03040130CITY OF CUPERTINO
WONT",CTOR�Ir ORANTIOIV �.M
BUILDING DIVISION PERMIT
. SM.{ Y 110— a, 1 X., .
B Dll,3NgDrM1TE LP
SOUTH BAY
CONSTRUCTION CO
PI5EN0.03040130
(�+Lg lita:COMPUTER INC.
511 DIVISION
STREET
"rt5SUOD4729/2003
PIM:
(408)379-0400
SANITARY NO. CONTROL NO.
ARCHInC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
licensed under of Chapter 9 (commencing
I hobby of ince that 1 am Provisions
with Section 70111)of DM.ion 3 of the Susi ynand Professions Code.md my license is
mrAllmtcosd 7
I ER O T.
j
T,-
License CI LC
Date Con cmr
ARCHnECr MCI.k�R 1T10N
f
1 undo my punsdull be used As public records
Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm the, i am exempt from the Commerce's License Law for IM
following resom, (Section 7131.5, Business and Pmfusimu Cafe: Any city or county
which requires a permit In construct, slur, bmprow, demolish, or repair my structure
primin be Inumco. Alan requires the applicant for such Permit out Jim A signed wkmem
that he Is licensed pursuant to the previsions of ft Contractor'. License LAw,(Chapter 9
Sq. Ft. Floor Area
$10 �MUgon
l7 VUII
I (commencing with Section 7000) of Division 3 of the Business and Profcasinm CMk)er
Net W is Attempt therefrom and the buss for Na Alleged exemption. Any vinlatiun of
3AMlgUT05tr. 0 0 Occupancy Type
Section 703 1.5 by Any applicant ser A Permit mbiecu the applicant m A NMI penalty of
act mom than fin hundred dollen (5500).
0 1, As owner of the pmpmty, on my employees with wages As their rale compensAdon,
will do Ne work. mad the swcmreu net Intended or offered for spin (Sec. 7044, Business
LUI
—C( tq Inspections
and p efesslotu Code: the Conummrs U. Law does not apply m An ower, or
102
— PIERS
property who build, m Im prows Nebon, end who does such work hlmsel f m through his
ownemploy=,pmvideda.itwhimprovemmuvene,in,eMed moffmadfmsslalf,
103
— UFER
however, the building or Improwmmt Is sold within one year of eompledon. the owner.
Wilder will have the burden of proving dist he did set build Or Improv for purpose of
104
- REBAR
"Is.).
105
- ANCHOR BOLTS
0 I, As Owner of Ne properly, am uelusiwly contracting with licensed mnuacwn to
construct the pmjcct (Sec. TOM. Business and Profession, Coale) The Contractor'. U.
106
— SEWER & WATER
soma law does not appy to M ownes of property who builds or impmws dkmer,w•
202
— UNDERFLOOR PLUMBING
who contracts for such pmJeeu with a commener(U licensed pursuant to the Conme,ur's
License Low.
203
- UNDERFLOOR MECHANICAL
0 l am uempt under sx , B k P C for this Mason
204
- UNDERFLOOR FRAME
OwnerDate
205
- UNDERFLOOR INSULATION
WORKERS COMPENSATION DECLARATION
301
— ROUGH PLUMBING
I hereby alarm under penalty or perjury one of the following decimations:
302
— TUB & OR SHOWER
01how and will maintain a CenlOcak of Consent to alf-lesum forworknes Compen-
udon, As provided fm by Section 3700 of du Ubor Code. for me performance or she,
303
- ROUGH MECHANICAL
work (or which this permit is issued'
304
- ROUGH ELECTRICAL
0 I haw and will maintain Worker's Compounder, lesuramm, As required by Settlor
37M.f the Ubor CMc, for Ne performance of the wok for which this permit is issued.
305
— FRAME
Myworte�f) CompemeN°� oaf Mmm Policy comber tae:
• T5 a` T�sroip-Ne.. (93tZ2,20
�� 306
— HOLDOWNS
Card-7.�
CERTIFlCATE OF PXEMPfI0N Fll0 ORKERS'
307
- INSULATION
COMPENSATION INSU cE
308
- SHEETROCK
Ilon need notWcomplekJlfthe permll is fmonchundmd dnllaa (5100)
309
- EXTERIOR LATH
mica
310
- INTERIOR LATH
issued. I shall n
certify NW et In,mance of the work for which this Pamir ism
emyany penoaIftimy mmy manneranmmbecome mb)m„o due worken'Compenudm
311
— SCRATCH COAT
Law. of California. Data
313
501
- ROOF NAIL
- FINAL ELECTRICAL ENERGY
Applicant
ouli
after of ion,
NOTICTO APPLICANT.ftWoo IL Nlenwiaos
Componking
of Latour c. you most
become n ermidom of Ile Latour Code, You most
become ubjm ro it WoheM1 Comsat this
foMwithcnmplywithmchprnvlelnnsonhiapermllMallWdcemMeovuked.
SO2
— FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
503
- FINAL MECHANICAL ENERGY
I hereby affirm that there Is. construction lending Agency for thepedormance of
504
— FINAL BUILDING ENERGY
the for wmchthis Permit uiumd(Sec.7097,Civ,C.)
505
- FINAL ELECTRICAL
� Lender's Name
Ur,der, Add..
506
- GAS TEST
I mnlfy that l haw bbd this application and mu that LM aWw information u507
- FINAL PLUMBING
scouts. I Agree Io comply with all city and county Ordinates, and Arab, lows milling to
bulldingcmuuucdon, and botchy sudodm bprraenudwa of Nis city to coke more the
for Imnify
Ahove-(We) eep
L
FIN MECjtNWG'�
A47
Me kOn
ho
(We) mete ro caw. indemnify and keep homeless, h City of Cupertino Against
y agree
09
FI
y3 limill,ies,Judgments.eosts And expenses which may Inmymyacme gains,oidCiy
g
In conseq neC of the gnn,iK
prmit.'A C UNDEMAD WIL COMPLY WITH ALL NON-POINT
Issued by:5
RKS Date
SOUR R ULATIONS.f
PIAA✓QD- � C°
Re-roofs
Type of Roof
S cab �u
US MATE RIALS DISCLOSURE
HAZARDOUS
WIII the Applicant or frum building occupat more or handle hazardous material
ss donned by the Cupertino Municipal Code. Chapter 9.13, and NC Healthand Safety
Code, Section 35532(m)7LJ
All roofs shall be
inspected prior to any roofing material being installed.
0Yea No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or tutu Wilding rucupam esu equipment or devices which
emit havardnus air conummmu; As defined by the Bay Ares Air Quality Management
all new materials
for inspection.
District?
Dye, No
I haw real she hnandmsmekrleu bquircmenu uMerChapter6.95 mthe Celifm-
DIAHes SAlety Cottle Socri 2505,15533 25534.1 ondomundthuirft Wilding
doss ecu mly hawateno, Irk my m lily tonalm pmt of the
wqm men ienmmRhCm mtavan o cclull rOemP .--�
0
Signature of Applicant
Date .
All roof coverings to be Class "B" or better
0orbed. em O,k
6PYLIllo
U