00050202OFFICE
CITY INO
DIVISIION
CONTRACTOR INFORMATION:
BUILDING PERMIT
RUILDING&DITNFINITE LP
DPR CONSTRUCTION INC
PERMIT NO.
OWNER'S W)PLECOMPUTERS
555 TWIN DOLPHIN DR
APPLICATION SUB DATE
PHONE:
SANITARY NO. O TR O.
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ARCHITECT/ENGINEER :
(650) 592-4800
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
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LICENSEDCONTRACTOR'S DECLARATION
Job Descrt tion
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1 hereby affirm dont In"Ileens.clocation ander ,...Chaplet 9l r mmencia,
as
with Section 7001➢of Dlvlsum 3ofine Busineseand Pnde,00n, Code, undnty wase
be a
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'n am force and etreat.
Liense Clans Lic.d
Date
Ear
DECLCLARA'f10N
1,,ndersmad my Plans shall he aced as ramie records
Ei:ARCHITECT'SS
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dos
TENANT TENANT IMPROVEMENT 1
OWNER-BUILDER DECLARATION
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1 hereby affirm that I am exempt from the Contractors License Law for the
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following reason. (Section A)3L5, Baldness and Profession, Code: Any it, matronly
❑
which requires a pemtir to construct, alter, improve, demolish. or repair any stmcmre
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pritch, ask aneal requiros,haid,hemaf r yernoune file ti,iouted starturean,
Sq, Ft. Floor Area
Yaluatio
114000
thathe is licensed pt to the provisions offlie Contractors License Law (Chaprr9
'
me tela
(mm mng with Sat 7030) of Div s an 3 of ss the Business and Prolc"nam, Code)
or that he is exempt thamfmnt and the haov for the alleged exemption. Any violation
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af Sccdon 9031.5 by any applicant far a Permit xtibi,cl, the npplicanr la a aml penalty
of nm more than rive hea load dollars ($500).
AS1N&2I K6. 00
Occupancy Type
❑h downer Property, or employees with wages usld their sole eompensmlon,
-
mthend the a
will ne the work, bud., Code T e is not intended or named for sale (Sec. 7M4,
Business dna Case: The Com Law doss not apply m an
mid
Required Inspections
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nary Who th there..,
r of progeny Who build, or improver rheum, and who aae.v such work himself
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or through own employees. that such irnpmt not one dedyear or
budded n sola within one year of
sal is sol within
for rale. If, however, the building or urden
comple of
anavefn.the aweefoudar w�u bade me burden ar pmaing that be na'n°i1e"`
101 — FOUNDATION '
improve for puT^se nL,uleJ.
- "
1.02 — PIERS
❑ Las owner of the property, oto exclusively contracting with haettved contractor, to
construct the project (Sec. 7044, B micas and Profusianx Code:) 'the Contractor's
'who
1.03 — UFER .
"
License Law doe, net apply to an ownerof propertybuilds or improves thereon,
ace he m,mmcs rat r.an projeus w(h a eommele,h) licensed pmoment no the
104 — REBAR
Contractors License Low.
_
❑ 1.,a exempt under See. .B& P C for has rmsa.1
1.05 — ANCHOR BOLTS
Owner Done
106 — SEWER & WATER
WORKER'S COMPENSATION DECLARATION
202 —UNDERFLOOR PLUMBING
I hereby arfirni under penalty of perjury one onhe following declarations
203' UNDERFLOOR MECHANICAL
❑ I nave and whi amemain a Cerdreare of Consent a eir-insure for Worker's
Compensation, ar provided for by Section 3700 of the Lunar Code, far the
204 UNDERFLOOR FRAME
pmrtarmancearde work for which this twoolir ixsued -
205 — UNDERFLOOR. INSULATION
[D 1 have and will mniomi. Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performattce of the work lar which this permit is
301 — ROUGH PLUMBING
issued. My WorkersCompensation lnsara.ceoarderandPolicy carrier aat
302 — TUB A OR SHOWER
Carrier: Policy No. -
3f0T3 — ROUGH MECHAN L•--�'�"1'y'!pi{
EIiECT�L�t, 1]
CERTIFICATIONOFEXEMPTIONFROMWORKERS'
COMPENSATION INSURANCE
3,4r4 — ROUGH tit
('fh'.. ar e not n darter dr m p. r it r t hundred d ammra
(SIBBI rte :)
305 — FRAME
1 certify that m herr ne nh k I whicht b. p 't is: ea, 1
306 — HOEDOWNS r) vJ
w ,
vaillour employ Y le. any mann r. r n nrme.uM1p m t rile W risen
�Ay
307 _ INSULATION' .
