00070056CITY OF CUPERTINO
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CONTRYT R I]' ? RLVL Tj%:
00070056
BUILDING ADDRESS:
.
PERMIT NO.
5880 W.
LAS POSITAS
BLV, #3707/11/2000
OWNER'S NAME:
APPLICATION SUB DATH
5-1200
]ONE -
SANITARY NO, CONTROL NO.
ARCHI'FEC nENGINEEk:
BUILDING PERM[ '1'INFO
BLDG ELECT PLUMB MECH
I hereby' rothatEDCONTRunderSDECLARATION
that I am p
I'mm of Chapter 9 (cnmmccense
ENLARGE EXII�I5NCipQQMPUTER ROOM
lia.7affirm
with Sectionelan) officlicensed sinev and
mnlofIM1c Rurinere and Professions Code, and my license
full tures and effect
effect.
I�in
iccmc Class tic R
_ Doc Comnsmr
ARCIII fEC'r'S UIiChlic
mION
nJe Imd my p ane puhlic recnNs
'
r .
%
xSiu.nst lJa RinnalM1�.,
W NfR BIM DI R CI \RATION
n R-nm70 Ilan theContractor's L l for he
front
mshy
followingra . Is f ]631 S t n and 1. Code. y lY ammy
�
] whicht t c I t alar p demolish, poi any a mere
rtqu rc. pe—"'aro v
pan I ".'nee almregans the uP�liram for such pertain fleasigtmd statement
5 @
mal he List heenwd pursuant to me provisions of the contractors License Law (Chapter 9
(cmmucheing with Section 7")ofOn, men Sof the Business and Prof ..ob Code)
S Ft. Floor
q•
Area
V-jfuation
or that he is exempt merefmm and the basin for the alleged exemption. Any violation
of Section 7631.5 by, any applicam for a permit subject, thepplm ecaso a civil penalty
of dot more man roemundred dnuars(saa).
APN Number
-
Occupancy Type
❑ L ns owner of the property, or at, employ cel with wages as their soleed rmatioatio a
NP
will tit) the work, and the stratum is not inicnded or offered 1,11 sale see. 71144,
- ] @2
— IOSPCCt10U5
P IE1i
Iluslnt's and Profession, Code: The Conmtemr's Lic... a Law does nut apply to un
w nmper y h builds or inlpmvas thra
em, and who does such work hinuell'
or Oumugh his own employees, -provided that .such impowements are not immardml nr
103
II'Ulred
— UFE R
offemfill rale. If, however. me holding ar lrimovenlem is sold within ane year of
inmpletion, the owner -bander will have the harden of proving that he did inn build or
1 @4
— REBRR
mprove for pagmsetar sale.).
-'
.
01. as owmerof the properly, am exclusively contracting with licensed nmtramma a,
105
— ANCHOR BOLTS
construct the project (sem. 7614. Barium.. and Proa.amm code:) The Commctor's
License Law does not apply Iw
o an oner of pmpeny who builds or impmn re
vtheon,
1 @6
— SEWER R WATER
and who contracts for catch p tectc with a combatants) licensed pttrsuam at the
coommo is Lireme law.
202
— UNDERFLOOR. PLUMBING
❑ I and axempt trader Sec. ,e&Pc for mi. reason
203
— UNDERFLOOR MECHANICAL_
Gw"ef -D"t"
WORKER'S COMPENSATION DECLARATION
204
— UNDERFLOOR FRAME
ulereny arlrm sumer penahy of perimy Lite art me following J«Iar:,I11111,,,
•• 205
— UNDERFLOOR INSULATION
J I Iowa and will maimain a Cenilicme of Consent m e
slf-insure for WorAcr's
301
— ROUGH PLUMBING
•
Compensation m provided far by Section 17M of the Labor Code, for he
302
— TUB & OR SHOWER
can
131hpea,fitwthewarkmWarkerch ,Compeirsi.cued.
