01080146 CITY Bur F C pPERTTIN,,.
I
;. PERMITCONTRACTOR INFORMATION: .
I •
BUILDING ADDRESS: - -,.,� r PERMITNO ,
;710555 `,RIDGE _VIEW CT f. XL CONSTRUCTION ' '"010801.46
_., _. .._ _._ _ ._. _—. .— .._ _..._—_.-_._ _ ... ._...
ON'NER'SNAME I I I + - - APPLICATION SU DATER
COMPAQ COMPUTER BLDG CAC-06 1 1500 BERGER DR 08/302001
PHONE: SANITARY NO. CONTROL NO.
t (408) 271-2425
AOC ARCHITECTIENGINEER: - BUILDING PERMIT INFO
m p BLDG ELECT PLUMB MECH
n¢i I--1 : I_I IUI
LICENSED CONTRACTOR'S DECLARATION
$z .. - Job Description
iN G
I hereby affirm that I um licensed under provisions of Chapter 9(commencing
m �p-p._3-pnheBJLsictep„and
/LPrf-o tel.>ion.Zcwnyetcdmrueense ADA RESTRM UPGRADES .
zmisfallforceand (i4ye.
6 License CI t�
D 3lZacos
-
1RCHITECi'S DPCLAR TION
1 nder l nd my plans shall be sed as public records
CaCCLicensed Pf..
o OWNER BUILDER DECLARATION
so
m—n 1 he by offinar hat 1 um eBusin from the Professions
C 1' La for the
t M O ronpx g (Suction mal 5 Business and se,demolish,cud e y. ty uurr $60000
F z o which ns i issuance,
permit na tons,the peer.impose,dcmobsh repair any structure
t- ..prim t I q the applicant t t ahpetm a fl grse t t t
3m .
I mho ecce cupursuant t to prosof meContractors Licenselawpt J q }� I,x p,,�
(can gwlhSaon7(kl))ofDivso 3 ft-B .s d'PretendersCod) e `;'+ .d!3 .�tF1Kb �',.yCf�P „F 5 " � Valuation
pf thino s pith f dthe bast f th lleged exe pt Ayvmlai 1, -ux.. P ... .,------
on
._
Sean y peratfor apcndt subj cis the p.o.ols rot eciv1p•enalty.
er Occupancy Typenormnrtethanfive hundrede n,: ssoo101�PN'I� DATION,
0 1,as owner I he property.or my 'ploYes with ag. 'mer sole compensation --.. . _1.02. ---- ___._...__.
ll'd the- k' d the structure is not,intended or offered for sale(Sec.70W4 ll
10 3
Bevin andrProfessums Coal The Contractor's License Law does tat apply to an — UFER Required Inspections
sync
rof progeny Who builds or improves themon,and who does such work himself 104 — REBAR
or m f I wn misv y .provided con h- p veme t. t' tended or _
efrep a f- "I.If how a to building e p tit is sold to -rte rear of - -.. -10 5 — ANCHOR BOLTS
-- ---- ---' --
iomNve fro me owner-sunder will have me burden of moving that he aid nm nulla or .' . .. .
mprove mrpptppse prsale.). 106 — SEWER & WATER '
ol,as6waer<imem ;,r.a;=xcwielYoGndiax;huan.edcontractors re 202 - UNDERFLOOR PLUMBING” _ _ -. .. .. ._
construct to projert(See.7044,Business and Professions Costs:)The Courmcmr's 203 — UNDERFLOOR MECHANICAL
License Law does not apply to an owner of property who builds or improves thereon,
( * .and.who contras far such project,with a macoadmI,d licensed panum,to his t... 2 04 — UNDERFLOOR FRAME
' Contractor's License law. _. .....-._....... ....... ..._ .. . _-.
