01100042 clBUILDING DISOyO
VIINPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0,
10550 DE ANZA BLVD K E CURTIS CONSTRUCTION O INC 01100042
W NER'S NAME:
APPLICATION SUB DATE
ARCO PRODS CO. 1400 OLD CONEJO RD 10/08/2001
rPHONE: SANITARY NO. CONTROL NO.
(805) 350-0428
C O O ARCHITECf/ENGINEER: T�/7- 16 Q BUILDING PERMIT INFO
w� /Oa L y a�
BLDG ELECT PLUMB MECH
fin¢i ILS CJ I`. I -U
LICENSED CONTRACTOR'S DECLARATION
S= 1 hereby affirm that l am licensed under provisions of Chapter 9(commencing Job Description
,w t_m with Section 7000)of Division 3 ache Businessand Professions Cade,and my license REMOVE TANKS, GAS PUMPS & ISLAND
;yf is in full dee a 972700 PER JOE A 3/25/02 EXTENDED PERMIT FOR 6 M
a a License Class ^ Gruc.p
c. Da m .�Q� Commaor
iLLoy / ��ARCHITECT'SUECLAR TON EXPIRE ON SEPTEMBER 25, 2002 .
1 understand my plain shall be used as public retards
T
i a O ce LicenseA Professional
ce OWNER-BUILDER DECLARATION
¢i o' 1 hereby aflmn that I am exempt from the Commnm's License Law for the
!'Z< following reason.(Srnion 7031.5.Business and Professions Code:Any city m county
F o which requires a permit to construct,alar,improve,demolish,or repair any structure
prim to itsissuance. Iw 9 thef suchPc min flsignedstatement ...- _
a i m that h '.licensed pu w t theprovisions f me Contractor's L' se La (Chapter 9 I t Gall
(commencingth5 un]gq)ofDivisionJohhB meas dProf Code) t�i:, i� :Sq, Flit{34. :.tf`V.�l^tf;led i�'.' 2
.,,ban he is exempt merefrom and the basis for the allege)exempt ort Any violation r `
-of Section]031.5 by any...hard for a permit subjects the applicant m a civil penalty-
.of not dime man five handled dollars($500). 3 6 9`� � �� r'f:. Occupancy Type
°I,as owner of the property,or my employees wim wages as their sole compensation.
will do the work.and the structure is not intended or offeredforsale(See:]OW:
Business and Professions Code:The Contractor's Llansc Law does not apply to an 101 - FOUNDAT304bired Inspections `
owner of propeny Who builds or improves thereon,and who does such work himself
or through his own employees,provided that such improvements is sol are not Intended or - 2 - PIERS_
completion.
sale.If,however,the building or improvement n sold within one rear or - - - - - - " -' -
iomplminn,the nwncr-builJerwillhavetheburaenofprovingthathedidnmtWildor 103 - UFER
mprove fmpnrpmsa ofsale.). 104 - REBAR
contracting Covens we Contractsm
_ oLasmwnermru,eprnpenr.amexelasivay g„� SOS - ANCHOR'BOLTS_ _
construct the project(sec.]034,Business and property
whe h GMo:)The Contractor iicenselawamesnmappywanmvnerofpropenywnonaimsmrimprmve>meremn. 106 - SEWER & WATER
--and who.co mucts for such projects wit commcmr(s)licenced.pu annt.m th<
' emurechYSucameUs, - -202 -_ UNDERFLOOR PLUMBING — '-- _...-. ._.. _. _._ ...
01 wo exempt rude,Sac, ,B&P C for this re...o 203 - UNDERFLOOR' MECHANICAL
Data 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
�wne lnerehyarEmt under Renahy of p<.;ary one gene following aalaatinns. 301 — ROUGH PLUMBING
° 1 have and will maintain Cemficate of Consent to self-Insure for Worker's 302 - TUB & OR SHOWER
Cumion, m provides for by Section nom of he Labor code, for me 303 — ROUGH MECHANICAL
perfarnafomtance of rite work for which this permit is issued.