❑ 1 have and will Compensation as by Section
or
303
— ROUGH MECHANICAL
l]BB r Carlo the of t ework f which
the work for wh'ah this pern;t err
his
the Labor Carl for the pcnsurance
3@4
— ROUGH ELECTRICAL
.
ic,Lied.Mywareefacampenaatfonhlsuan«aan;erand Policy number arc:
c rr
3@5
— FRAME
Caries PolicyNo
CERTIPICATIONOFE%EA1P'rIONFROMWORKERs•
306
— HOLDOWNS .
COMPENSA3'IONINSURANCE
307
— INSULATION
rslnn�,�i�.imdm,nmmmnnealtnplm«lif(it. crmhisfuturentmdrcddo1hiry
308
—'SHEETROCK
I certify that in the Performance of the work for which this permit it issued..1
309
— EXTERIOR LATH
shall not employ any Person in any manner so as m become subject to the Workers'
Compensation laws of Calfomin. Dam
31 @
— INTERIOR LATH
Applicant
NOTIC
NOTICE TD APPLICANT: If, afar mnMng the Certihcme of Exemption, youshould
311
— SCRATCH COAT
becamanuhjecltolhe Warkefs Campcnantion provisions of 'he labor cal,, you must
313
—' ROOF MAIL .
forthwith comply with such pmvisinm or this permit shall be deemed revoked
CONSTRUCTION LENDING AGENCY
501
— FINAL ELECTRICAL ENERGY
I hereby alErrn mar roam is It commacdon madinii.seamy rpt the Perfomtana
ar the work lot which this permh is i..oed (Sae. 3697, Civ, Cl
- 502
— FINAL PLUMBING ENERGY
Iaadcr's N"unc
Lendnr:s Addmse
503
— FINAL MECHANICAL ENERGY
I certify that l have mad this appi;cation anti state thinme above mPomtaaan is
504*
— FINAL BUILDING ENERGY. '.
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby amhorim represemmises of This city to enter uptm
505
— FINAL ELECTRICAL '
The above-memioned Property for inspection purposes.
506
— GAS TEST
(We) agree so arm. indemnify and keep harmless the City of CuPcninuiii
I ahilities, judgments, costs and expenses which may in any way averse atimmi eoid
507
— FINAL PLUMBING
City in consequence oFbeytwx' of thi reit.
APPLIC NTUNOERSTAN LCOMPLY WITH AI. N N -POINT
sou E uLAn
Issued by: 508
- FINAL MECHANICAL
Date
_V1IAV—
VOW
q;nxm me Yale ac
IIA2ARDOUSMATERInlsulscLasueE
Re-roofs 510
— FINAL PLANNING
Will tire umlcaud.1 maw haddiagowcainan acre or handle lamnlousmamdal
u der by the Cupertino Municipal Coale, Chapter 9.12, and the Health ad nSafety
Type of Roof 514 •—
FINAL PUBLIC,
Code, Seatlmn 25532(x)'!'
.WORKS
0 YesNo
All roofs %hall be inspected prior to any roofing material being installed.
Will the applicant orfuture building mseequipment ordnvices which
mit hmrdnm aircontaminants as bythe BuyeaAir QualityManagement
If a roof is installed without
first obtaining an inspection, I agreeree to remove°1f1"nt?
❑Yes ON.
all new materials for inspection.
Applicant understands and will comply with
PP P y
all non -point source regulations.
1 have read the hazardous materials requirements under Chapter 6.95 of the
Calimmio Health & Safety Code, Sections 25565, 25533 end 25534. 1 undersand that
1f the building does oar emmoly have u tenon[. that'a is my responsibility a, notify the
o"alftm of the requirements which mast M amt pri n to Issuance of a Ccnireate of
Occupancy.
Signature of Applicant
Date
All roof coverings to be Class `B" or better
Owner or uerhmtzed ,an, Dam
OFFICE