Rtmpensar on Luws of California. Data
Cmar
Applicant
308 — SHEETROCK
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O�.r
NOTICE TO APPLICANT IL afwr, making this Cenificam of Exemption, you should
hecano ahjenmmowarkon,compo... I uprovisions ofthe Labor Code you most
forthwith Bair, he deemed
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309 — EXTERIOR LAT H
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comply with seat pmvisie.s or penny shall rooked.
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`8y
31.0 — INTERIOR LATH—
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CONSTRUCTION LENDING AGENCY
Ilobby that ixaconsl(Set. lending agency fonheperformance
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31.1.. — SCRATCH TORT
a q
rkforwfirm
ispsne
oldie work for which this permit is issum (See. 31197, Co,. C.)
Lenders Name
313 '— ROOF NAIL
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Lender's Address
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501 — FINAL ELECTRICAL ENERGY
PN E~
I eerfir man n:we redo lnix,a t .brae root me above m,nranatmn is'.
y 1, iea ion ran
cancel. I agree to comply with all city and county ordinances and state laws minting
502 — FINAL PLUMBING ENERGY
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to building construction, and hereby authorize representatives of this city to color upon
ateclave-memianedp,.patyrarinspemian purposes.
503 — FINAL MECHANICAL ENERGY
Ey A.
. toy
We) agree to save, indemnity and keep harmless the City of Carothers against
liabilities,judgments, costs and expenses which may in any way acymeagainst said
504 — FINAL BUILDING ENERGY
CitAPPLICANT in UNDERS Aoams, of the NDS ANDfWILLeCOMPLY WITH ALL NON-POINT ratic
Issued — FINAL ELECTRICAL
ISSUed by: Date
SOURCE REGULATIONS.
Signature of Appficam/Centmctor Data
HAZARDOUS MAI'HRIAIS DISCLOSURE
Re-roofs
507 — FINAL PLUMBING
Will meappfiwmmfuture naildlos.,arm,ton, onhandle hamNousmaterial
Type ofRoa�€09 — FINAL MECHANICRL
as coined by the Cupertino Municipal Code, Chuprer9.12, a.erhe Health and Safety
Cade, Section 25532(x)?
we` ° No
iso
All roofs shim in;phjFc l or trM Foofingg material being installed.
Will the appfiom o, future baddieg occupant egaipor m (it devices which
If a roof is i�Aed-wFffi i rst F1�TNIFt speetion, I agree to remove
emit hamrdous air contaminants its defined by the Bay Arca Air Quality Mawgement
Or... a,I
all new matAIA for itgllc EiiTt. 4RVi01;ACudd&RKffis and will comply with
❑Yes El No
all non-point source regulations.
1 hove out the hm..do., materials requirements under Chapter 6.95 of the
Calif naia Health & Safety Come, Senior 25505, 25533 and 25534. 1 understand that
ry taificat the
lha_t it i.r myruance
whit
ofhe acenotcans
of
ocdupam or the rcyuir menu which must be mm prior rte issuance of a CeniEeote of
occupantmust
Occupancy.
'Signature of Applicant Date
All roof coverings to be Class "B" or better
Diner an saponified age,,, Date
OFFICE