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CITY OF CUPERTINO
BUILDING DIVISIONPERMIT
CONTRACTOR
INFORMATION'
❑UILDING ADURI3S5:
PERMIT NO.
20672 HOMESTEAD RD
02090140
NER'S NAME:
APPLICATION SUB DATE
VIADELI, INC
09/19/2002
PIIONE:
SANITARY NO. CONTROL NO,
ARCHITECf1ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
0 0 0 0
LICENSEDCONTRACTORSDECLARATION
I hereby (form mat 1 am licensed under Provisions ors Y (commencing
under
Job Descriptio�' �G ■
A
with Benson ]land of Division J of Ne Business anJ Professions bWc. and my license is
Codr.
, V L E
inroRforceandeffect.
TENANT IMPROVEMENT
License Class Lic.ar
Dam Contractor
FEB 2 5 2003
ARCIIITECT'S DECLARATION
I understand my plans shall w used as public records
B
BUILDING UILDING
DWNER-BUILDER DECLARATION
hereby affirm that 1 stn exempt from .he Cnnrracmra License Law for the
Section ]I1J1.5, Business and Professions Gale: Any city vumy
Ire
a.
which requires ah.0 i demolish, nr repair any structure
which rite m s a P.
also re quires t e t [or su tatement
Pdnrtnitscense ec,alsore to the the applicant toe such PemNtoolessigned hapterm
that mouterat thcprovision, wlChare)Or
Sq. Ft.
Floor Area
$1006'S16htion
and
(commencing with Section ]lan) nl Division 30(Ne Business and
sioofthe the Code) of
Net io is exempt Therefrom and the arils on. Any
the alleged exemption. Any violation of
Section by any it
Occupancy Type
P Y YP
Tedd(ntfmapermitsubjectstheapplicantmacivilpenallyof
not more than live hundred dollars ($51)(0).
than
1, as owner of the property, or my employees with wages as their sole compensation,
102 —
PIERS squired In
will do the work, and Ne swctum is nm intended or offered for sale (See. ]INA, Business
and Pmfas:inn, Code: The Contractors License law does not appy man owner of
property who Guilds or improves Hereon, and whodoes such work himself or Nmugh his
own employees. provided that such impavcmems am not intended or offered for sale. If,
103 —
UFER
however, the building of improvement is sold within nate year of completion. the owner.
104 —
REBAR
builder will have the burden of proving that he did not build or improve far purpose of
105 -
ANCHOR BOLTS
1, as owner of the property, am exclusively contracting with licensed contractors to
106 -
SEWER & WATER
emislnl.t the pmjeci (Sea ]INA, Business and Professions Code:) The Conlncmrs Li.
cense law does not apply to an owner of propsny who wilds or improves Nemnn,and,
202 —
UNDERFLOOR PLUMBING
who contracts for such projects with a compactor(s) licensed preauanto the Common
License Line
203 -
UNDERFLOOR MECHANICAL
❑lam exch,I der S//e�c�.B&PCf this. a,n"
(Date/` /� QZ
204 -
UNDERFLOOR FRAME
205 -
UNDERFLOOR INSULATION
ORKER'SC MPENSATIONDECLARATION
301 -
ROUGH PLUMBING
1 hereby affirm under Penalty of Perjury one of the following dec (ration:
302 —
TUB & OR SHOWER
❑ I have and will maintain a Certificate mComma to self-insum(nr Worker's Conflict.
sution, as provided for by Section 3]110 of the labor Code, for Ne Performance of the
3 03 -
ROUGH MECHANICAL
workmlis
rwhichthisrmisumed.
304 -
ROUGH ELECTRICAL
❑ 1 have and will maintain Worker's Compensation Insurance, u required by Section
3 05 -
FRAME
3]M of the Labor Cade, for the performance of the work for which this Permit is iau.d.
My Worker'( Compensation Insurance carrier and Policy number are:
306 —
HOLDOWNS
Carver: Policy No.:
307 -
INSULATION
CERTIFICATEEXEMPTION
COMPENSATIONE
INSURANCE
308 —
SHEETROCK
('ITissacfitm predator Mcompletedifthe Permit isforanc hundred dollars(Slg)
309 -
EXTERIOR LATH
of leaa.)
310 -
INTERIOR LATH
I eenily mat in me Refgr m e of the work lin which this Permit is issued, I shall not
311 -
SCRATCH COAT
employ any Peru W y manner sats m become subject to the Workers Compensation
Laws of CalifnrnieAem
Applican J1"H
313 -
ROOF NAIL
NOT!'OAPPLICAN.-If, of rmakingthisCenifcateofEsempfion,youshould
501 -
FINAL ELECTRICAL ENERGY
become subject n the Worker ' a Compensation Provisions of the Loth Code. you must
502 -
FINAL PLUMBING ENERGY
forthwith comply with such provisions ar fair permit shall be deemed mvnkcd.
503 -
FINAL MECHANICAL ENERGY
CONSTRUCTION is. ON LENDING AGENCY
isaml(Sce.30D,lending agency Iia NC Perbarmanac of
Ihcmwhich thi memit
504 -
FINAL BUILDING ENERGY
i
the work Na which this Permit is issucJ (Scc.l(H], Civ. CJ
1<ndcr's Name
505 -
506 -
FINAL ELECTRICAL
GAS TEST
Lender's Address
(certify that 1haw mad this the above inharmarm,is
507 -
FINAL PLUMBING
cortealagree mermaid, ty ad county Ordinances
and with.11 yauthor eoumyordinanees and cute l entrelatingm
building construction,tioneand M1emay auNonurposes. rives of this city mentor upon me
5 -
FINAL MECHANICAL
awvomemioncJ PmPeny for inspection purposes.
509 —
FIN
(We) agree m sere. indemnify and keep hostile. the Ci.y of Cupeninn again,.
liabilities, judgments, costs and expenses which may in any way acetue against said City
in
1"
5
N G S
APPLICANT UNDERSTANDStA�N�DWILT, COMPLY WITH AL POINT
Issued by?
WORKCJ /
Date
/.
SOURCE :GU.ATIONS. 17
Re -roofs
Type of Roof
L
t naturcof Applican onuacmr Dam
A, RDOUS MATERIALS DISCLOSURE
Will the applicam or furor, building xcupant.norc or handle hv(rduus material
defined by the Cupeni no Municipal Code, Chanter 9.12, and the Ilealth and Safely
,2
e. sec25532553200?❑yeS
All roofs shall be
inspected to any roofing material being installed.
X.
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devicca which
emit hxaxrdnus air contamina'defined by the Bay Arca Air Quality Management
all new materials
for inspection.
onts/as
District? D4N
❑Yes ///��� ��`
I have read me haasrdous mamrialsmquirchicnm under Chapmf6.95 of the Califon
nix Health &Safety CtWe,Section;25505,25533 and 25534.1undersand thin Tube wilding
does not curremly haw a tenant, that it ismy mmur sibili.y to notify HIC OCCuP rm of me
reyuiremen hichmutwmcipnur n issuanpenfo ¢nificmcnf G cy.
Signature of Applicant
Date
V/
All roof coverings to be Class "B" or better
perm aamnri.re (gen. Dat.