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CITY OF CUPERTINO
BUILDING DIVISION
PERMIT
BUILDING ADDRESS:
PERMIT NO.
10500 RIDGE VIEW CT
02010096
OWNER'S NAME:
APPLICATION SU DATE
CIENA CORPATION
01/2312002
.ONE:
SANITARY NO. CONTROL No.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
l__J U L J L_J
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000yof Division 3 of the Business and Professions Code, and my license
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EXTENT I ON PAD
is in fult fy4ce and effect.
License ss "Cic. M74
Dat Con r�
A'RCHITECT'S DE ARATf
S
,X
I understand my plans shall be used as public records I N
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
$17000
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
_
A-96 N615`T
that he is,liccnsed puquanit0 the provlslons of the Contractor's License Law (Chapter 9Valllatlon
(commencing with. Section 7080) of Division 3 of the Business and Professions Code)
orthat he is' exempt therefrom and the basis for the alleged exemption Any violation
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of Section 7031.5 by any applicant for a permit subjects the applicant -to arivil-penalty,
of not more than five hundred dollars ($500).
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PH T*DAT I ON
10 �"P
Occupancy Type
❑ I, as owner of the property, or my employees with wages as their sole compensation,
will do the w6rk, and the structure is not intended or offered for sale (Sec. 7044,
Business and Professions Code: The Contractor's License Law does not apply to an
103
-
— UFER Required Inspections `
owner of property Who builds or improves thereon, and who does such work himself
104
— RE BAR
or throwgh his own employees. provided that such improvements are not intended or
offered for sale. If, however, the building or improvement is sold within one year of
10 5
— ANCHOR BOLTS '
completion, the owner -builder will have the burden of proving that he did not build or
improve for purpose of sale.).
106
— SEWER & WATER
Cl 1, as owner of the property, am exclusively contracting with licensed contractors to
202
— UNDERFLOOR PLUMBING
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's
203
— UNDERFLOOR MECHANICAL
License Law does not apply to an owner of property who builds or improves thereon,
and who contracts for such Projects, with a contractor(=) licensed pursuant. to the_
- 2 04-
----UNDERFLOOR FRAME - - - - - - -
Conrractor's License Law. ,
❑ I am exempt under Sec. , B & P C for this reason
205
— UNDERFLOOR INSULATION
owner Date
301
— ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
302
— TUB & OR SHOWER
I hereby affirm under penalty of perjury one of the following declarations:
303
— ROUGH ME C HAN I CAL
J I have and will maintain a Certificate of Consent to self -insure for Worker's
304
— ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
305
— FRAME
Cl I have and will maintain Worker's Compensation Insurance, as required by Section
306
— HOLDOWNS
3700 of the Labor Code, for the performance of the work for which this permit is
307
— INSULATION
issued. My Workers Compensation Insurance cam and Policynum er are:
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Cat��%� Lk/ly`l�olicy N 7
308;
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:—: SI EETROCK
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EXTERIOR
IrPr A Io of XEMPTION, OM WORKERS
3
— LATH
COMPENSATIONINSURANCE :.., ;//
/'y0
310
--ZNTRIOR'-LATH
(This section need not be completed if the permit is for one huVrered dollars
311
— SCRATCH COAT
($100) or less.)
313
— -ROOF -NA,I L - - -
I certifythat in the, rformano of the work for which thispermit-
pe is issued, I
N shall not employ any person in any manner'so as to become subject to the Workers'
501
— FINAL ELECTRI CAL '"ENERGY
Compensation Laws or California. Date
Applicant
502 .
503
- FINAL PLUMBING ENERGY
— FINAL MECHANICAL ENERGY
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
I become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
504
— F I NAL BUILDING ENERGY
CONSTRUCTION LENDING AGENCY
505
— F I NAL ELECTRICAL
1 hereby affirm that there is a construction lending agency for the performance
for is issued
506
— GAS TEST
of the work which this permit (Sec. 7097, Civ. C.)
Lender's Name507
FINAL PLUMBING
Lender's Address 'I
—
508
— FINAL MECHANICAL
certify that I have read this application and state that theabove information is
correct. I agree to comply with all city and county. ordinances and state laws relating
509
— FINAL GRADE
to building construction, and hereby authorize representatives of this city to enter upon
the above-mentioned property for inspection purposes.
510
— FINAL PLANNING
r2,4�
(We) agree to save, indemnify and keep harmless the City of Cupertino against
514
— FINAL PU IC WORKSCity
liabilities, judgments, costs and expenses which may in any way accrue against said
in consequence of the granting of this permit
APPLICANT UNDE ALNDS ND %'ZILL C 4PLY WITH ALL NON -POINT
"RCE
Issued b Y'
Date
SO NS. Q 9y,U
t arure of App U ont ctor ate
Re -roofs f
HAZARDO AT S DISCLOSURE
Will the applicant or future bui mg occupant store or handle hazardous material
Type of Roof
_
as defined by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety
Code, Section 25532(x}? �
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All roofs shall
be inspected prior to any roofing material being installed.
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
,mit hazardous air contaminants as defined by the Bay Area Air Quality Management
iistrict?
all new materials
for inspection. Applicant understands and will comply with
El Yes Ko
all non -point source regulations..
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that
_
if the building does not currently have a tenant, that it is my responsibility to notify the
occupant of the.requirements w ' h must be met prior to issuance of a Certificate of
Occupancy.
Signature of Applicant Date
_
All roof coverings to be Class `B" or better
Owner or &6oriffidicfm Date
�� OFFICE