Loading...
01110072 OF CI BUILD G DIIVISSIIONNO NPERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 1 RESULTS WAY BLD 6 SOUTHBAY CONSTRUCTION CC INC 01110072 OWNER'S NAME: APPLICATIONSU DATE RWC, UC 511 DIVISION STREET 11/152001 / HONE: (408) 379--0400 SANITARY NO. CONTROL NO. O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO WE- BLDG ELECT PLUMB MECH N< LICENSED CONTRACTOR'S DECLARATION 5 I humn firm mat I am ncc.scd meet f Chapter 9 cson meneio Job Description y u ptovlsiofe aa RELOCATpp pp U--Ir'ppprrSs��dppp��mm i-sewith Section]WO)Of Division3oflhe Business ane Profcninnn Q+de.and my licenu +..y.a WXLDj w in full force and Rea r 0 ■b a p a+ Licer"CIa. Lic.p :o a nae eom actor f �S:Lr ?LL u.an A C ECI"S DECLARATION ;— I nnden dm,• all lir records DEC 0 3 2001 1 to C O Licc Pr c nal 41 OWN[RA UILDER DECLARATION an v 1 hereby affirm thm I an exempt front the Contractor's License Law far the BUILDING I- a following=son.(Section 7031.5.Business and Professions Code:Any city or county' $25000 _ a E D mlil n romtmn otter improve.demolish or rt vrvcmm which requires a pc fr Pair any pdononsiesuancaulmnit(.the thezploo ,fine mchpermlr Licensfile.e a- herplrem mrtanni liccnwitpursuhni.700dpmvisi,imfinetheStr i,LicenseLawls.,Cor9 t's I^d .a rp� �; 1 . Valuation or that he is cxea Scction4000)of e basis or t the alleged xuand Professions Coda (•. 4J•a E t�3'D17 V �1,;jll�'I'4 .:I ^d}sr^ or that he is.3155 b anefmm-and the basis for the cts the cacmpnt to Any violation of Section a Iran by any applicant fears Permit subjects the applicant to a civil pcnmry or oat are Iran hse Wnatm dollars rasa». 106pN Nl°C7bNDATI ON ' '^ Occupancy Type °1.asy, er oflhe pmFenormyemecploywith wagesas Meir sole compensation. 102 - PIERS will do thhe'work:'and the secretion,is not Intended or offered for rale(see.]aw.' 10 3 - UFER Required Inspections' 'Buxinesi and Profm essions Code:The Commer'x License law does not apply to an 9 P owner or property Who build,or improves thereon.and who does such work himself 104 - REBAR or borough his o n however. provided that such improvements me not intended or ilding or impmscmcm is sold within one year of - --.. ___._. _. ... _. ... ___. om-ve for he owned,.Ir.y will have IM1<M1UN<n of proving that he did not Wild or 105 - ANCHOR BOLTS improv= farposeo 106 - SEWER & WATER _.. ...__ —'202 - UNDERFLOOR" PLUMBING_-. :.I -01.as owner of the property_ exclusively xclusively contracting with licensed'contractors to construct the project(Sm.70a4,Business and Profession.Code:)The Contractor: 203 - UNDERFLOOR MECHANICAL" - License Law does not apply to an owner of property who Wiles or improves themon, and who.contracts for such projects with a contmctoas).ficensed.pursuant la the 204 — UNDERFLOOR FRAME---- ----— Cont'sem's License Law. °I am pat.I W c,sec. .B&P C for this reason 205 - UNDERFLOOR INSULATION Owoar Date 301 - ROUGH PLUMBING WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER I thereby affirm under penalty of perjury one of the following eeclaraliom: 303 - ROUGH MECHANICAL ° I have and will nomotmn .Cenificale of Consent to self-imine far workers 3 04 - ROUGH ELECTRICAL Compensation, as provided for by Section 3700 of the Labor Gide. for the performance ofib,work for which this permit is issued. 