02090127 ` CITY OF CUPERTINO
BUILDING DIVISION PERMIT ".CONTRACTOR INFORMATION
BDI�NDCAO cESLAZANEO GRANUM PARTNERS PI'RMITN02090127
owGF MbFUM PARTNERS APPLICATI3VyB1D9ry2002
ONE: SANITARY NO.// / CONTROL NO.
0�5 3�S 0101
ARCHITE ENGINEER: BUILDING PERMIT INTO
eO ELECT PLja 0,5 UMB MECH
Gzi LICENSED COMM ACTOR'S DECLARATION
1 herebyaffirm in.,1 on licensed under, rovisiom of Cha ter 9(commencingCr 1
with Section7( r)of Division 3 of be Business and professions Code and my licenses TENANT IMPROVEIIA �� Mb FL. )
infnufevemolfri' 1. TEMP PERMIT #02100188 EXPIRES 11/29/2002
O �Z License Class Li,.Y
Z F Date Contractor
qZO ARCHITECT'S DECLARATION y UI I understand my plans shall M used re
as public cords
W LL 03 Licensed Professional
OWNER-0UILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's Liecom Law litr the
m 00 following fusion.(Section 7031.5.Business and Professions Code:Any city or county
which requires a permit m construct,alter,improve,demolish,or mpair any structure $441350
F$ prior In its issuance,also requires the applicant for such permino file a signed statement
m< that he is licensed purwammmepravi,torsoffeConwewr'sLicense Law(Chapter 9 Sq. FL Floor Area Valuation
yF� (commencing with Section 7000)of Division 3 of the Bust nest and Professions Code)(it
my $ fast he is exempt therefrom and the basis for the alleged exemption.Any violation of 32634070 . 00
Section 7031.5 by any applicant for a permit subjects the applicant 1.a civil pcnallyof APN Number Occupancy Type
n moretIf li handreddoBafa(S5BB). 101 - FOUNDATION P Y YP
I Las owner of the property,or my employees with wages u Ncir wee compensation,
'I do Ne work,and the itroctam is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License law does not apply to an owner of 103 - UFER Required Inspections
property who buildsnr improves thereon,and who does such work himself or through his
own employees,provided that Such improvements are not Intended or offered for sale,If, 104 — REBAR
however,be building or improvement is sold within one year of completion,be owner.
builder will have the burden of proving that he did not(wild or improve for purpose of 105 - ANCHOR BOLTS
106 - SEWER & WATER
41
as at,of be property,am exclusively contracting with hafted contractors to 202 - UNDERFLOOR PLUMBING
4o Qt be project(Sec.7044.Business and Professions Code:)no Contractor's Li-
censelawdoesnotapplytoanownerofpropenywhobaddsorimprovesmemon,and, 203 — UNDERFLOOR MECHANICAL
who contracts for such projects with a comeacmr(s)limned pursuant o be Contractor's 204 - UNDERFLOOR FRAME
License La .
❑ lame amp cr Sec //�� ,BR PC for N' rcmnn 205 - UNDERFLOOR INSULATION
owner -�.1. Dam l t9 301 - ROUGH PLUMBING
WORKER'S MPENSATIONDECLARATION 302 - TUB & OR SHOWER
Iherc yaRrmunderpevlryof perjury ore of de following declarations: 303 — ROUGH MECHANICAL
❑I have and will maimmia.Ceniffcam of C..nt in self-Insall for WorkefsComPcn- 3O4 — ROUGH ELECTRICAL
.firm,.).video for by Section 3701 of the labor title,for the performance of the
work for which this permit is Issued. 3 05 — FRAME
❑I have and will maintain Worker's Compensation Insurance,as required by Section 306 - HOLDOWNS
370)rf Ne Labor Code,fm On fardomtartee m Ne work for which this permit is swed.
My Worker's Compensation Insurance carrier and Policy number are: 307 — INSULATION
Carrier. Policy No.; 308 - SHEETROCK
CERTIFICATE
C MPENSATIONINSURANccoRKERs 309 - EXTERIOR LATH
(This section need not be completed ifthe p<rmh is forms,hundred dollen(sur) 310 — INTERIOR LATH
'file..) 311 - SCRATCH COAT
1 certify that in the performance of the work for which this Permit is issued,l shall not 313 - ROOF NAIL
employ any person in any mannerau M m hcnsmc aubject m the Workers'Compensation
Laws of California.Date 501 - FINAL ELECTRICAL ENERGY
Applicant
NOTICE TO APPLICANT:If,after making this Cenificate of Exemption,you should 502 - FINAL PLUMBING ENERGY
become subject it)the Worker's Compensation provisions of the Labor Code,you must 503 - FINAL MECHANICAL ENERGY
O O forthwith comply with such provisions or this Permit shall he deemed revoked.
z CONSTRUCTION LENDING AGENCY 504 - FINAL BUILDING ENERGY
(-. I hereby affirm that there is a construction lending agency for the performance of 505 - FINAL ELECTRICAL
as 7 the work for which this Pcrmitisissued(See,3097.Cis,C.) 506 - GAS TEST
aw ^p LandersAidn 507 - FINAL PLUMBING
z Isndcr's Address
U O 1 certify that 1 have read this application and Stam Nal the above infuriation is 508 - FINAL MECHANICAL
c.orw F., building construction,
and with yauthori represounty atiati races and nam la enter Upon
butWingc fore 1.i comply hcrcbya ll city
ad rcprcsenmtivesof sadstmemeruponthe 5 FINAL GRADE
w shove-mentioned property for inspection purposes. lO FIN I G
gL (We)agree m save,indemnify and keep harmleu the City of Cupertino against
VI liabilities.judgments,costs and expenses which may in any way acme against said City [j N LI WORKS
U 7 in consequence of the granting of this perm it.
�i APPLICANT UNDERSTANDS AND WILT.COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature ol'ApplicandConaractor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will be applicant ofuni building apt stere or handle hvallous material
as defined by the Cupcninn Municipal Ctre,Chl,,Chapter 9.12,and the Health and Salcey
CredYon 25532dT1 All roofs shall be inspected prior to an roofing material beim installed.
et ❑NoIV
P P Y g g
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazallous air commemmus as defined by Be Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes Nn
1 mat lCtAc, am05,25quimd255 .IudeamnGatif cCalding
nolle de Illy iSmada,that it is to r sod 25534.1 of nedln[a occ Nuri of the
)res i curt rally hu W rat,Net it is my respf ilitY ur notify the aeupanl nl Nc
rcyu men ichm s he et If nnissu cof crificateof 0.scupency.
a� � Signature of Applicant Date
own n rimJagent ate All roof coverings to be Class "B" or better