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BUILDING DIVISION pERMIT I CONTRACTOR INFORMATION: 1
BUILDING ADDRESS: PERMIT NO.
20100 STEVENS.CREEK BLVD 01090070
OWNER'S NAME: APPLICATION SUB DATE
UNITED CALIFRONIA BANK #200 09/18/2001
k-1,7— —
,ONE SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 91 commencing
with Section ]0(10) of Division 3 of the Business end'PIrofessions Code, and my license
ce
is in full forand affect T�5
License Clnss (j Lic.p T Yl
Date f•31. o'er Contracmr1r. --1"w3Z T.
ARCHITECI"S DECLARATION
1 understand my plans shall be used as public records
Licensed Pmf... im el
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am evempt from the Commnor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct. alter, improve, demolish, or repair any stmcture
prior m its issuance also reP.d
uire the applicwt tw such permino file a signal statement
that be isliminthe provisions aide, Contests License Law (Chapter 9l
(commencing pg0)bf Divii on 3 of the Business and Professions Code)
or Nat he is' em and the b ( leged exemptin. Any violation
.ofSection 703licant for a permit he lie ttoacivilpenalty
of"" methd dollars (E500),r1as asher. or in employees with ra h oosaco"Cn 4 n,,ill do Ihe'wwEtur'i s anti ddd&&& be
c YOOC.
mgerco for sate, it. nowever, me mammg m tmpmverV m wn on t
completion, the ownembuilder will have the burden of prov' m he dad or
improve for purpose of sale).
41 m my. er of on pr p rty mbte ely contracnin with licensed contractors to
construct the project (Sm. 7066, Business and Professors Cade:) The Cmuschn's
License Law does not apply in an owner of property who builds or improves thereon,
and who. conosen.for such pmjeas with a commands) licensed pursuant to the
Conwctols License Law..
111 am eaempt err Sec: 1 B &,P C fonhis reason
Owner oate
ORKER'S COMPENSATION DECLARATION
I hereby or. under penally of perjury one of, the following declarations:
❑ 1 have and will maintain a Cemifcate of Consent to self -insure for Worker'a
Compensation, as provided far by Section 3700 of the Labor Code, for the
performance of the work for which this permit, is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
37W of the Labor Code. for the performance of the work for which this permit is
issued: My Worker's Compensation Insurance carrier and Policy number are:
Camel: sTirl-t �'iT
Policy Nw:' 5� 1' t! I
!:'CERTIRCATIONOFEXEMP ONPROMWORKERS'
COMPENSATION INSURANCE
(Thus secuon read hot be completed if the permit is for one hundred dollars
(E 100) or less)
I cenirY That is 'no
b pe"Oure nee of me'work for which Ih s permit is issued, )
shall t ploy any pea. m any man' r io ppee55oom yb)em to the W rken%'
Compensation Lew, e m a Date 1 t •i V' O 1
Applicant
NOTICE TO APPWC T If, a ter making thisC nifcate fE mq on, you�hould
become subject to me workers Compensation provisions o(the lotion COEc. non mars
forthwith
c mply with 'h p ions or this permit shall be tleemetl revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affrin that Here is a conswct on lending agency for the performance
of the wa k fo which Ih i issued S 3097. Civ. C )
Lender's Name' N A
Lender s Address
I certify that I have Lead this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
mmless the City of Cuperti e, against
may in any wey acerae against said
t. I
MPLY WITH ALL NON -POINT
SOURCE REGI'B: ON .1 'f ' q b
Signature of gpphc HAZARDOUS
- ',Date
HAZARDOUS MATERIALS DISCLOSURE "
Will y the Cupert or Tamm building occupant store or handle Heallous ma
C defined by the Cupertino MumciPeolC d apse 9.12, and the Health and 5
Cade Section 25532l id?
0. -
p Yes
Will he applicant ca,future building occupant use eq 'pme t o devi
emt hazard air comamt
❑ Yes O t defined b rty Area A' Quality Manage
Distn. i 0 .
the
that
:really have a tenant. Nat it is my responsibility
ms which must be met prior to issuance of a C
Job Desci
TI.
REMODEL FOR BANK USE
102 - PIERS Required inspections'
103 - UFER
i1104 - REBAR
/_105 - ANCHOR BOLTS
J _.... _.
106 - SEWER "& WATER
202 - UNDERFLOOR PLUMBING
203 = UNDERFLOOR MECHANICAL
204 - UNDERFLOOR FRAME I
205 - UNDERFLOOR INSULATION
301 - ROUGH PLUMBING
302 - TUB & OR SHOWER
303 - ROUGH MECHANICAL
304 - ROUGH ELECTRICAL
305 - FRAME
306 - HOLDOWNS
307:,; - }`,.INSULATION,-,.
308-'`SHEETROCK
309 {
310 - INTERIOR LATH'
_.. ..3i.1_",,._.SCRATCH ; COAT
313 - ROOF NAIli" "
- 501--F"INAL--ELECTR-ICAL-ENERGY --
502 - FINAL PLUMBING ENERGY
503-- --- RINAL-MECHANICAL ENERGY _...
504 - FINAL BUILDING ENERGY,
505. --,FINAL ELECTRICAL .. .-
506 - GAS TEST ,
507 - FINAL PLUMBING
508 - FINAL MECHANICAL
509 - FINAL GRADE
510 - FINAL PL ING
Issued by1Za�,)_
4 -i dN I WORKS Date �
Re -roofs fs
Type of Roof
_ All roofs.shall be inspected priorto any.roofing.material-being installed.
If a roof is installed -Without first obtaining an inspection, I'agiae to' ilemove
all new, materials, for inspection. Applicant understands and will comply,with
all non -point source regulations. 1
Signature of Applicant _ Date„All roof coverings to be Class `B" or better "
OFFICE