01120016 OF CUPERTINO
CI
BUI DING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10400 RIDGEVIEW 2ND FLR LSI 01120016
Gyy�tFg'�J'1PME: 256 E HAMILTON AVE AfP�ICyI'[104N$ rffl
PCH.OINEE:;NA (408) 370-1970 SANITARY NO.NO. CONTROL NO.
q 0 z0 ARCHITECT/ENGINEER: BUILDING PERMIT INFO
kC of- B DG ELECT PLU B ME H
J Lr-
LICENSED
- C 7
�NH
z CONTRACTOR'S DECLARATION Job De cri tion
oz`- Ihereby affirmthat Ivatlicensed underprovisionsofChupier9(commencing TENANT IMPROVEMENT-s2 NU FLOOR
F„-,C,;r with Sec ind7000)of Division 3 of the Business and Professions Code,and my license
ask m y is in full forte and eHeet.
¢w a License Class Lto.x
3`a U to Date Conn. - n F'i0 0 /p p E D
t- ARCHITECT'S DECLARATION l�lFllir Ne!
t_ O 1 understand my plans shall be used as public records TNC"
N
oo Licensed Professional JUN 1 0 2002
OWNER-BUILDER DECLARATION
1 hweby affirm but I.m exempt from the Comracars License Law for the $19 91517
C?a followso
following reason.Section 7031.5.Business and Professions,Code:Any city oreconry,
Fdx 0 which requires a permit to construct,alter,improve,demolish,or minor any structurt
ed et n.,.its issuance.al.mruiasmeapplicant forsuchpmm,t.fileasigrod staresnem
Rim niNe-
pr, py --------
thatbeisrcemetpweuanitaa the prOner ars of the Conuacron's License Law(Chapter 9 - 31`010$tO�JQA6 �a->.•, '1" , - Valuation
(cdmmedcing with Section 70i of Division 3 of the Business and Professions Code) 1.{p,"( ,�,, 1tii•w \�' J$sy�(r`1 y.1{7:\, '
or that he ii exempt tnercf ion vnd the basis for the alleged ciemption.Any violation
-of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty
-
,of ew mare man me hundred dollars(s50o1. 10 lAQN P{ AT I ON . . . Occupancy Type
ol.aaownmofinepro'd, irmyemployeeswith wages asmei"me<ompansatmn, 102 - PIERS
-will do-rhe'work,and me'strrema,I,nor Intendedtooffered for sale(See.'7(14; -- - --""1 O 3 - UFER
Business and'Pmres.mns Code:The Contractors License Law does not appy to an Required Inspections
owner of property WK.build.,,or improves thereon,and who dues such work himself 104 - REBAR
or through his own employees.provided that such improvements are not intended or _
-,ofeeed"foraide:If.howe.er.me Budding or improvement is sola within aceyen<orT.O'S.-' ANCHOR-BOliTS-- -'_ 1 .-—... _.__—....-..--------_--. - --
completion,the oanenbuilder will have the burden of proving that he did not build or ,
)improve for octose of,ude.). 106 - SEWER & WATER
undo vnvcontracting Gnu«nssdeoma<So to
--UNDERFLOOR-PLUMBING
ns0uctthe project(Sec 70,1e Business and Professions Code)The Comoscoma 203 - UNDERFLOOR MECHANICAL r
s - - License raw does not apply to an owner of property who builds or improves rhe and.
.,.-. ._a who contracts for su
ch.proewith a.comacmrs)license .pursomalto.me 204 ---UNDERFLOOR
Ciu is License Law.
Client
pt.nd sec: 12, Pcfor rhis return 205 - UNDERFLOOR ',INSULATION
301 - ROUGH PLUMBING
ORKER'SCOMPENSATION DECLARATION 302 - TUB & OR SHOWER
aY
line
}}}fffeeerrrby 1Brm a pe hyurpej y fihefll gddararion.. 303 - ROUGH MECHANICAL
�• O 1 have ad will maintain C hificme f Consent au self-immano for workers 3 04 _ ROUGH ELECTRICAL
pc
J __ Comn f as Provided forby S a on 3700 f th Labor Code,for me
pedorma-< nr mew kr hmtm�pe, 'r .. ed. , 305 FRAME
-" O 1 Lave and will ri,aint5ln Wsorker' ComnpensatioIn.sumnce,-as required by,§ecrion 306 - HOEDOWNS
3700 of the Labor Code,for the pcdoimance of the work'lbr which this permf is 307 - INSULATION
is ed MyWorker's Compensation Insurance M dP Policy be __-
i( A� � rrl IfvlP.l<yN 14iin9?2 "-308 - SHEETROCK—
/ f/CF RT ICATION,OF E%EM"ION FROM ORK k \ .'�s71 3O J.':at EATERSOR `}LYATHs t
.44,1 ',-� OMIFNSATION INSURANCE
Tai INTERIOR-LATHr _ _.. .
