02120071 CITY OF CUPERTINO
BUILDING DIVISION PERMIT af CON RAC-TORyINFO,RMATION
BUILDING ADDRESS SOUTH BAY CONSTRUCTION CO . NTTAIF O.
10050 FOOTHILL BLVD # 200 02120071
IPFR'S NAME: 511 DIVISION STREET APPLICATION SUB DATE
DON BECK — 12/17/2002
0101,47 4 0 B 3 7 9—0 4 0 0 SANITARY NO. CONTROL NO.
ARCH]LEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MMH
0 0 0 0
aOat,w, 1 hereby fLICEh SED"CONTRACTOR S DECLARATION
0u y provisions(if Chapter 9(commencing Job Description
Zyt with Section 70x1 of Division 3nffac Dutinns and Professions Code.and my license is
�" Licem ^ TENANT IMPROVEMENT
n? Liccrt at. Lic.N
off— Dam Commnor
k-y f!� ARCHITE=DECLARATION
y K ati 1 undersand my plans shall he used as public records
Nnr a0!;; Licensed Prolessional
a OWNER-BUILDER DECLARATION
ad <Z I hereby Whim that I am exempt from the Contractor's License Law for the
ada,a lidlowmg reason.(Sect^n 7031.5.Business and Profescrems Code:Any city or county
w$� which requires a permit to construct,alter.Improve.demolish,or repair any.arumure
F x a prior to its issuance,also recentness the applicant fonuch permit to file a signed statement
PSG that he is licensed peomantInthe provisinnenftheCommennsLicense Law(Chapter 9 Sq. Ft. Floor Area $16Y00ation
yl- (commerce,with Section 70()0)of Division 3ofne Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom than fire hundred dmlari(Ss0fif Occupancy Type
❑ I,as owner of the property.or my employees with wages as their ale compensation.
will do the work,and the structure is not intended m offered for ale(Sec.7044.Business
and Professions Cock:The Condamine,License Law it.not apply to an owner of 102 - PIERS euir
qed Inspections ���
pmpeny who buildsor improves thereon,and who doessuch work himself orfamugh his
own employees,provided Nal such improvements am not intended()termed for sale.If. 103 — UFER
however,the building or improvement s sold within one year of completion,the owner O
builder will have the burden of proving that he did not(wild or improve for purpose of 104 - REBAR AN 2003
We.). 105 - ANCHOR BOLTS
Les owner of the f...he .am exclusively contracting with licensed contractom to 106 — SEWER & WATER
co street the project(Sec 70,14.Business and Professions Coded The Contractor's Li-
censelawdoesnotapplyinanownerofpropertywhobuildsorimprovesthemor.and 202 — UNDERFLOOR PLUMBING i3il/L®�N(j
who comment for such projects with a contractor(s)licensed pursuant to the Contractor's M
License Law. 203 — UNDERFLOOR MECHANICAL
❑l am ex mpt under Sec. ,B&P C for this reason 204 — UNDERFLOOR FRAME
n Dare �' 205 — UNDERFLOOR INSULATION
ORKER'P COMPENSATION DECLAR 301 — ROUGH PLUMBING
I hereby alRmt under Per
of perjury one of following declarations: 302 — TUB & OR SHOWER
❑I have and will maintain a Certificate of Cementto set insure for Worker's Compen-
aoon,as provided for by Section ria)of the Labor CMe.for the perrnrmaxe or he 303 - ROUGH MECHANICAL
work Dor which thimK.It lstsacd. 304 — ROUGH ELECTRICAL
I have and will maintain Workers Compensation Insurance,as required by Section 305 — FRAME
370D of the Labor CMth
L for the performance of she work for which this permit is issued.
My Workers Compensamm Insurance carrier and Policy mom her are: 306 — HOLDOWNS
Came': Policy 307 — INSULATION
CERTIFICATE OF EXMON FROM WORKERS'
COMPENSATION INSURANCE 308 — SHEETROCK
les (Ttis.scction need nm Mcomplcad done permit ishoonchundeeddollars(51010 309 — EXTERIOR LATH
It cenify 310 — INTERIOR LATH
e m ploy nat in the perm [c f the work for which this permit is issued.1 shall not 311 — SCRATCH COAT
Semploy any pcmnn in logUi In bccumc xuhjca to the Workers'Comsensition
awa nrcar�µ� GI 11(17 313 — ROOF NAIL
Afpbca 113" /IVY -`
NOT�csro AP�LICAM:II:after making this Certificate of Exemption,you should 5 01 - FINAL ELECTRICAL ENERGY
bee ubject to the Worker's Compensation provisions of the Labor Coda you must
Z forthwith comply with such provisions(it this permnshall Ise deemed revoked, 502 — FINAL PLUMBING ENERGY
Z O CONSTRUCI'IONLENDING AGENCY 503 — FINAL MECHANICAL ENERGY
FIhereby affirmthat there isae^nmm�ino]coding agency lot nepmlormanceof 504 — FINAL BUILDING ENERGY
C > thcworkrwhich nmit
isfcrisissuodlSec.3(MJ7,Civ.C.7
Q Lendersder'sName 505 — FINAL ELECTRICAL
Z)a.
Z Leader Atl°res` 506 — GAS TEST
U O 1 eeniry fast 1 has.read this affliction.and tate that he above information is 507 — FINAL PLUMBING
W correct.1 agree tit comply with all city and county ordinances and sate laws relating m
OU building conswction.and hereby milloriampresentaives(if this city toenter upon lbe 5 — FINAL MECHANICAL
above mentioned property for inspection purposes. 5 9 — FIN
F Pr (we)agree to save,indemnify and keep harmless the City of Cupertino against
V) liabilities,judgments,costs and expenses which may in anyway accrue against said Cny 5 N G )
U Z m PLICA nee UNDERSTANDS
Sthis) WILL
/ V
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b)5 1 — WORKS Dale /
SOIRCBREGULATIONS.
1V
L— . Jn67 Re-roots
gna sere or Afphcaare
HAZARDOUS MATERIALS DISCLOSURE Type()(Roo(
Will the applicant or future building e,Chapter
tion or handle Health
material
I define)by the Cupertino Municipal Code,Chapter 9.13,and the lica0h and Safety
de.Section 25532(x)'!
❑Yca All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupent use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as derined by the Bay Area Air Quality Management all new materials for inspection.
District?
0W
1 have read the hvartous materials ayuiremenu under ,Chapmr 6.q5 of the Califor-
nia I It&Safety Cole,Sections 25505,25533 and 25534.1 undersand Ihztif tom building
does not c.m mly have a avant,nal it is.,responsibility to.only the Ioca,mf he
r•q ' B hich must be act pd or tissuanm nfa Ccrdfieamof LLruWny
Signature of Applicant Dale
ver or moth ited agent st ,m All roof coverings to be Class "B" or better