01110053 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10525 DE ANZA BLVD 01110053
OWNER'S NAME: APPLICATION SUB DATE.
DONLON DE ANZA PARTNERS 11/08/2001
PHONE: SANITARY NO. CONTROL NO.
µ�O O ARCHITECT/EIJGINEER: BUILDING PERMIT INFO
E w BLDG ELECT PLUMB MECH
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y<i L_1 CJ I.J LJ
5 m Z LICENSED CONTRACTOR'S DECLARATION
z_O 1 hereby aR tat I am licensed under provisions of Chapter 9(commencing Job Description
,eCm with Section700(h.fDivoion3oftheBusiness and Pmfn,donsCWe,and mylicense TENANT IMPROVEMENT (HARD WALL)
SmsS isinrmlrar«ane erre` (STATE FARM INSURANCE)
mp a V Liansc Ch.
s Lic.a Q
Dae Comrac nr
j a Fn A CHITECT'S D[CLARAn
,g I uokerstark my plans shall w used as public records
OWNER-BUILDER DECLARATION
j O O LicrnsN Rofcuional
uL 1 hereby amen that 1 ion exempt from the Conions,C s e Air,c Ww for the
C?a following reason.(Section 7031.5.Business ark Re,And li Cade:My city st county
zp which mquims n permit ss communal,dos t aper improve,h'frin sn.or mpair,any sttuamm
a3°O._Prionoiuissmod,shsa«qubes provisions of far Cmumimds o Ifni.Licese Law(Chaateno _.. _ ___ __ _ __ - __ .__ __ ___.
monaraticirwith Seuun70(s provisions to the Basurea License Forawlis Coors S Ft-FJOOC•p eaa,.
(commencing with Section 90W)of Division3orthe Business and�rofvssions Code) i�'(`F`•:;'e 'lx a.r96E7.. e1,2'�.,tet',�-Ci<2',.�, -Valuation
or tat Xe ii exempt tercfrom end to basis for the ellegm ekemptw7t.Any violation I
-of Sectian 70313 by any applicvm for.permit subjects the applicant to a civil penalty
:of a., methan five hundred dollars ls500y A umber Occupancy Type
ID 1,as owner Oldie property,Or my employees with wages as their sole compensation, _ k
will do he work,and the swcwoe is nut intended Or offered for sue(Sec.7016"
Business and Professions care:The Commamrs License law does not apply to an 102 - PIERS Required Inspections'
owner of formerly Who builds or improves tenon,and who does such work himself
or through his own employees,provided that such improvements are not intended or 103 - UFER
offered foo tile.If.however,thn building or improvement is sold within one Yru of
confliction,file owner-builder will have the burden ofproving that he did not build or 104 - REBAR -
improveforpurprseofsaef, _ 105 - ANCHOR BOLTS i
-) •as owner ofd.pooperty:am exclusively con"clina with haertsed commators to ..... . 106 - SEWER & WATER
nstrum the project(Sec.]t W,Business and Professions Code)The Comnaors i - _ _-
awdasnntapplyto.mm�ernfprapnywhawudsorimpovesme arl. 202 — UNDERFLOOR PLUMBING
_a lam eaemptunder Sec. 'Vrolec ,B&PC for this reatr 203' _ 'UNDERFLOOR MECHANI CAli-----
nd.who contracts for such wit a comm t A I licensed pursuant to
C nmecton' License law.. ,rte
204 — UNDERFLOOR FRAME"'
— "N Dae 205 — UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
Ihereby afr„nunder,fenallyOfpermrymfg ofthe following declamations: 302 - TUB & OR SHOWER
❑ l have and will maintain',cerlircate of Comeni l. It-insu far Workers 303 — ROUGH MECHANICAL
Compensation, as provided for by Section 3]00 of the labor Code, for to
a oar «nrdewod for which niap itiaiuuea.. 304 — ROUGH ELECTRICAL
❑1 have and will mumein Worker's Compensation Insurance,as required by Section 305 — FRAME
37W of the Labor Code,for the performance of to valid fw which this permit'u 3 0 6 - HOEDOWNS
issuedM. W.A.Com
- y pcnsadon Insurerre curia end Polity number tie:
cairtE { M1.i.E't.R:a;• PmayN - 307 • = INSUliATION. . . :_
H10ER TICAnON OF E)IEMPI'fON FROM WORKERS - - '`.r 1(3`O8v( t1SHEETROCKt' Va'ti'
(aloB)o iesuataanew�notxtmlaedtnn< 30o.i--=INTERIOR"I;ATH
,- ATIONINSURANCE
o p � permitufw hu area dollef r �— � -- �-
RIOR LATH
-1 certify m t in'me perrormame of tk r �nich m' 311' —SCRATCH SCRATCH "COAT ..- ..' ..-. - .. ... .. _
shall 't p1 y any person to any mantic - t become bjectto t Workers- 313 - ROOF NAIII"':!'
