00100135 (2) CITY OF CUPERTINO '""""' *�'
BUILDING DIVISION PERMIT `} 4N�,'� G'"T ??N ORMXUQNy 4 0 Q
BUILDING ADDRESS: SOUTH BAY CONSTRUCTION CO INCT
0 ER'S NAME: 511 DIVISION STREET PERMIT L4
E:RTITX I -
SANITARY OL NO.
(408) 379-0400
ARCHOECYENGINEER: BUILDING PERMITINFO
HGF ELECT PLUMB MECH
O
00 Z' LICENSED CONTRACTOR'S DECLARATION
OF 1 hereby affirm that 1 am licensed under provisions ofChapur9(commenting Job Description
-� with Section 70(N)afDivision 3 arrive Husincseand Professions Code,and my license is
In full force and effect.
uceme Cl..a uc.g TEN. IMPV/ PLUS ELECT AND MECH
i Dem Contractor
ARCHITECTS DECLARATION 11— �IjI�V;,IG=v11�L:ca
I I understand my palm shall h used As public records
euD Limmed Prefeammal DEC 1 Q v
& OWNER-BUILDER DECLARATION
0 f I hereby.(Seat that 1 1. exempt Imo the Contractor,is License Law far the
o D following Onesna,Permit
a]031.3,Business end Pne.rico ns Code:Any city s county
$� which requires•permit u cnmtruct.situ,Improve,Jcmnlixh.or rtNir.y atmnure
prior In its issuance.also requires the applicant for such permit o Bleasigned&uccoml
G that he is licensed pursuant In the provisions of the Conlracter'aL¢nac Law(Chapter 9 Sq.Ft. Floor Area $4(316)6lon
zC� (commencing with Section 7000)of Division 3 ofthe Business and Profession.Corm)or
3 that his exempt Marefrom and Ne hand,for the alleged exemption.Any violad,am of
Section 7031.5 by any Appliu"I for a permit subjects the applamlto a civil Penalty of 3 � p�y�r00 Occupancy Type
not more Nan five hundred dollar.($3W).
❑1,as owner of the property,or my employes with wages.their auto compensation,
will do Ne work,and thesuuctore is not Intended arolfmed far.1.(Sm.7044.Business 101 — FOUNDPI$eFjQp�d Inspections
and Professions Code: sc
The Conuror't Liame law does cot apply to An owner of
propeny who Wild.whaprove&themer.mal whodaesauchworkhletsetfarNmugh his 102 — PIERS
own employcea,provided that such Improvements art not ntended oroRered farads.It. 103 — UFER
hove
wer,Nh on
e building or improvement sold within e year of completion,Ne owner-
builder .will have the burden of proving that he did not mild ar Improve for purpose or 104 — REBAR
ark.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to 105 - ANCHOR BOLTS
construct the pmjem(Sec.7W,Business and Professions Code:)The Contractor's Li. 106 — SEWER & WATER
ante law does not apply to anowner or progeny who wilds or Improves thercon.and. 2O2 — UNDERFLOOR PLUMBING
who contracts for such pmjeets with a contractor(s)licensed pursam to the Camnclo's
License Law. 203 - UNDERFLOOR MECHANICAL
❑lam exempt undesSec. ,B&PCfar this rcnson
Data 204 - UNDERFLOOR FRAME
WORKERS COMPENSATION DECLARATION 205 — UNDERFLOOR INSULATION
I hereby alRrm under penalty of perjury one of the following dechraon.: 301 — ROUGH PLUMBING
In.ve.na will m.inrsm.cereHateafeaa.entmseu-Inwmfar w.mr.camP.n- 302 — TUB & OR SHOWER
.tion.u provided for by Section 3700 of the Labor Cede,fu the performance at the 303 - ROUGH MECHANICAL
work for which this permit is lulled.
