02050011yBUILDINGDI\'ISIONxv PERMIT I CONTRACTOR INFORMATION:
BUILDING ADDRESS:
10725 DE ANZA BLVD
L C O_ ARCHITECT/ENGINEER:
H = LICENSED CONTRACTOR'S DECLARATION
2 = 1 hereby grit. that Iamhcam,isd under provisions of Chapter (mencing
with Section ]Oro)of�Division Jof oflhathe BusinensYrofesi nsC de.. mcomse
andlicen
f
acas e < is mfull fa
O SCtD
? i ,, x Lia. e'
Comas
a 0 RCHITECus tas ATI
g 1 understand my plans shall be oseJ as public recoNs
r
t O O Licensed Professional
OWNER -BUILDER firms
I hereby a(frm that 1 1. exempt from N< ContramCo License taw for the
ad< following rcasoa (Section ]031 S, Busing. and Professions Code: Any city or county
nO which requires a permit w construct. the, altcc improve, demolish, or repair arty structure
i3 = drit hear oiscoissuance. asantto the thovisio armso for such pemdtmBensle aeLaedvatemetn
Nat he is cing with
pursuant m the provisions of the the Business
License Law ons(Chapter )
(commencingwith Section]BOB)l Division 3of the Businessand professions Code)
or that io is exempt tang applicant
li and the basis for the subjects
t e e pliant to Any violation
of Section ]03n vanyapplicantforapermit subjmsthe applicant toanvil penalty
of not mnrc than five hundred dollars (ESW).
❑ I, as owner of the property, or my employees with wages as Weir, sola compematran,
will do the work, and the structure is not intended or offered for sale (Sec. TWA,
Bulinus and Professions Code: The Contractor's License law does not apply to an
owner of property Who builds or improves thereon, and who dues such work himself
or through his own employees, provideat such improvements we not intended or
od N
offered for w1C. If, however, Nc building of improvement is sold within ane year of
o ndehnn. the nwnerpadre, will have the burden of proving Nat he did not build or
improve for purpose of sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed evntmemrs m
Larious, the police, (Sec. 70,W. Business and Prons fessioCoda:) The Contractor's
icense Law does not apply to an on, of pmp m, who builds in improve, thereon
.- and who contractsfor such pmjems with a.cnntranorts) licensed pursuant to Ne
Contractor's License law.
Q I am esempt under Sec. B & P C for Nis reason
- owner - Dole
- • WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Cenreewe of Consent to self -insure for Worker,
Compensation, provided for by Section 37W of th< labor Code, for Ne
perfonnantt of thehe work for which this permit is insucd.
❑ I have and will maintain Worker's Compensation Insurance, as acquired by section
37M of the Labor Code, for the performance of the work for which this permit is
sued. My Worker's Causation Insumnce,farricr and Policy nu9tber are:
' (This :eaion need not he completed ii the permit is for one hundred dollars
1T 103) or leu.)
1 verify ihm in the permimunce of the work for which this permit is issued, 1
shall not employ any parson in any manner so as to become subject to the Workers
Compensation taws of California. Date Applicant
NOTICE
NOTICE TO APPLICANT: If, after making this Cantles, of Exemption, you shoultl
z become subject m the Worker's Compensation provisions of the Labor Code, you must
ZQ forthwith comply with such provisions or Nis permit shall redeemed ravaged.
F' ' ' CONSTRUCTION [.ENDING AGENCY
E
7 I hereby atlirm Nat there is a constmenim lending agency for the parfe rmarea
�0 of the work for which Nis permit is issued (Sec. 3097, Civ. C.)
Landers Name.... :- , . .. .. . . ..... . ....
.e,7 Z Lender s Address
V I certify that 1 have mad this application and state [hat above information is
W .F. corten. I agree a comply with all city and county ordinances and slide laws relating
to building construction, and hereby authorim muesentatives of this cirymcn¢r upon
�a W the above-mentioned property for inspection purposes.
F.. 4 (We) agree to uvc, indemnify and keep harmless the City of Cupertino against
f0 liabilities, judgments, costs and expenses which may in any way accrue against said
U,z
City in con, f th grunting of this pemtit. - ..
(�PPLI �/r��ill�'1yt'R. A" S AND WILL COMPLY WITH ALL POIM'
/SOUI N.O "VS I
I - HAZARDOUS MATERIALS DISCLOSURE
Wilma applicant or future b (ding occupant st or handle hvardo s mmerim
as def W by the Cupertino M n c pal Code Chapter 9.12. oral the Health and Safety
Code Section 255320)? �
❑Ye. 8No � t. .
WdW irc t ft b'Itred asp to wi Ai t de Management rm hare, d air roma n tuns de neve by the Bay Area At Quality M nagemcm
Disn n
(`rrI{4 ❑Ys No
J
1 have read the h materials iequ o manta under Chapter'6 95 of Ne
recar'
alifornia Health &Sa Castle,Sections25505,25533 and 25534.. l understand that
f the boildt999999ffffff tl in trimly have a aaam, that it is my responsibility to notify the
upanIs which most be ton prior to issuantt of ¢Cenificme of
otic \ i.r77
GOLDEN GATE MECHANICAL
1793 LAFAYETTE ST #130
02050011
;B
/2002
(408) 246-3355 IbANf1AKYNU.
t. I I.vt )'
uu�allx.�
Job Description
AIR HANDLER (5 TON)
10
MAY 0 9 2002 $15000
TION
iso
PLUMB MECH
luL
el GtCb I
103 -
UFER Required Inspections
104 -
REBAR
105 -
ANCHOR BOLTS
._..
106 -
SEWER & WATER
202 -
UNDERFLOOR PLUMBING
-
203 -
UNDERFLOOR MECHANICAL'
-204 -
UNDERFLOOR -FRAME -
205 -
UNDERFLOOR INSULATION
301 -
ROUGH PLUMBING
302 -
TUB & OR SHOWER
303 -
ROUGH MECHANICAL
304 -
ROUGH ELECTRICAL
305 -
FRAME
306 -
HOLDOWNS
307 -
INSULATION
308 :-
:SHEETROCK '
f 3096=__J.EXTERIOI2:`LATH.:
_.. —310:-,
-.INTERIOR'--LATH.-...-
311"-
SCRATCH COAT
313 -
ROOF NAIL.
501 -
FINAL ELECTRICAL'ENERGY
502 -.-FINAL
PLUMBING ENERGY
503 -
FINAL MECHANICAL ENERGY
504 -FINAL
BUILDING ENERGY
505 -
FINAL ELECTRICAL
506 -
GAS TEST
507 -
FINAL PLUMBING
508 -
FINAL MECHANICAL
509 -
FINAL GRADE
510 -
FINAL PLANNING
514 -
FINAL -PUBLIC WORKS
O
Issued by: —� —�C� Date z
Re -roofs
Type of Roof
_All roofs.
shall _be inspected prior to any roofng.material being installed.
If a roof is installed without first obtaining an inspection, I agree taremove
_all new materials for'inspection. Applicant understands and will comply with
all non point source regulations. -
Signature of Applicant Date
Ali roof coverings to be Class "B" or better
- — UFFICE