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01090070ti _Cu o Ewe ;u.Oa i6CC IW'ca Z� i3= Oz a� W A tO wF OU rrw U� 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