TI (Thisscaionneednotbecompleadifthefamousisforonehundreddollars 311 ,I '. SCRATCH COAT
313.,.:-.--ROOF-
1-unifythat b performance t the 1f h h m permit issue'employ
nypernoninanyma araoa..dbe<n. ,, n"th<wrrkdem1 501 - FINAL EliECTRICAL�`IENERGY
I
cournpimtionLa1caliu ,note p .1 11.
,nt . 21
- - .502-._- ._FINAL—PLUMB ING__ENERGY_...-.. .
NOTICE TO APPLICANT:if after..king this CanificritofE tion.:yon should 503 — FINAL MECHANICAL' ENERGY '
be subjoin to theta s kerCo pen i p isof theLaborCalc you List
O forthwithcomply with suchprovisions a this permit 504 - FINAL BUILDING ENERGY
CONSTRUCTION LENDING AGENCY " '•': 505 FINAL ELECTRICAL `
I heati effrmthm there knimmou<iion leadingdone forme do.orncp
L d 'ndfGwhichm. Perrot ssu d(See 3097 e 506 - GAS TEST
Lee N _ 1 -.-__... ..5.07- _--FINAL"PLUMBING - .. ..... _. .._ ... ..--
r
'of th k for
o Z ). t 508 - FINAL MECHANICAL '''
C_)_0 co _I codify that I have need this application and sum mat the above information is
rtcct.I agree to comply with all city and county ordinarau and state laws relating 509 - FINAL GRADE
O p to building construction,and hereby vumod<erepresernativesOfdrAcity,toenterupon 510 - FINAL PLANNING
-W the nlxwe-mentioned prypeny for inspection purposes...
�r 46 (We);,,me to ove,.indemnifr and keep harm Iris the City of Cerrito..,.a.,, 514 - FINAL PUB C WORKS
Vi` li 61 t ) dg mors cos,,and expenseswhi ch may in any ay again.r said
U z City in consequence of the grant ng nthis,annit. -_
:oX'ASfPP_PULAR IC�ANTEGUUWL ERSTA. SA WILL\ M'PLYdWITH ALL
I NO
N-POI`f'
's
� 1
_,
-
1Issued by: Date
u pcOu"O ��, Re-roofs
HZARDUSMATRl\ OSUE
lithe a pf
HAZARDOUS
Wilding v antcore o handle as _Type of Roof. ._ ,_.. .
adt dmnoMunicipal Cod Ch pr9.1 rW he Health adSfry I
Cae Sectiion335I1mH _ r
El Y<. d, v
Z-
- All-roofs shall be.inspected.,prior.to any roofing traterial.being.installed.
WlI the applicant or future Wilding Occupant use equipment or devices which' If a roof is installedwithout first obtaining an inspection;I'agree,to remove
emit hamrdom err contaminates as defined by he Bay A.Air Quilts,Miumagerse.I
District? all new materials for inspection. Applicant un -erstands;and will comply with
. all non-point source regulations., ,,i 1
I have read the hazardous'materials requirements�under'Chapter 6.95 of the,
California Health h Safety Code,Sections 25505:25533 and 15534.1 understand that
ifinebuildingdoea antcumenrlY .rco I nano that it is my asveirmbility 10 notify the: -"-'-- "- --'- - - --' - ---' -" - - _ -_-
occupam of�hc rtquirc ort ch be tett prior 1.issuance of,.Ceniftcate of
Signature of Applicant Date
ounce Alt roof coverings to be Class "B" or better
r¢ &cm T.I! Dor
' -OFFICE