01050179 CITY DIVISIIONNDPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10600 N DE ANZA BLVDNxc�z 01@50179
OWNER'S NAME: • APPLICATION SUB DATE
BAY PARTNERS 22 2 V t . 05/224/2001
PHONE: SANITARY NO. CONTROL NO.
5`
m Z ARCHITEC IENGINf:F.R: ! S BUILDING PERMIT INFO
`r'Q /�J� �/ G—� BLDG ELECT PLUMB MECtI
T r+ — �V IJ IJ Cl 1=1
S?Z LICENSED CONTRACTOR'S DECLARATION Job Description
Z—p Ihereby.Man that 1 am licensed under provisions of Chapter 9(commencing
Fy Fm wiNSindou'R )o''f}}�pion Sof me Businns and f ons Code,snit license
am is in full force andx _/r/ T N T P OVEMENT.
s C < License Class hie.g11, �'t
3 a U Dam Contractor_ J
ARCHITECf'S IICCL
p AR I
I understand my plans shall be awed ns puhlic recur
`1on
�
ad mp O Licensed Professional
aO' OWNER-BUILDER DECLARATION
of so so I hereby a1Rnr that I am exempt from the Contractors License Law for the
RF
F Z_ following reason.(Section 7031.5,Business and Professions Cede:Any city or county EXF
p which requires a permit to construct,alter,improve,demolish,or repair any stricture
prior m it,issuance,alnn requires the applicant for ouch permino Me aligned samment
— that he is licensed pursuant nthe grovi, inftheCommrroraLicenseLaw(Chapter9 Sq. Ft. Floor Area Valuation
(commenemg with secdmt 7ro))of Division 3 or the Business aril Pmressiom Code) $140000
or that he Is exempt tlmnfrom and the basin Iia the alleged exemption Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant m a civil readily
of not more than Five hundred dollars($500). APN Number occupancy'type
❑I,u ownerofthe progeny,or my employee with wags as their sole compensation, 316021
will do the work,wed the swcwre is not intended or offered fm vie(See.70,14• Required Inspections
Business and Professions Code:The Contractor's License Law does not apply m an q p
caner of rmpeny Who build,or improves thereon,dad who does arch work himself 101 — FOUNDATION
or through his own employees pmvided that,such improvements fire not intended or
offered for vle.If,however,the building or improve vent is sold within one year of 1022 — P I ER$.
completion,the owner builder will have the burden of proving that he did not build or
improve far Paepa,e of ode). . 103 — UFER
O 1,as owner of the property.am exclusively contracting with licensed commctom m 104 — REBAR
construct the project(Sec.70P,4.Business and Professions Cede:)The Contractor's
LicromLaw does not apply toanowner ofproperty who Wilds mimproves meream. 105 — ANCHOR BOLTS
and who metric, Par such rrojcas with a carnations)liceorad pcomom as the
contmefor,Licen,eLaw, 106 — SEWER & WATER
O l am exempt under Sea. ,l1&1'C rnr this reason
202 — UNDERFLOOR PLUMBING
Dwyer
WORKER'S COMPE.NSAI]ON DECLARA'I'ION 203 — UNDERFLOOR MECHANICAL
Iherebyafrom under peraltyofpdo,one afine following declaration,: 204 — UNDERFLOOR FRAME
)� O 1 have and will ardhlahs a Certificate of Coastal in no[Nuiare for Wmkers 205 UNDERFLOOR INSULATION
Compensation, as m
provided far by section TAH) of the Labor Cade. for ` 301 ROUGH PLUMBING
pv romaan or the work far which this perm _it In issued. -a
Olhaveand will onda"n Worker's Cn a,nvfma Insurance,ass required by Section 3@2 — TI-10 &• OR SHOWER
37W of the Laid C pe,for the perhsmance of the work far which thin pemtil 1, 303 — ROUGH MECHANICAL
iss�a,d//My .counteraction lnsyfunce carrier
d'Policy nvat: Q 321 304 — ROUGH ELECTRICAL
CERTIFICATION OF EXEMPTION FROM WORKERS' �/ 305 — FRAME
COMPENSATION INSURANA 9/ IT_ —
(Thin,.Iiiomdintbecomplatedifli.,nmhisIore�m�d�a? 306 H01_DOWNS
tgulo)or ltd,.) 307 — INSULATION
1 certify mut in the p(ronin ce of the work for which this permit is issued,1 308 — SHEET ROCK
shall not employ any person in any manner so as to become subject m the Workers'
309 — EXTERIOR LATH
Com mosian Laws of California.Data
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should 310 — INTERIOR LATH
became C suhjecnn the Workers Compensation provisions of the Luton Code,you must mnhwith connply with such pow sat n.or this p init shall be decried revokcd. 31.1. _ SCRATCH COAT'
CONSTRUCT ION LENDING AGENCY 3,IS ROOF NATI_
7 1 hereby 61Bmn that there is a conswction lending agency for the performance
of the work for which this permit is issued(Sm.3197,Civ.C.)
L Q lender's Name
Q Z Lender's Address
V C I many that l have read this application and state that the above information is
G+ Fs correct.1 agree In comply with all city unit,county ordimnce,and state lows relating
O Ill building ennsnu,l,ion,and hereby.,,It lie representative,at this city m emm upon
�s the above-mentioned property for Inspection wilmes.
iy (We)agree in save.indemnify and keep harmless the Cityof Cupertino aromil
fn liabilities,judgments,costs and expenses which may in any way accme against said
in mnsryurn c.4granting of this permit.
CA
P NTUbll) S'lt. SAND WI COMPLY WITH ALL NON-POINT Issued by: Date
5 +REGULATID 2 Y'
Signature r AppecrVContrear D e Re-roofs
HAZAR1QUSM (RIALS DISCLOSURE
nptillemn or iota Iny cup; (core fir handle hand,un material Type of Roof
us defined by the Cupcnino Municipal hatter 9.12,and the Health and Safety
Code,Section 25332b)^
0Yee ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or furore building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air commodious as claimed by the Bay Arta Air Quality Management
District? all new materials for inspection. Applicant understands and will comply with
°Yen Cl No all non-point source regulations.
1 1 have rend the hazardous materials requirements under Chapter 6.95 of the
Cnlifamia Hr Ith&Safety Code,Sections 255115,25533 and 25534.1 understand that
if thehuildingJ of current yhave a tenant.that it is my resronsihility to notify the
upam of the to cuts which mail be met no,as issuance of u Cenificate of
°i panty' Signature of Applicant Date
otmmen ag , In All roof coverings to be Class"B" or better
OFFICE