01050058CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
10601 S. DE ANZA BLVD.
e
PERNITT NO.
01050058
0IXYNgxSE:EN
1 HLV JU
APPLIC TION S B DATE
05,04x2001
PHONE,
SANITARY NO. CONTROL NO.
O ARCHITECT/ENGINEER
BUILDING PERMIT LYEO
BLDG ELECT PLUMB MECH
ap
r.
LJ L.7 I— I l_i
'e LICENSED CONTRACTOR'S DECLARATION
I hedWitifrm that l am licensed undermanis nsof Chipper 9(commending
TENANT
Job Description
IMPROVEMENT.
w with Senion]0(0)of Division3of the Businessand Professions Code.xndmylicenu
Is in fall force and effect.
License Class Lic. M
Date Convector
ARCHITECT'S DECLARATION
g 1 underswnd my plans shall be used as public rccards
Licensed Professional
ax, OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
a following brawn, (Section 7031.5. Business and Professions Code: Any city or county
$30000 3 O O O O
0 which requirea Report to consumer, alter, improve, demolish, or repair any swerurt
. pd.,1.i. issuanca.lm requires tw.pplic.nt Tor such pemduo file. signed suemcm
_
that he is licensed I .... I to thc provisions of rhe Commerce, License Us, (Chapter9
(commencing whh Section 70001 of Division 3.f the Business aqa Professions Coda
X13 1�gPF�oop Area
�, f -p •„' t
Valuation
or that he is asempt,harefm7n and the basis for the alleged exemption. Any violation
"`
- of Section 9031.5 by any applicant for a pxmd: subjects the applicant to a civil Penalty
of w orae than five hundred dollars(s5a).
g3.rs..�
101AP-N 4`t'JIIfVDATION
'
'-„w..' Occupancy Type
ol,asuwneranneprapny,nrmrempmyeeswitnwagesasnd...leean,co,ado..
102
PIERS
will -do the work, -and the .structure Is nor intended or offered for .wale (See. 2044;
Buiines.i andProfessions Code: The Contractor's License Law does not apply ,o an
10 3
- UFER 'a foT!. -
Required Inspections ^ ”
Owner of property Who builds or improves rnercun, and who doss such work himsdf
104
- REBAR
or through his awn employees. provided] That such improvements are not intended or
building or improvement is sold her did Ont Weld or
Fo mpJ or sale IL howe.der will
Completion. the owner -builder ildcr will have the burden of proving the he aid not Wild
ANCHOR BOLTS____ � . r.,..,:.r `_ _
improve for purpose of sale.l.
106
- SEWER & WATER i
- ' I; .popny.amexd Siehconductingwini dconditionro
- - ---202 -=
UNDERFLOOR -'PLUMBING.._.._.--
eonsw<t the Proj t see. 9044. Business and Profession, Code) The Contramor's
License Law a«z not apply to an owner of property who Wilds or improve. thereon,
203
- UNDERFLOOR MECHANICAL"' - -
,' _ane who.comtuss for.such projects ,with a eonrracmns).fiamed.pursmm m.me
.. _".__...__2.04
----UNDERFLOOR --FRAME
ContractorsLicense Law.
- ❑I ,1.rep Hiders --'''`,B1.&PCT mi.Rpn,1p
205
- UNDERFLOOR-I)INSULATION
owl bone " "' J �1 ='J+d
'WOIthLR OMIENSAl
301
- ROUGH PLUMBING
t ION DECI,ARATIDN
302
— TUB & OR SHOWER
I hereby M. onder peplit, ofajpry doh of d, following aeelaradnns:-
303
- ROUGH MECHANICAL
a I haver and will lwirtiiii.'. cenifieat or'emi an, 55 self -insure for worker's
304
- ROUGH ELECTRICAL
Cmnpeexatiom us provided for by Section 3]00 of the labor Code. for the
performance of rhe work for which,his permit is issued.
305
- FRAME
❑ 1 nave and will maintain Worker's Compensation Iniumnc<, a inquired by Section
306
- HOLDOWNS
37M of,he Labor Code. far the pedomtancc of Ina work for which this perm, la
ssuad My W k P Co pe r 1 Ura c c rend Pol' y tic
307
- INSULATION
cam � vnuerN .
