03010059 CITY OF CUPERTINO = ::. w ,•d ;zea.'
RUILDINC DIVISION PERMIT CONTKACTpK INFQRMATION
BUILDINGADDRUSS: GIACALONE ELECTRICAL SERVI ffgf IT NO.
19929/79 STEVENS CRK BLVD
NER'S NAME: 6300 MONTEREY RD. APPLICATION SUIT DATE
STEENS CREEEK INVESTORS INC 01/09/2003
PHONE: 408) 842-9655 SANITARY NO. CONTROL NO,
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
w,
�00 LICENSED CONnsed under provisions
CON Job 4qt , On
1 hereby alrirm That I am licensed under Provisions of Chapter Y(commencing YN IEripi\RIAL f�'
with Section 7000)of Division 3 of Ne Business and Professions Cale,and my license is ED
in full force a ct. �e
q: sec-seCl w.« y4g PARKING LIGHTING
N ❑ Date Centra tar
p—�p� ARCfI1Tr:CT'S DE RID .JUL 1 4 200
�a K 1 unJcrsanJ my plans shall M used as public records
r 'U
a u.G Licensed Professional L DING
s.=.Os OWNER-BUILDER DECLARATION BUILDING
a4 Tri o o hereby affirm on 1 1. exempt from the Contractors ;License Law lin the
S p O following reason,Permit
he 703str Business and vefdemoli Cole:Any tiny or county
$ Which RyYVeSa Po toss reCOres the allot,improve.forsu.demmSM1.IIIrepair anytWment
tpoor hathe alissuance.also requites the inion offer such Sertoli to file taimedsnemem
CZ< thmrouncccnudpunuion7007000).1
Sq. Fl. Floor Area $50NA4ttt10❑
(matuat he nrixempth Sectionntand l basis.]of the Business andnJAnyvii Calc?m
y — Natis exempt therefrom and be bars for the alleged exemption.nto Any violation of
notSection than vehundreby any dollaronperm;tsubjecuNeepplicamtoac;v;lpcnel,y of Occupancy Type
not more Than ave hundred dollars($50D, P Y YP
01,as owner of the properly,or my employees with wages es their Sole compensation,
will do the work,and de structure is not intended or offered for sale(Sm.7044,Business a 1 FOUN
—
and Professions Code:The Contractors License Law does nota 1 to an owner of red Ins ections
property who builds or improves thereon.and maxims such work himselfor through his 102 - PIERS C qcoP
own employers,provided that such imprommeina are not intended oroRered for sale.If, 103 — UFER
however,the building or improvement is sold within one year of completion,the owner,
builder will have the burden of proving Nat he did not build or improve for purpose of 104 - REBAR
"I`) 105 - ANCHOR BOLTS
❑1,as owner of the property,am exclusively contracting with licensed contractor no 106 - SEWER & WATER
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
unse Law does not apply to an owner of property who Wilds or reprown doemon.and 202 - UNDERFLOOR PLUMBING
e
who contracts for such pmjecuwith ecumracmr(aHicenuuntrem
d pursuant the cuors
License Law. ' '203 — UNDERFLOOR MECHANICAL
❑ I am exempt under Sec. ,B&PC for Nis reason 204 - UNDERFLOOR FRAME
Dae 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATIONDECLARATION 301 - ROUGH PLUMBING
I hereby affirm under Penalty of perjury one of the following declaratiem: 302 — TUB & OR SHOWER
❑1 have end will emim tin a Certificate ofC.nsenuo sclbimme for Worker's Course.-
sation,as Provided for by Settle.3701 of the l.ahnr Code,far the performance of the 303 - ROUGH MECHANICAL
work tar which this peril is issued. 304 - ROUGH ELECTRICAL
❑1 have and will maintain Worker's Compensation Insurance,m required by Section 305 - FRAME
3701 of the Labor Cole,for the performance of fie work for which this permit is issued.
My Werker's Compensation Insurance carrier and_Pol/icy numMe are: 306 — HOLDOWNS
carie S vt Peticy.Mr.: oyb-IIS LING(' 307 - INSULATION
ATE OF CERTIPI COMPENSATION INSURANCE 308
308 — SHEETROCK
(This section need not be completed ifthcpcomit is forone hundred dollars PS 0) 309 - EXTERIOR LATH
.-mss) 310 - INTERIOR LATH
I certify that in the performance(if,hc work for which this permit is issued,1 shall not 311 - SCRATCH COAT
employ aso
ny form.to any manner m m u to became subject the Wmkeri Compensatin
o
Laws of Ca1imtoi..Dole 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT:If,after making this Celli licme of Eseurption.you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Worker's Compensation provisions of the lather Code,you must 502 - FINAL PLUMBING ENERGY
OO forthwith comply with such provisions or Nis Permit shall be deemed evoked.
y CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
[.. I herchy union out from is a construction lending agency Ior the Performance of 504 - FINAL BUILDING ENERGY
94 the work for which this Permit isissued(Sm.31N7,Co,C.)
Lender's Name 505 - FINAL ELECTRICAL
(y 0
.a7 Z Lendcr's Address 506 - GAS TEST
U O 1 eerily that I have read this application and state that the above information is 507 - FINAL PLUMBING
H. — correct.1 agree to comply with all city and county ordinances and state laws relating 1.
pU building conswction.and hereby authOHMrepresentatives ofjus city toenerupmthe 5 FINAL MECHANICAL
u7 stove-me.bo.ed reetosve,inemnifyan keep
09 FIN
We)amen to save,indemnify and kith harmless theyCity of scenic
against (/
U fiathiatatei-norudgmcnls,arsnor inspensesection which may in any way accwc amainst said City fj NW
til,'�' mcsryucnccof grainingof lhi.e permit.APPLICANT ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by51RKS Date
SOURCE ATIONS.
Re-roofs
naw.-of AppliwZDm
HAZARDOUS MATERIALS
excup DISCLOSURE handf Type of Roof
Will the applicant or futon Municipal
Co e,Chapter
erre or handle hazardous.-aerial
u defined by Ne Cupeninn Municipal DMc.Chaster 9.13,and the HcaIN and Safety
,dc.secret 25532(e77 `/• All roofs shall be inspected prior to an roofing material bei. installed.
❑YeaNe P P Y g g
Will Inc applicant or lure building occupant vu cyvipmcm or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazallous air coneeminnts as dclincd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes No
I have mail the hiverde manals requirements undcr Ch,a r6.95oftheCelifor-
i i.11e.IN&Safmy Ceak,Sections 25505,35533 and 35534.1 undersand has irNe building
fres non cmroml a tenant,that it is my responsibility to notify the.ecuput of the
requiemcn n ns,nemet poor toimemor,uraccvincawofacupancy Signature of Applicant Date
Owneraaawhonud.genl ate 0 All roof coverings to be Class"B" or better