°I have and will mountain Wo�kcr's Cmepeniation Insurance,as recoiled by section 3 04 - ROUGH ELECTRICAL
3700 of the labor Code,for the Fair m ninmen of the work for which his permit is
issued My W k s Compensation Insure carrier and Policy be are 3 0 5 — FRAME
cwccir'15T67ErN41)'PmI rN L4�f7fa�0 306 -= HOLDOWNS
,CERTIFICATION OF EXEMPTION FROM WOR ERS ( t!."; v3.O 7 h INSULZATI ON a v-
COM PLNSATIONINSURANCE^ ';- —
Sloo)Irnc section`dea notxc pladd if Permit is for one hundred dollars 3 087 SHEETROCK-
309 — EXTERIOR LATH
-'' l'rectifyThat in the "work for which thspcnnt is issued, "-- " 3'10•• -=-'INTERIOR--LATH
performance off"he -
shall not employ any.person in any manner suits m become subject to thowmkers' 311 — SCRATCH 'COAT.• '
Compensation Laws of California.Date
Aper t 313-. -
' Worker '
ROOF _NAIL_NOTICFTOANIfo akgtn� cmret rExept yoarWmd
ro m to the W k C pc t previsions mf theLabor Codeyou most 501 — FINAL ELECTRICAL ENERGY
Z forthwith complywith suchprevisions orthsp mtsnanxaeema revokod
502 - FINAL PLUMBING ENERGY, _
_
'CONSTRUCTION LENDING AGENCY
a_' •thereby aRtm mat hcrz isoconsdvaion lending agency�onneperformando 503 - FINAL MECHANICAL ENERGY" '" 1' ;
W. ooh wmrkrorwmrnthisp mdis'issmed(sec.3o9].Civ.C.) 504 - FINAL BUILDING ENERGY
Z Z Lender's Aed.css
505 FINAL ELECTRICAL
U O 1 certify that 1 has' read this application and nam that the above ivformetion ix 506 - GAS- TEST '
Q-1.., correct.I egme to comply with all city and county ordinances and state laws re Wing 507 - FINAL PLUMBING
,V m Wilding construction.and hereby authorize representatives ofthis city to emernwit
}.W metWvomemieetosavprogeny demify inspectionpurposes.... 508 - FINAL MECHANICAL
E...0.i (We)agr&msave;indemnify ant keep h Iesi the City'of Cupeninoagainst
Z? liabilities.judgments.costs a mes which ay int any way accrue against aid 509 - FINAL GRA
U,Z city i sequence of the of mit pe
.. .� h,p GR UNDER YxITH'ALL NON- V Issued (] l N NG Z "�
V Ud[e
"-. s...are i AR,i,ra ' n mil., .. ,Date. , Re-roofs /
HAZARDOUS MATERIALS DISCLOSURE,
` uric(Wit ibe applicant or,fumm building maupmir sins of nandle hazmdous material _-Type Of.Roof .-.
- all by m CatalanoMunicipal Cod Chapter 9.12.end the Health and Safety
Cote S tin25532(x)^
All roofs shall be inspected prior-to any roofing material being installed.
Will m at,amisi r metro defined cup BayAm.sc Aualitae devices' an If a roof is installed without first obtaining an inspection; I'agree.to remove
mit h d e ata t defined ed by upamu Areq equipment Quality ty M1vices' mem
^ Dis'"" all-new materials for inspection. Applicant understands and willI tom .
Q!�} °r °No all non-point source regulations. p y'with
1 hasc'"ad the'bmrdo s mammals requirements under Chaprcr'b.95 of the ''t
califomia atm&Safely Code,Sectio 5 5,25533a 25534,1 undcrsmnd that
if the bei Jas not cutrend a -ma nsibili,m notify the
oceu the requirements He Ve met ro of a Cenificme of
0
Signature of Applicant Dale
neroramW zed=gent, DAll roof coverings to be Class "B"or better'
._ •. . . _ ...-. .- OFFICE... _
CIBUILDING DPESIONO
SINPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS. PERMIT NO.
10550 DE ANZA BLVD K E CURTIS CONSTRUCTION 0 INC 01100042
WNER'S NAME: APPLICATION SUB DATE
RCO PRODS CO. 1400 OLD CONEJO RD 10/08/2001
PHONE: SANITARY NO. CONTROL NO.