❑Iban And will maintain Worker's Compensation Insurance,as required by Section 304 - ROUGH ELECTRICAL
371.1'the laborCode.for the Performance ofthe work for which w.Pemdtlalaad 305 — FRAME
My Worker's Compensation Insurance artier and Policy rump am: 306 — HOEDOWNS
Carrier: CERTIFICATE OFEKEMPIONFROM WORKERT 307 — INSULATION
COMPENSATION INSURANCE 308 — SHEETROCK
(This section need notes completed if th perm,is far one hundred dollars(1100) 309 — EXTERIOR LATH
m lams.)
1 certify wt In the panfarmmce of the work fax which this permit is issued,t shall not - 310 — INTERIOR LATH - -'
employ any person in my manner an As In become tubjmi to the Workcas Cocarmudon 311 — SCRATCH COAT
Laws of California.Data
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT.If.after making this Certificate of Exemption,you should 314 - T-BAR CEILING
become subject to Ne Worker's Campens.tlon provisions of Ne labor Cade,you most
3z forthwith comply with tachprovisions Ofthis Permit ahall heturned revoked, 501 — FINAL ELECTRICAL. ENERGY
�55 CONSTRUCTIONLENDINGAOENCY 502 — FINAL PLUMBING ENERGY
I hereby eRsm that ft.
its commando.lending egroey for dm performance of 503 - FINAL MECHANICAL ENERGY
x?•r the work for which this permit Is issued(Sec.3087,Civ,C.)
� A a""r'a"°"" 504 - FINAL BUILDING ENERGY
D z Lendees Address
DO 1carry dust lluveread Mr.Application And suethat the Above information is 505 FINAL ELECTRICAL
i correct.I agree to comply with all city and county ordinances and state hes relating to 506 - GAS TEST
building construction,and hereby authodre mpmsenmives of this city to enter upon MeFIN PLUMB G
above-mcntianad property for ImN
pean purpose&.
(We)agree to save,indemnify and kap harmless the City of Cupertino against 0 8 F I L
h Iiabllitles,judgments,emu and eapemea which may In any way =a .last said City
J t'+ APPLICANTeUNDERSTANDS Aof Me grantiofIND WILL COMPLY WITH ALL NON-POINT Issued b 5 Date
SOURCE REGULATIONS. y 5
Signuurt of AppliceRe-roofs 514 NAL PUBLIC WORKS
HAZARDOUS
Dae
HAZAUS MATERIALS DISCLOSURE Type of R 6 - FINAL BUILDING
Will Ne applicantorfuture buildings,Chapter 9.1or handle Health
sd Surisi
As dcOned by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety
Code,Section 35531(4)7 All roofs shall he inspected prior to any roofing material being installed.
❑Yet ❑No
Will the applicant orlmum building occupant arc equipment or dcvles which If a roof is installed without first obtaining an inspection,I agree to remove
ith'=11sirronuminom as do0ncd by the Bay Area Air Ga.] Mmagemem all new materials for inspection.
Dlatrict7
❑Yes ONO
I have mad Ne haardim&materials requirements under Chapter&95 of the Califor-
niaHostile&Safety Code,Sections M505.25533 And 25534.1 undenuvd At,if the building
deal not currently have a unam that it is my responsibility to and I tic«coup.,of the
rcyulremcnts which must be met prior to issuance of a CcrsiOcau or Occup.cy. Signature Of Applicant - Date
Owner o milanized agent Data All roof coverings to be Class "Bo or better
OK
PERMIT NO 00100135 „ 31609030.00 OBLIx
PERM TYPE COMML-TI 1118922 FORGE DR n.m�
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P E C, TIS O N i, H I S T 0'R o � Ia _
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!,TNSP, TYPE'.NO INSPECTOR ,INSP DTin-RES NOTES" ' �Fj
SOB " 2 TO 12/16 00- P
516 ' 1'TO .12116/00' P: IM
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" 304 1 Td"' -12%08/00`-P
508' - ' ' 1 TO : '12/08/00 C
314 1 TO :12106100 Fy5
308;;< r..l CCyr t e,"",11/30/00 ; P. a 48 .
= 303'' - -1;CCj r '11/27/00 "P r a
305 1 CC 11/27/00 P
y
103
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