❑I emesempt under Sec. 's " " .B at PC for this reason 205 — UNDERFLOOR INSULATION -
0x7ta Date .301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION - 302 - TUB & OR SHOWER
Iheribyaffirmorder prrally ofpar;urynncoftngfollowing declarations 303. — ROUGH -MECHANICAL.
i� ❑ 1 have and will randon d Canificme of cnn:ent'to,elf-mune for Wmkar's 304 —� ROUGH -ELECTRICAli -,
Com tion, as provided for by Sermon 3701 the labor Code, for the L .. - - -
Ashe work Ibr whim this t is issued. 3 0 5 - FRAME
Performance, o permit
❑I he and win amimoi worker's Compensmron Insurance,as required by Section 306 — HOLDOWNS
_ 37W of the labor Code,forto performance of be-work for which this permit is 307 — INSULATION
issued.My Worker s C.mr,oratim.Insurance c- d P6Imy he
Art IoycGrgeP •Patios ,WGZ9$&92401 308 , —r'SHEETROCKCarrier ,r —'
CERTIFICATION OF EXEMPTION FROM WORKERS, 7,�1 fir,+ ' �3j09i }EXTERIOR'e LATH '
" COMPENSATION INSURANCE ; ..._ ` I
310 "INTERIOR -------
Crrxtimidned'not be completed if he pe—it is for one ngnared dollars 311 - SCRATCH'aCOAT
(pion) ) •.. - _. _ _
31'3"' ROOF MAID"
A I carry that the p'd f the k 7 r then th permit is issued,7 �, 4
shall not employ any pe y r so as to become ublem to the Workers' S O l — FINAL ELECTRI CAL':ENERGY
CompensationLawsnrcEmrnaDmr ` 502 - FINAL PLUMBING ENERGY..... . .
cant -
NOTICE TO APPLICANT:IQLafter makingt Certificate ofEempton-you should 503 — FINAL MECHANICAL ENERGY
become surest to be Workers Compemai on pro aioo,ofthe Labor Code,7.a must
p zp Forthwith comply with such provisions or this Permit shall be deemedrevukea. 504 -. - FINAL, BUILDING.,ENERGY _,.
F � CONSTRUCTION LENDING AGENCY _ 505 - FINAL ELECTRICAL
I hereby klan that there constructed ed lending agency forme performance 506 — GAS TEST
oft work( which thispermit is .sued IS c.3097 Civ.C r "
gL, Lind Name' '507 FINAL .PLUMBING. "_,..._ .. .
a Z Lend rk Address ." ^ ^.. .
U O 1 ernify mat I have read this application and state that me above information is 508 - FINAL MECHANI GAL
'x+.F omen I agree to plr with all city and coundy,ondfirance.s and state laws relining 509 - FINAL GRADE
C.7
to building comarvetion,and
FCJ Z h < threpresentatives of th 'ty t ¢rayon
the ab ( t dp prtyrrinspectionpro '
510 — FINAL PLANNING
a w) get indemnify ak ph radn aCpen eagainst 514 _ FINAL PUB ICW
ORKS
W judgments, r J exp which y any way against said
City consequence 6f to gran ng of this Permit.
APPLICANT UNDERSTAND AND LCOMPLY WITH ALL NO -PO IssuedDate
SOURCE REGULATIONS Ii;C Nll c I[//Fro Y J r
Signature of App— licanUCo�rI [1Wt7w'f 'L'yi 1D ni .. Re-roof$ `
I HAZARDOUS MATERIALS DISCLOSURE
Will the pplicant a,future building scup scene cor handle h=ard at r;alTYPe of Roof .. __ _ _ ..... . _... .
as
def d by the Cupertino Municipal Cod Chapter 9.12. d theHealth d Safety ,.
Cnde.Section 25532(.) } l ,Cl .''+ , t _
'ElYc`• r " +_ Allroofs shall be inspected prior-to any roofing material_being installed.
'.WIIItheapplicantor,futurebuildingoccupantuseequipmentordeviceswhich If a roof is installed:without.first obtaining•anlinspection,I agree.tdremove
smith xad us air contionamants as defined by me Bay Area Air Quality Management
District .. , ..all new,materialsfor inspection.,Applicant understands and wfll.comply,with ... _ .
/p
01 yes" q�va . ' _ ` all non-point source regulatims,,.
`a.._. 1 nice end me'hazardous materials requ remenx under•Chapter 695 of to
California Health&Safety Cole.Sections 25505:]5533 and 25534:1 understand that -
if the building does not currently have a tenant:that it it my responsibility to notify the
Occ
onceparnth'-q fPt It 2h must be met prior to issuance" f a i cni(,wm of -
p Signature of Applicant Dale
own r nr umnd:ea agent Data All roof coverings to be Class"B"or better '
v _.