(805) 350-0428
O eco z° ARCHITECDENGINEER: BUILDING PERMIT INFO
Qv U E BLDG ELECT PLUMB MECH
z
F- so LICENSED CONTRACTOR'S'DECLARATION
°h 1 Hereby afE,m mat 1 am hcenua unser r visions of Chapmr 9 kommcncing Job Description
with Section 000)of Division 3 eine Bull d Profess.....Code,and on license
to �t„ INSTALL NEW TANKS & GAS PUMPS . H/C RAMP
'owV Lia`xl
all fi°c` ttp7 oaf L. .n
PERT_O
0 J.OIICE A 3/25/02 EXTENDED PERMIT FOR 6 M
I S F ARCHITECT'S DE �`� L 1 EX-P yilyxy N T ;; 2002 .
°; 1 undermmnd my plans shall be used as public records
1 re p O Licensed Professional
'se o a. OWNER.BUILDER DECLARATION ,
.-s, 1 hereby affirm that 1 am exempt from the Comractor'x License Law for the
C 3< following reason.(Section 9031.5.Business and Professions Cade:Any city or county
which requires o perm.,m canamct,alter improve,demolish,or repair any swcmrc
d3er prior to its issuance,also requires the applicant for such permino fit,,tithed statement
that he is Icensedpursuant om proorsomm,of be Contractor's License La (Chapter9 r .,,,; S Ft. Floor Area �[,.�t��
Rom 'ngwth Sect 7000) f ision 3 of Bupinea dP f<. 'ons Code) ,.t?"k.'. rs_'Lc9:g i,la : , s)(1 C}. .a•gl;' $200UtT ation
or that he is uiempt merefmm and the basis for Ne alleged uemphon.Any violation
of Section 7031.5 by any applicant fora permit subjects the app]teamt
o a civil penahy-
ofnotmoremanfivehundredd"nas($5W). 36 �Q }'�i6�0 Occupancy Type
01.as owner of the property,or my employees with wages as their sole compensation.
-will do,he work,and,he stricture is no,intended or uttered for sale(Sec.7014,'
Business and Professions Code:The ConvactiaCs License taw does no,apply m an 101 - FOUNDATEMired Inspections'
ovidiverof property Who builds or improves thereon.and who does such work himself
of through His awn employees,eve.tbuilding
that such improvement
improvements are not intended of 102 — PIERS
.offered for sale:l[nowuilder will
hv - 103
or impmvemem is sold within one ycai ofcompletion,me owner-builder wBl nave me Women of proving that he eat Hat Huila or 10 3 - UFER • ' _
improve for purpose of sale.). 104 - REBAR _
_ - -
L as"wee jrope.,ant enniness and Profession
Code:)
The Contractors 10 5 - ANCHOR BOliTSconstru
Luensc ,he does
project(Sec Ito a Business and Profusions CMc:7 The vesbetter,
and
contaesnmapalymajects%owner taconnywhoHausesei.pr"verttoth. 106 - SEWER & WATER .
.. and who.commns for such projects wi,n n<pmmapr(s).iicenred.pursuam m me. _ _... .._.._.
Contractors License Law. 202-= UNDERFLOOR---PliUMBING_.__..__._.__.__ .----.._._.. ...
0 l am exempt under Sec. - ,B&P C for this Mason 203 - UNDERFLOOR' MECHANICAL
woos lime
WORKER'S COM11 PDateENSATION DECLARATION 204 - UNDERFLOOR FRAME
Inereby arrm,uneer penalty or pC)perjury one or me ronowing a«laratmn'' 205 - UNDERFLOOR INSULATION
t301 — ROUGH PLUMBING
0 1mn,ve add will maintain a Cen;Bcae of Consent m self-insure for Workers 3 02 - TUB & OR SHOWER
Copensmion, as provided for by Section 37W of me Labor Code, for he
perom,ance of the work far which that permit is irrued. 3 03 - ROUGH MECHANICAL
❑I have and will maintain Worker's Compensation Insurance,as required by Section 3 04 - ROUGH ELECTRICAL
37W of the Labor Code,for the performance of me work for which this permit is
issued rea
My Workers copefonsuran ad Policy aumb
n Ie,are 305 - FRAME
<r_STarl f-n N 9 t .Poll 15'GS I-f G I D ) .. 3.0,6'l.- -,HOEDOWNS
CERTIFICATION OF EKE.. NMOM W RKERS'; " 5+ ' 1307k`_It*INSU�LATION'\;.' ' 1 '
.. COMPIt ATIO INSURANCE
.. . __._...__ . . -- ..
