02120032 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ;C0NT'RASCTQI2�IN�' RMATIUN ,g
BUILDING ADDRESS: L S+I PERMIT NO.
10480 RIDGEVIEW
R'S NAME: 256 E HAMILTON AVE PERMIT ISSUE DATE
�IENA CORP
NE: (408) 370-1970 SANITARY NO. CONTROL NO.
IAppp
ARCHITP.LT/ENOINEeR: BUILDING PERMIT INFO• 1 BO ELECT" PLUMB MOECH
`. Y1
3ffiO LIC ENSEDCONTRACIORS DECLARATION f ;. JO C D
i hereby D).r that 1 em of
under ml prefectures;
of Chapter 9(commenting CfV p,
with Section]000)arDiWdon3of drat Budn/�e�yeM ProfeWms Code,and mylicuseh
n 1.fullo ndIII Lk.p �6�6`g TENANT IMPROVEMENT _
3 p Dau Comrkelal i�•- `/T• /A//- U U i
�r37y RCH DEC'LA T ds t r
1 understood "II and my pW use T
W used u public records
58 Licensed PmkWnnd
OWNER-BUILDER DECLARATION
.�0 E I hereby.(in on 1 1. exempt from the Cosional os License City O for the •-+•-._!�
O O whichfollowingmu resson.(Soudan EDI3,Budness and ate.de loll Code:My city m county
$ which requires•pemlt re cares the Blur,improv.demolish,t Or repair any atmman
F�F< that he 1,licensed pureraniqinithe provisiolcant forsuch ns of d¢Camrraaclor,License o rile a signed
plm9 Sq.Ft.Floor Area $91V�(y4tion
S$ mccomomingwlthS.6on7000)of DivWon3ofthe Budnneand ProreWms Code)or
a Thu he u umlpl mmodrem end Ne basis for the Ilctcd oenpdm.Any Nolatim of
Section 7031.3 by eny applicant for a permit subjects the epplic"uo a tivil penalty of 3 JWRN '8Ciro 0 Occupancy Type
not more than Ow hundred dolims(f3WL
❑1.u ower of the property,mmy employer with wagesu d ehsole compewdm. .
wllldo drcworkamithementerchrotinudedmoOered forede(Sec.70N.eudrcts - Ins actions
and Professions Code:The Contractor's License Lew does not apply m an owner of 102 - PIERS
p
property who builds m imprmea immon,and who does ouch work himself or through his
cram employces.provided that such improvement vent inunded mo@redfmselelf, 103 - UFER
however,the building Or improvement Is sold within one year of mmplWon,the owner
builder will new the barren or paving that he did oat bund or Improve for propose or 104 - REBAR
"Is.). 105 - ANCHOR BOLTS
3 I.as Owner Or the property,em uclns"eiy contraving with licensed eontnmon to 106 - SEWER & WATER
construct the pmjm(Sec.7044.Business and ProfeWans Code:)That Contractor's Ll-
conse law does not apply to an owner or property who builds or improve themon.and. 202 - UNDERFLOOR PLUMBING
who nntrectr for such pmjem with a ormusemr(s)licensed puransnt in the Gnuactors
LRatnte aw. 203 - UNDERFLOOR MECHANICAL
amertemptunderSea. .BkPCford"emodon 204 - UNDERFLOOR FRAME
r WORKER'S COMPENSATIONDECLA0.ATalm 205 - UNDERFLOOR INSULATION ,
I hereby anhm under penalty of perjury one of the following dcclandolu 301 - ROUGH PLUMBING
Iha-
"dwill maintain eCeNOnu of CeLabor Code.
a Wmkefaceof the
302 - TUB & OR SHOWER
eek as provided for by Sutton 3700 of the labor Code,fa the performance of W 303 - ROUGH MECHANICAL
work forwhich this permit is issued. 304 - ROUGH ELECTRICAL
73700 ban and
IAWrlCmaintain
tle m tWM performance Compensation the work con ni n Npttml�e Issued. 305 - FRAME
Myworke's Compemadm l sumxe canimand Policy numberan: 306 - HOLDOWNS
Gnlar�/%OZ2M ASPolicy No p -O uN/ 307 - INSULATION
N'- ?& �y m-CEICfIFlCATE OF EXEMPTION WORKERS'
71 COMPENSATIONINSURANCE 308 - SHEETROCK
r1ro"seNmrtud'notlN rampkue lydle pemll tforone nunNWdo11[n lsl0y 309 — EXTERIOR LATH
Or leas.) -, .. .
310 - -INTERIOR-LATH
1 eerily that in the performance of the work for which Nle permit IsAct Issued.I shall
employ any person in any mannrso as in become subject to the Worlun'Compensation 311 - SCRATCH COAT
Lowe 0f GallfomlL Dam 313 - ROOF NAIL
NOTICE 70 APPLICANP.If.after provinces Gnor of ExemptCode.yuhmuat 501 - FINAL ELECTRICAL ENERGY
become subject y it W 1 pro COmrcwdon nd,maof the Ldhodrummed
Code.you court
,JO rarthwtth cempy with auh proHdou or cola prmit andl be Named ranked. 502 — FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hemby a?m that Nem is a construction lending Agency for the performance of 504 - FINAL BUILDING ENERGY
W'> thowork for which did.permit"issued(Sec.3o77,Civ.C.) 505 - FINAL ELECTRICAL
W Q I-ndcr Name
]z Lander'sAddrum 506 - GAS TEST
U0 1 certify that I Mw read this application sad cuts that the chow infomlvlon Is 507 - FINAL PLUMBING
LL U c mmi.l gree m comply with all city and county ordimuncennd suis laws mladng a
0 SV" building construction,and hereby Authorize mpmmmadws of this any to enter upon the FINA MECHAN CAL
W shove-mentionetl properly for ImpeNan purposes.
(We)egrea ro saw,orindemnify Clonal hep harmlOu the City of Cupertino egdnst 0 9 FIN
zy Ilabllidu,judgmm cosu"dexhich mmy
In my way acme against aid City 5J G
APPPLIICC race A S AWWish. MPLY WITH ALL NON-POINT Issued by5 WORKS Date
SOURC N
.6 —t-r7ur PEYWOUI) NAIL
Re-roofs
603 - OOF BATTENS
ulw afA HAZARDOUS MATERIALS DISCLOSURE [t Type of R844 - ROOF IN-PROGRESS
Will'
Iil the""iunl or forum building Occupant score orhmdle Mentons maudal
sod by the Cup:Nno Muni Ipal Code,Gaper 9.13."d alis Health and Safely
e.
Section
3SS331O1 All roofs shall be inspected prior to any roofing material being installed.
3 Yea Na
Will the applicant or future building occupant use equlpmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mlt hvaNnns dr eommunenu d rued by the Bay Ares Air Quality Maugement all new materials for inspection.
Get
3Yca mNu
Ihave read eMrardmts mats ulremcnu under Clupur6.Y7of the Glifor
n"Hcaltha:sal C 27 3J" 7 .I urdepw6.9vifth r lding
alas no Y w m th It my IIIIY m ndfY the up"t of the
require m Ih Ipd "` a 'Ler" ra p y Signature of Applicant Date
41
nes .nthm"e ant Dau All roof coverings to be Class "B" or better