Compemeuun laws of California.Date
"ppliaam 501 — FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
zbecome'subjauomcWorkerscompensationpiovisionsof[heLabwCode,you-moa 502 — FINAL PLUMBING ENERGY
Zp rarinwitaomplywiminch mavismnsormiapemitanann d mearevokea. ... _..503 .- . FINAL _MECHANICAL ENERGY._.
E-4 p.r4 ,'CONSTRUCfIONLENDINGAGENCY 504 - FINAL BUILDING ENERGY °• " '
thereby ffirm that them consuucuon lendng agency for the anforandr. ,
W :., of the walk far hichthis permit I.issued(Sea 309],cn.c.) _ _ 505 - FINAL ELECTRICAL
a
r 'O -'Ianer506 — GAS TEST
z Lena ,nee - '
O 507 - FINAL PLUMBING
I grey that ad all city
and
O Mane nancesa bre-grbio is l
0 U
correct I g or c ply ha Ilcty and runty d' nen and state laws reinrng 508 - FINAL MECHANICAL
0:W to li Ivoc-dan,aonsuucuon,and hertby autlioiiss represcmatives of t'x ny to enter upon
:W1 ;meawve-mentipaedpmprlyforms,ectionpuraves. 509 — FINAL GRADE
�.y (We)agree to save indemnify and tieD harmless"Ne City'af Cu 509 ING
Z) liabilities•judgments,amts and rxpnm:,which may in any way-cave aguna said 510 - FINAL P
V-rz. City in consequence of to granting of tho pontile"
APPLICANT UNDERSTANDS AND ILL LY ALL NON-PUBNT 514 N WORKS
souacE REcuunous. ¢.� Issued by: r Dale
bopontrc of AnlicanUConE D .. '� •:Date Re-roofs
HAZARDOUS MATISCLOSURE
Will the rrppiahhl w r talc wadi g we t uni iften,excloundfle hiaiducks material Type of Roof
as def el by the Cupertino Municipal Code Chapter 9 12 and the Heald and Safety yP -
code"ov sss32(,), Y ,�•. „ t :_�•, Ir .t•fi;iVla: f': 1.: It. ._. .
' dee ei _All,roofs shall,be inspected prior.to-any..roofing.material being installed.
Will the ppl cant o f 0.
i re b iild'ag p tit qts p s e saes p titan If a roof is inst911ed without first obtaining an ins ectioti,'IL agree•to remove
emit District?
us au contain gra t rued by to B y Area Ai Qual ly Management g p
°i""'oY all new materials for inspection. Applicant understands and will comply with _
all non-point source regulations'
1 have mail the Invention,rustafels requirements undo Cloqu r 6.95W the
California Health A,safety Cude'Sections 25505,25533 and 25536.1 understand tat
if to wildioog does not cumently have a mnant.tet it ix mY rexponsibiliry to notify the-
dccupam of to regdirerhenu •M1ich m rte ma poor to issuance of a Certificate of
Occupancy. y
Signature of Applicant
Date
ownrrr a t„ Date All roof coverings to be Class "B"or better '
=i ' OFFICE 1