01080024 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20300 STEVENS CRK # 400 CONSTRUCTIVE BUILDING SV--, INCO1080024
OWNER'S NAME: APPLICATION SUB DATE
KRISTN/CASEBEER DAY 3937 39TH AVE 08/06/2001
PRONE: (510) 531-1175 SANITARY NO. CONTROL NO.
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O m z ARCHITECrlENG1,NEER: BUILDING PERMIT INFO
FOO BLDG ELECT PLUMB MECI4
=1 I I _I
S i LICENSED CONTRACTOR'S DECLARATION Job Description
I hembyafim that l am licensed underpo.isions of Chapter9(commencing NEW INTERIOR PARTITIONS .
�_C J withscnlon70W)of Dr f e Business and PrefesslonsCWC.and n license
in full forte
ipm< Li<cnxC ` Lic.p (/ FINALE®
i 3 a y mess eommcmr
ARCHI'MCI, IIECLA
"O.5 1 understand
my plans shall he used as Public records
�<o ].armed Professional NOV 14 2001
z OWNER-BUILDER DECLARATION
a 1 hcmby affirm that 1 am exempt from the Commcror's License Law for the
s- a following reason.(section 7031.5.Business end Professions Cade:Any city m coumy BUILDING
$250000
I O which mquims a pairo m m em,nrum alar,improve,demolish,or mpmr any swcma
1p"niaitcamed[palsomquiru@gopPliewt foe suchpemiuo Bks La (Chapter
Na mro li<gns'd punuam rob the piovisvisi of the Contract 's
Liana law inu Cash)
9
fc,butbe ingarra therefrom'and tDi hall, odNCleged ssand Professions Code) (':;}`.; �'?13�.�c i',('�1°9R; ®a'd 1?1,j.Ja} Valuation
.,,but Sartain
7 exempt therefrom applicant
p li and the M1aels for the alleged exemption.Any violation
-of Ser mon IB3L5 by anydre d.11foropermit subjecss he applicanuoocivil penalty
'ofnet maaman.B.ehuaareamlmr.tasan. 103°•PNIIlfl9 Ipf'<• ;":r, Occupancy Type
❑1,as owner,of the property m my employees with wages as their sale cmapeowalit o, 3 04 —
- But as Nt' pro professions
the sndeme'IC ntrmemdLi or a Law
me snot(see:to an 5 0 5 — FINAL EIB tR1$1CYd$#1Y,C[iohs'
Owner of and property Who ie il&Cods:The Coes them
s License law does not apply m an
owner or property Who builds or improves themon,and who arcs work lf
himse
or through his own employees.provided rhos such impo sol artm not:.ander of
oRgrW for sales If.M1owcvm.the Wilding a impeeiveermm is¢sold within ohe year of
completion,the owner-builder will have the Wrden of moving that W did not Wilda
improve for purpose of sale.)
❑I......a,of the property-am esdusivdy comracming with licensed mntranon m
'
construct he pri(Bre.7(94,Business and Professions Codc:)no Comorram's
License I.aw does not apply ,,an no,of property who builds or improves thereon,
i. ).i ..and..who.contracts for such projects with a comracmgs).licensedpursuant m the.. .. ..._ _.. __...._ - _" -.". ...._ __ -_.f..__.._...._...._ _..._ ... ._..-.�_...._....._..
C.Olow ur'a Licenw Ww. t � 4.t -' +
❑I am cxampm under Sic. ;B&,P C for this reason) i1.IJ IJd-'.'I(Ii LLJII
_ Owl c
WORKER'S COMPENSATION DECLARATION
'- I hereby Of.u adla,penahy of lgau one of the following declarations:
❑ 1 hive and will mainidin alCkirramc of Coment'to selLinsure for workers
Cmr,hasmion. a_ provided fm by Section 3700 of the LIW, Cende. I., the
perforrvr¢e of Ne work fm which Nis peemh;x issuN.t�,
01 have and will mairimin Workcr's CoopensaIon Insuran'.,as'rar;mmd Cy Section
3rt 7' ]00 of the Labur ad f th perform a, Qlf h h m,rt Perm t
soh d M' d r C pe _i
sumna came
cio 7Po1 Policy
�1(TTrs sec Ra need nm be co npine 'if the paonil .KERS ll
COMPENSATION INSURANCE''.
� 1 - is rm ane hnaamd dollars ' .` I`• • ' -. (r,:kujl,) .. ha•.
,.rat
„I censph that in the yerfoimy..no the
work fIslame this permit a issues,
nM1ill'not employ boy parson':.any mannbr so aslo Wcome`subject m the WorAess'
Coope'. t Lows of C I f' Dees
Afipflhcrnnf
' Ir NOTICE TO APPLICANT1l all.r ing mh.Ceni&ate ofEcor,tou.yea should ' r `I'
O We rte bjea t the Wp Acr.C f< 'm on pmv i ons of th Labor Code,you est I
z Ofohhi&im crImply with such P to visions or this permit shall the deemed to voted
4 "CONSTRUCTION LENDING AGENCY
1 hereby Amo that mhc conswct 6n lending age ty for]he Perfoms ce
a�a s Addrtssh ch th ant rn is:wcd(Sce'31y)] CIv.C)
g� M ... _.. ..,..'. . . _ . . . .. . . _ _ .. _._.. _. . "
ao
_�.Z lind
V 1 cenify that i have mad this application sand nae that the above information is
'carie,,I agmc to anmply,with all city and c......Win..and sura lows relating'
Q f.) to Wilding mnswction:and hereby aalloriremprt'motadves of this city to enter upon
"^ ythe ahoycmcnuoned propmy for inspersion purposes.,
cj cap e i cannily and keep harmlesdie City of Cupeninn'againsr
V) liubi' a jus n mss O> r espemes which,ma any way ottme ogeinst said.
'U..� Cli m e' aming.1 "s Permit'
'A DCII : L D c e.-P'iTH'A 'N `o `T" Issued by: Dale
�.
m r P a wetm. ate " Re-roofs
UlpRDOU S'MATERIAIS DISCLOSURE ,-,
eaW tiding occupant smm handle haaardoas macnrd Type of Roof rneamen M e Ieaa CTaq 91z nesmeHnlN.nes remy ,� s ; T4a32(al VSn' as.a,Y:^. ;Lar, y+s ,' t`' '� '. `.;•-J . ,. . .W" " All roofs.shall,be ins acted rior.to an -roofing material bein .Installed.-._.-1. ..
Will the applicant ornate banking occupant use equipmem or devices,which If a roof is installed without firs[obtaining an inspection, Pagreeao remove
troth ry m t dfrod bjth Bay A .A Quality Management
nst t ,.. all new materials-for inspection. Applicant understands and will comply with -
°Y al] on-point source regulations, .,. fl, ;t;e; •I,
r ,I have reW:ihe h¢ us"menials mqu ants under Chapter 6.9s of to
Cel' is Hcafi oft tde.Sections 85 . D aWM534.lunderstand Nat _ _ _
iltlin I curly havcvrna .that t msponsibilimy mo notify the moRl
I
up nt o! s Is. is rGi dor toviss ffgla f
S: y 0 Signature of Applicant Date _
All roof coverings to be Class"B"of better
_ i OFFICE. ._