03020121CITY OF CUPERTINOr
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BUILDING DIVISION PERMIT"CONTR�.CTOR
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INFOitMATION.
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BUILDING ADDRESS:
DEVUUN CONSTRUCTION INC
PERMIT NO,
Amikk 20230 STEVENS CREEK BLVD
03020121
'S NAME;
555 LOS COCHES ST
PERMUSSUEDATR
DEADZA PROPERTIES (SUITE C)
02/27/2003
PHONE:
—
SANDARY NO. CONTROL NO.
ARCHITECT/ENGINEER:BUILDING
PERMDINFO
BIDO ELECT' PLUMB M[CH
0 1� t� 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hemby.fOrm the, 1 ren li«nand underJ�rovbiom n(Cloqu r9 (commencing
with Seetian] )of Dlvbian Sof the Bmitte) dPraremmm coM,and my0«nmb
m mu m an erre.
TI--NEW INTERIOR
WALLS/P.WALL DEMO &
Ji(f q_
LI""rt G' `�
Data
ELECT/MECH
ARCHDECI'S IIATION
1 dernenJ my plena [hall W use _
pu
.
MAR 2 7 2003
Licensed pmfesainnal
OWNER-BUILDER DECLARATION
1 hereby Affirm that 1 am exempt from the Contrmlort License Law for the
.
follnwing won. (Section un 703I3, Business,nd Panfevoum Code: My city or county
which require, a pereall b construct, altar. Improve.w, demalixh, or repair my ,clum
poor to its issuance. Alm requires LAC applicant for such permit to file a signed statement
that he is licensed pursuant ID the provisions of the Contractor's License Uw (Chapter 9
Sq. Ft. Floor Area
'nation
(commencing with Section 7000) of Division 7 of the Businc s and Professions Code) sur
$11500 .
Nal M Is exempt therefrom and the bub frr the alleged exemption. Any violation of
pN �j' 1
9 Ij1
Occupancy Type
Section 7071.5 by any Applicant for a permit subjects the opplicent to 0. civil penally of
not more than fin hundred dollars (55(107.-
3 O jtj o
.$beT 0 0
2 b 1
❑ I. As awxr Africa property, an my employee, with mgmn their sole Compensation,
101
vs,r., 1
— FOUNDA "t'T&# Inspections
will do Ne work,end Ne,wctute lino(intembulmaffered formic (Sec. IDN, Business
and Profession, Code: The Contactors Licenm Low does an, apply to An owner or
property who build, or impransNeeson, and whmdoes,urph work hlmselfor through his
.- 102 .-
.PIERS, --
own employees, provided that.uch improvements an, not intended or offered for We. It.
hawewr, the building or improvement B mid within am you ofcompledon, the owner.
- 103
- UFER
builder will have the burden of proving out M did not build or improve for purpose or
ilk.).
.104
- REBAR
❑I, as Owner of the property, am esclosively contracting with licensed tema,ctonto
105
— ANCHOR BOLTS
contract ct the project (Sec. 7044, Buslneu and Professions Code:) The Contactor, Ll-
106
came law does nol apply m an owner of property who Wild, Or Improw thenen, and,
who contracts for Such projects with.cmnt,acmgs) licensed punuam in the Contractor,
202
— UNDERFLOOR PLUMBING
Licenm Law,
e,emasOr&,Sece. BaPCfor this reason
203
- UNDERFLOOR MECHANICAL
Data
204
205
- UNDERFLOOR FRAME
- UNDERFLOOR,INSULATION,
WORKER'S COMPENSATION DECLARATION
I hereby amtm under penally of perjury, one of the following declarations.
301
— ROUGH PLUMBING
❑ T haw and will maintain a Cenfinuofeomcnt to m6-imum dnrworkeftCompen.
302
— TUB & OR SHOWER
tenon, As provided for by Section 7700 of the LAW, Code. for the performance of the
work for which this permit isdmued.
303
- ROUGH MECHANICAL
❑ I ban and will maintain Workers Compensation Insurance, As required by Section
304
— ROUGH ELECTRICAL
s]o0a thel�bnrcadc,rarNepe,farm.n«arthewa,kfmwhbhmbpemtubinsmd.
'-
'
y W rkcrk Cmmpensatlen Inaunnce carter and Policy numhcr e2:
305
FRAME
I avvTtraY7yR)cu PoIIryNo.; U7LZ
C-11
r70 306
- HOLDOWNS
CERTIFlC NFRAM ORKER5
'
307
- INSULATION
O PE SATION1I
COMPENSATION INSURANCE
(This amino need notes completed ifthe permit is fare= hundred collars(SIM)
308
- SHEETROCK
oricm.)
309
- EXTERIOR. LATH
1 «Wily that in the performance of the work for which Nis permll Is imuad. I shall am
31 O
— INTERIOR LATH
employ any person In any manner an As to become subject G the Workers'Compens.11m
Iawsaf CAllfamia.Date
311
- SCRATCH COAT
AO`°"'
313
- ROOF NAIL
NOTICE 7O APPLICANT: If, after making this Cenifinte of Exemption, you anould
Wmme subject to the Waher, Compensation provisions of Ne LAW Cade. you must
501
- FINAL ELECTRICAL ENERGY
forthwith comply with such provisions or this permit hall W dcemad ranked.
502
— FINAL PLUMBING ENERGY,
CONSTRUCTION LENDING AGENCY
1 ncreby.mrn that there i,. ION mdm
Inn lending agency , perrurmaru of
503
- FINAL MECHANICAL ENERGY
the work fur which this permit b issued (Sm 3OB7, Cb. Ca
504
- FINAL BUILDING ENERGY
Lender,e
Nama
505
- FINAL ELECTRICAL
Lender's naa
1 candy that I haw rod this application and sum Nal the .how information is
5,•0 6
—. GAS TEST
cored. l agree to comply with all city and county ordinances and stale laws totaling to
INAL PLUMBING
building conswction. and hereby rvNorin: rtprmenutiw of Nb city to enter upon Uteahovo-memtoned
Propcny dm inspeNan purposes
FI N E C C L(We)
agree to un. idemnify and keep harmku tite City of Cupertino againstIlabilides,jWgmenlLcotts
t5F
and expenses which may In any way Amus against mid CityIin
consequence of the Annung of the Permit.APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
I$sued by:
NG Date
s0UEGUL ONS.
V( AAAiZ
Re-roofs
Type of Roof
signature of ApplicanUCanraclorData
HAZARDOUS MATERIALS DISCLOSUR
Will the applicant or future building occupant smm or handle hamrdoes material
find by the Cupenino Municipal Code. Chapter 9.12. and the Health and Safety
Scelm.2sss2(.)T
0 Y.,No
❑Yc
All roofs shall be inspected
prior to any roofing material being installed.
1"iCL?
If a roof is installed without first obtaining an inspection, I agree to remove
Will the.ppReart A, room building =.part.an egolpmmt or devices wnkh
harurdrw air Concertiu call by the Bay Am. All Quality Management
all new materials for
inspection.
(-I Yea 1'blo -
-
I haw mad the handouuss mamrlelsmquir menu underChapwr6.95 critic Carter.
ria Haslib&Safety Cade, Sections 75505.25577 md75554. 1 tem,, it If Ne Wilding
- -
doesnalcurrentlyhawa¢pant, that It is my rospomlhility m madly lW upant rths
wyulre n��'qcrhylI�/qq�yl/p�me 1pdormiuumceofaCenficate amp
Signature of Applicant _- Date
�/ VyL[N AmeAM' St aitd
All roof coverings to be Class "B" or better
0
cronuthmivcdagcnt Dam