02010081 NO
OI BUILDING DPERONNo PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: PERMIT NO,
20370 RODRIGUES AV SOUTHBAY CONSTRUCTION CoINC 02010081
OWNER'S NAME: APPLICATION SUB DATE.
TOWN CENTER ASSOCIATES 511 DIVISION STREET 01/18/2002
f 'ROPE: SANITARY NO. CONTROL NO.
(408) 379-0400
C are oZ ARCHITECT/ENGINEER: BUILDING PERMIT INFO
x u C BLDG ELECT PLUMB MECH
LI I. J ___I
v i LICENSEDCONI'RACIORS DECLARATION lob Description
Z_Q 1 hereby animation 1 nm licensed ondm pravisi°ne of Clop er!)Commencing
;ytod witbSection700( Dls,�amJnnneen,me„andPmm>rinn,eai<.amamrbcen,< DEMO
is in fall to d
an
0 d,ut License CI o
Lia.
i`. U nit Cnmrinur
ARCHITECT'S DECLARXCION
so I understand my plans shall he used as public recoMs
or
a
i p C Licensed Professional
LL OWNER-BUILDER DECLARATION
so I hereby offilnm'tn thin I empt Buntthe Cuml'ncon,Limo,o Law fur the
following reason.(Section 7031.S,Business and Profusions Cnde Any city or county $7000
co^'a which requires pe 'u .a t la p d 1'h p y structure
apritard,it, mrl :'gedatmenl ___ _ _ ...
aha he lan.udpm nothe pqv si sof theC vain Ummela IChNxor9t �a]p Valuation
(tom cng with Seen..7000)of D...to J of he Buanes dPmfe,,on,Cool fa v3% 01'f
or that he is exempt thererrom rind the basis for the a11egW exemption.Any violation' t
of Section 7031.5 by any applicant for a penim subjects the applicant to a civil penalty
of not come mon five hundred unbar.,lsxxu. NOp`�i��IU TED INSPEC IONS' Occupancy Type
C 1,as owner of the property,or my employees with wages a,their sole comp<nsaion.
-will do the work,tad-the structure is not intended or offered for sole(Sec.7014..
Business and Professions Code:The Contractors License Law does not apply to an Required Inspections "
oti
r of property Who builds or improves thereon,and who docs such work himself
orr throe h his awn employees,provided vidin improvements are thus such im mes anot intended or
offciid or sale.If,howaoci:the buildiri8 or imprd✓cmcni i4 sold within dna year of- -- -- --"""�- �-�-� � � - --" -- - —, -- � -�- . .-, "....-" "-
completion,tn<owner-builder will base the burden of proving that he did not build or
improve for purpose of sale.).
Of,er owner of the p(Sm.7.vnt Business
Professiniractm,ons
ns Ceicenmd C nctors to „..
License the project(Sec.9mn,Business and Professions Cade:)The Contractor's t
and who
Law dri<,noirapplyme to an owner of a conlY who builds ce improver thereon,
_ and who commas for such projects with.v crinvuctorts).licrnud.pursuant m.Nc .. _ .. ._ .._.. _-.. _.. _..._.. . .._-.. ._ _. __ ..
esiLicense s Lice law.
El I a. _
❑ ame,<mpt under$e<: ,B&PCfor this nods, y,r•
Owner Date \ .
_ WORKER'S COMPENSATION DECLARATION
I hereby aRrm under penvlry of perjury one of the following declarations:
or
•J 1 have and will rimmain a Certificate of Conten to self-made for Worker's
„ Camiscro .a" as provided for by Section 37W of the labor Cade, for the
perfoman
rce-.fthe work rnr which his permit is issued.
❑I have and will maintain Workers Compensation Insurance,as required by Section
3700 of the IabOf Cone,for the performance of me work for which this permit is
its .My Wmkc{'s Cion lnamve<ca ' mi
er a ,Pre:olicj number a
PoIiTN �ZZ 2'dL J, Uh•'I1...-
CERTIFlCATION OF EXEM ON FROM WORKERS'.COMPENSATION _
.. _._._.-. ... . -..__- ._.__._.. . .. .... .. .... .._........__._.._..... .___...__—...__ ._._.-_...._.... .
(This sec{inn need not to,ocinpleee if the permit is for one hundred dollars
($100)or less.)
1 cdnspl that in Ric bin any m nn r s wart forcome this pdto t e orke;1.
shall tat employ any person in any manner so as to become'subjen m the Worths' '
Compensation Laws of California.Date '
OIm :.
NOTICE
TOICEIU APPLICANT:Work is Co Compmakensation
this Certificate Labor on.de.you
"
Q 0 Isometrichi(eubj<cly the Wnrkcr'sC°mpenmthis provisinm of eche Labor Cale,you must.
forthwith comply with such provisinm at this permit shall be deemed revoked.
Fu ,'CONSTRUCTION LENDING AGENCY '
Ra I,hereby affnn that the¢is a construction lending agency for 0e Performance
r of the work for which this permd(S
it is issueec.3097,Civ.C.)
QLender',Name.. .. .-._ . _ .. _.:. - . ..... ...
0. Lendor's Address
U' 1 certify thin 1 have reds this application and swtc thnnhe dtuovc notion is 1
Ii [� correct.I agree to comply with all city and county ordinances and state laws relating
0.0 m building construction:and thereby maturities repre,cmatives ofthis city to enterupon
fie, the above-mentioned Property for in,p<airin limprisca..
p. Wo)agree disuse.indemnify and keep harmless the City of Cupertino against
UO liabilities,judgments,tuns and expenses which may in any way accrue agmon said
U Z City in consequence of the gra ling of this permit.
"•' APPLICANT 'ND r f ANDWILLCOMPLY WITH ALL NON-'POINT ' `+
uE r to . ' " •" —' Issued by: Date
Si na of cant! ont actor ,:.. ' Date Re-roofs /
HAZARDOUS MATERIALS DISCLOSURE
N ll the applicant or Etre bolding notation store or handle has tdous material Type of Roof _as def red by 25 3200' o Municipal Code,Coapt 9,12,and the Health and Safety - •. '
CodeSection,255321x1, /' "� 1,'''•' �'t , t
❑Yet.; . I.. 61�
;•::f . °�-.� ,;t;•.,�r' . . . . ....All roofs shall be,inspected.prior to any roofing material.being installed.
Will the applicant or future building orcupart use equipment or devices which If a roof is installed4ithout first obtaining an inspectiom,'`P'agree to remove
emit h d air Contaminants as defined by the ByArea A Quality Management
�ikoictl all new materials for inspection. Applicant understands and will comply with
rt oY all non-pont[source regulations. „
�y 1 have read the ha lido.,materials rcgmremords undo Chopter,6.95b1 he _
California Health&Safery Cade.San...8505.25533 and 25534.1 undardint that _
ifth5 building does not currently have sadism,that it is my responsibility to many the
- '- - --
cupant of the requit<nsenu whit us,be me,poor to Isadore of a Certificate of
°r Signature of Applicant _ _ _ - Date
own .ora a na dm .Daae. All roof coverings to be Class "B"or better
..I. .. . .. - . _:_t .. ... .OFFICE