305 - FRAME ❑I have Bad will maiamin worker's Comfrnealrni insurance,as required by section 3 06 - HOLDOWNS 37W of the I.uWr code,for the Performance of he work for winch his pmern is 3 07 - INSULATION issued My Work-en's Compensation 1 ranee canter and Policy number um 308 .- SHEETROCK, earth . p I Policy No.:o3/aa�—d7 D . , ')•;: f:l � ' ,+ I CEf IDCA ON OF E%EMPTIONFROMWORKERS'a "- a•.` t� j -i,3O91'-f EXTERIORtsiLATH• COMPGNSATION,INSURANCG" . . ......._. . . .. ._._._.___._...__.. --310-',_._.INTERIOR--LATH . _.......___.._...._._. ___.. (This section need at be completed if the perm it is for one hundred dollen 3111 ' SCRATCH COAT ' • thrum+.�:::' f.:l .' (SI00)mless.) _ t t i cenif thatin the perfomtancc of the work far which this permit in issued.1 313- ROOF• NAI3 _ ... __. _ ...,_..._.._.. _. .._.L,_.._. .. .. shall not mrs,oy any Person in any mmncr sa as j6 become subject to the warloos 501 - FINAL ELE CTR I CAL'' ENERGY` Compm cndon laws of cauhmu.0a1` 502 FINAL. PLUMBING ENERGY_.. Applicant _. _ _ NOTICE TO APPLICANT: 503 - FINAL MECHANICAL' E14ERGY become subject tb the Worker's Compensation Provisions of the Labor Code,you must O z0 fortsithcomply with rush provisions orhis farm,roanxcreated!orwked. _ _ _ 5.04 - _FINAL . BUILDING ENERGY - -,,, _ CONSTRUCTION LENDING AGENCY" 505 - FINAL ELECTRICAL •"' - \ a > "I hereby affirm that there Is a constmction lending agency for 1h2 kisormace 5 0 6 - GAS TEST _ of tAe work for which his permit is issued(Sec.309],Civ,C.) .. "'a Name._ ._ _.. _. _. ,. -: ._g. - _ p z nder'sAddress 507 -- -FINAL PLUMBING,.. U O b eerily that I have read this application and state hat he above information is 508 - FINAL MECHANICAL correct.1 agree to comply with all city and county ordinances and state laws orbiting 509 - FINAL GRADE O.V to Wilding contraction.and hereby mthad.erepresentatives othis city toenter upon 510 - FINAL PLANNING y �] the aM(We)agree to property for inspe d km,brunde.,, . , - - p IWpil,nemsme;ma,`dni addkcfa hmayinheCity ay Cupertino stsuid 514 FINAL PUB IC WORKS (// V1 liabilities,judgments,msn and penis which may in any way accrue against said U Cit-'n consequence ofm ng of Nis pe lit., �-• /1s 30UR`LAW( ATIO A, ANDw'IL 'OMPLY WITH ALL NON-POINT' Issued by: Date V/ Signa of AppiicmUContrmba - Date" ._` Re-roofs HAZARDOUS MATERIALS DISCLOSURE Will the a i,idant or forum building om pam stale or handle hvallom.,ad.] Type of Roof_ .:-- - :=-- -- -- - - -- as defined by the C.,enion Mootipul Code,Chapter 9,12,and the Health and Safety yp, a ., +,a.T iL a, M1 - � 1 1 Codes lion 25532(.) . .i� a t:r'+ , r l / .l \ �.r .t S L °Ya'' N All roofs shall be inspected prior to any roofing material being.installed.,— Will nstalled.,_W ll the appy, m r t W Ia g p �, q Pm t e' whim If a roof is installed without first obtaining an inspection, I agree'to'remove c it h mdr dire ta dgf d by t Bay A A Qua]by Management Dismet - all new materials for inspection._Applicant understands and will comply with A °r - all non-point source regulations, • ., `l aaa��F��� ,1 1 have read the�hazar mtadal. rcyu rcments under Chapter 6.95 of the Califomie HEalm&Safety Curl,Sa bra 25505:25533 Bad 25534.bmdcrstmdtWo _ if me W ilding docs not currently W a anam:that it is ary Rsponsihili y m notify the MC 1 a Iht RGYIttmC mY31 I%roll prtar Io inYeneC of a f.'NhCele of °r Signature of Applicant Date ow _ aunim:mf.gem Date All roof coverings to be Class "B"or better OFFICE .. .. - .. _