3'0'8- :-
SHEETROCK, - - -• < _ _ _ ...., ..
'[;CERTIFICATION OF EXEMPTION FROMWORKERS
(. {"j ) x3.09 t"-,'EXTER'I
OR °LATH,:., fi'''t 1
. A< '.
.._._..--
(Mixt ecfonraced nohec' mpleledNrthePermitisforonehundreddoll ^m
311-'
CRATCHRC OATH''_....___....-_-
-' SCRATCH COAT
(Sl(10)or1esal
,,, . I cert fy that the peA red. - f the work to, which sh pe' r such l
- - ,-313----ROOF--NAIL
.. ........ :. ..
swan, ployinyperson n y rimer:. f beysme b u the\Yorkers'
501
\ser
- FINAL ELECTRICAL ENERGY''
comps , w ,retro .Dte-
_.Apple t __.. - - ..
—APPLICANT;
_50.2._.-_
FINAL .PLUMBING.
IS CE If. 'fwmaking th ,c dr<,r rExemption, -you should
IS a TO m I Wokers after
on Provwortsof rh Code you must
503
- FINAL MECHANICAL' ENERGY
j reitnwrtn<nmplywirhwu<nvrovisi.nsarthispermitshanbed«mearcvakee;
_ 504
= FINAL BUILDING ENERGY
s 3 CONSTRUCTR LENDINGAGENCv
505
_.... _.. . - - - . .
,
- FINAL ELECTRICAL •' -'
1 h by ff that rhconstruction lending ager y f rn ped ' innor
'rrA kr h n.1
c
506
, .
- GAS TEST 11
-
w
i Lend Name .. L.. [ :.. , t _
LcnJ Aaa -•
....._ .. -...
507'
...
- FINAL -"PLUMBING
t
ordin that is.
1 ager thatcomp ad thiscity
508
- FINAL MECHANICAL
antoo county
with allcityanabori county aha cute laws
s and mining
uing
coWild L agree to roan.
509
- FINAL GRADE
Ia emiwnces
enter
thearhaie-mem .sed.andhcmbyamhorimbrpmunurivcsofthiscitymemerupon
i the obs .pectin pure^ s
u nd,"
510
- FINAL PLANNING
id didf
(Pel.grcfoss"vs �mRyatlkephmayinan wa income
1 liabilities. )udg ¢cost d expenses which may any was guns[ said
City m w q - of theg nt ng of this pe t
APPLICANT UNDERSTANDS AND WILLCOMPLY WITHALLNONPOIYT•1
514
- FINAL PUBLIC WORKS
SOURCE EGULATIONS S ,
-
Issued by:
Date
-.�
far fAppl UC , er, i 'Date �.
I, ,; HALARDOUS'MA7ERIALS DISCLOSURE
Re -roofs
t W II the hppl m 1 r hu IJ g oecupv t t r handl hazmdou t I
Type of Roof....-...
its deridedby rh Cupertino Mn iplCoJ Chapter add Health and Safe,,
Code Section 25532(
..
-. ., .•..
"' ''"' - •-�• •�
. .'.3,..^
)° c: s.
oyi�
'
•
All roofs shall
s
be inspected prior. to roofing being installed__
.0 1' rWJlthe applicant rfuture building «cup otuse,equipmentordevtceswnch
emit h dour nu t, defined by the Bay Area A Q 1 ty Management,
-any material
If a roof is installed without first obtaining an'ins ecoorgtl'agree to remove
p
Distha0y r '.•
-l' -
t-f"f 1 ti read ibe h afd ,muter y ;he;
-all _new materials
all non -point source
i,
for inspection. ,Applicant understands and will comply_with--
regulat3ons:.
ill menu elle Chapror 6.95 of
C.lif nHrhh'&Safety Cod Sections 25505 25533 and 35534 b ndersund ,nu:
Tihab IJ gene ,- tl k vtBnu inn t tnmv,rcspo :b litYmmitify h;
"
m
0cup:nt of the requr ems wh;ch must be mct prior ro Issiwae of. a'Ceniricme of
>,rL w
. - Signature of Applicant
_ _ . _ _ . '..._, . Date
ow^ernrn a=se^ Dat
_ ._. —
All roof coverings to be Class "B" or better
rri
..._: ......
' - - ' --- - OFFICE -�--