frits' rnm
ct nn need he nPkmd Ttne permit is for ebond rta dollars SHEETROCK.----- -".
s -.-_. /. _ _ -r 7',lt'- - ---, _
(51W) less.) 309 - EXTERIOR LATH. '
3.10...=•-INTERIOR-'LATH' _. .s
I c e fy ma,m Ne pert !r o k f h oh urs permit a Issued 1 i - _ - -
sitillCom n t plus any of
y marine a.i'became subject m me workers 311 - SCRATCH COAT -
Compensation taws of Cal'fo .Dae '
Applicant . ' -. - .. .. - ROOF-NAIL. -
313
NOTICE TO APPLeWorke's Compensation
CeNmdriv Exemption,yoou mdd 501 - FINAL ELECTRICAL ENERGY
become subject m me Worker's Compcnsaion arovisions ofine Labor Code;you must
Q 0 forthwith complywithsuch provisions or this permit shall be deemed revoked.
z . 502__-.-FINAL. PLUMBING ENERGY-,
'CONSTRUCTION LENDING AGENCY, --" -'
hereby affirm that there is a construction lending agency for the performance 503 - FINAL MECHANICAL ENERGY
w.?
arms,work for whis nm;sp fmitisissued(See JW7 Civ.Ca 504 - FINAL BUILDING ENERGY
0. Q Leede Name _. .. . _. __ .... .. __-
Dz Lena Addre . 505 - FINAL ELECTRICAL - - - - '
V-O 1 certifythat I have Wal this pplcat d state that the above' f at 506 — GAS- TEST
to Wil I g t ply m ail city a Wanlyordinances' a state1 relating 507 — FINAL PLUMBING
C.7 the abo - tm ton ndhereby aumon p eCt ofm sctymenrerupon
� (s] meeb 'ce) aree10ared p,apenyfat nspectmnphandle 508 - FINAL MECHANICAL
. ps (We)agree ts save,i and a pe dna keep harmless and City of Cupertino against
W liabilities,judgments,ror¢and expenses which may in any way accrue against said 5 0 9 - FINAL G E
U,.Z City in consequence of me granting of Nis permh.
APPLICANT UNDERST4NDS A WILL COMP LY WITH ALL'NON-POINT 510 N NG
Sot Ecu s Issued Date
gnat urc of App Lead ve tractor - - - Date ' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE -
:. Will the applicant f rat building"e<p t store -r handle W]Wddur matedal Type of Roof
as def ed by theC pen M 'pal Code Chapter 9.12.end me He ilm and Safety -
CMe S i 25532(si+ 6YJ ,, r I ,• = t t x \ __ _.
oY N `All„roofs.shall�be inspected_prior to any roofing-materia] being installed. _
W,
n mapplicant future building p , equipment' devices wn<n If a roof is installed without first obtaining an mspectlon;I�agree''to remove
nth d - ,am , d.Jied b)th ByA Ai0 ftyM gem t
Ove ro5V/ all new materials for inspection Applicant understands and will comply with _
all non-point`source regulations
sit
t have read me li Code; een...l2 requirtmcn¢undo Chapun 6.95 of.me '
Culifo it ingHealth does not
Code:Sections 25505,25533 end 25534.I,unaerstand that
.F ine W;Idin6 Jas not curtcnBy havea¢nenb ma,it is my responsibility mnmif dre
«cupaht of me requir<mcn„which must M met prior m iswnnce of a Cen.feme of
Occupa y. (” ..
Signature of Applicant _ Date
rorarchommdagem - Dare All roof coverings to be Class `B"or better
'-
' - � ' �' � - ` � - - OFFICE _ _ _