'becomesubjectin thewarkers' 501 - FINAL EliECTRICAL`IENERGY "
Cron mannan V ofC I fo e'D i
Applicant'' -502- .-_.F.INAL-.PLUMBING. ENERGY_..... _. .
'NOTICE TO APPLICANT If aft log this C rtf ariof Ex w on y sh Id -
O Z ° his b)<tio new kerseo x uonpro ono abs Cady m a 503 - FINAL MECHANICAL� ENERGY
plywth. chp .'nn,or thsp mtshall he ed yoked.
Z — - _L _504 - _ FINAL_BUILD.ING. ENERGY. _ _. ..... .__. ..._._ ____.
COt,hea,isar.nVLc'JDwcACI3NCY 505 - FINAL ELECTRICAL
1htrbyfar which
thusd siicued(S lending . .) for the pef once
-`Q of the..,it far'high this pertnitt issued(Sec.307,Ci c.) GAS TEST a• "
G tinder s Name - '• i
V Z
Leader's Address ' , � -
507 - FINAL 'PLUMBING " _ __
O 508 - FINAL MECHANICAli
• I comfy ram 1 have read rhrs ily had on anosmic ince the above maws reion
kr:U t'oncci.l agree to comply with eS city and a repre.mdinanca and scam law=enter
upon
:>o W thbaudiascanamed paanab for inspman:erewoses. yes Duni:city to corer nporgi 509 - FINAL GRADE
.t:A. hawve-mmiee1.immityarrify dkellirpose=.. 510 - FINAL PLANNING
p.. a (W) gemxav< d m pe dkehi harry the Cly fCupert oag5n',
LX) uabBr judgments.ofcosts des which any way roeag ,!seed 514 - FINA PU IC WORKS
City I'o sequ a of the Looming of this permit
ICATIT UNDERSTANDS WILL COMPLY NRH ALL NON POINT'^ If
s rrecr OULA o »Z,��� y Issued by: Date
s a TP. < a yawn - , •'-. re "j. Re-roofs
"' AZARDOUS MATERIALS DISCLOSORE
.� a wlby,the Cupertino
fvmni aimgapant tort haeme heindoadd Salty _._ Type of Roof
as del ed bYith Cupcn iw Municipal, Code,Chapter9 12 and the H IN and Safety ........- '• - � - -
CfiBe
sl .,( 1 \IZ�IG'
❑Yi'.jtl t J
All roofs shall be Inspected prior to any roofing_matenal being Installed.
Will Th aircapplicant.,f t bu'Iined eB tyAea p r de ana wpmh If a roof is installed'withotit first obtaining an�inspec[iori,'I'agree to remove
mit he tido and ams m Defined by rM1<Bay A Ai Q alhy Ma gemem
_ all new materials for inspection. Applicant understands and will comply with
r - oYx - -- '- - .
i;:, all non=point source regulations "
hh madtheh xhado ledali requirements undo CT wer 695 f the
Calif° ie HeBIN'&Safety CodeSections25505,25533 end 25534.1 understand Nat
-i r tip building does not Fumently have a tenant,that it is my responsibility to notify rhe
oce-P t-fine
o«mYrequiremenu h ch must be tiissuance f a C mfctp o
<
Signature of Applicant
a �m � _� g . - . _ PP . Date
A11 roof coverings to be Class "B"or better
ra, g
! u I .e --OFFICE . . . .. _ _. ._ . .