01100095 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20300 STEVENS CREEK BLVD HOWARD WRIGHT CONSTRUCTI N CO. 01100095
OWNER'S NAME: APPLICATION SUB DATE,
SYMATNTEC (CC1 , 2ND FL. ) PIER 9, THE EMBARCADERO 10/15/2001
I PHONE: SANITARY NO. CONTROL NO.
(206) 447-7672
Q O O ARCHITECT/ENGINHER: BUILDING PERMIT INFO
Sc a DG ELECT PLUMB MF-CH
w—
a i t L J CJ 1=J L..I
�N
Z' LICENSED am
under S DECLARATION Job Description
L o I hcrtby eRrm that I am licensed under provisions of Chapter 9(commencing
„C,y wnnfectiorcean cfgpiisirn3rnneBu=iMaaanarroreay�ns�d amrranae 30 DAYS TEMP. PERMIT.
C12,m P_ i=in full force and cff t 1 )
=earca Danseems: Con
Z _ L (EX)}�R$S_ON 11/15/01)
1 3 u v Date i0 sCf S DECLARATION— \
I understand plans shall brt
<used as public enrds
s�sE my D
a a p G Licensed Professional
Oat I an BUILDER DECLARATION
m 1 greasy affirm,hat 1 1. aempt from the Contractor'sLicenseCode: c Law co he
h?Q following reason,(Sermon 7onstru Business and Professions h.oAny city st county
mA O which requires a permit to construct,allcr,improve,demolish.or repair any structure
aim -Prior to ns,uuarca also req ties Ne eppliant fm such pcmuuo Bleas,gnm suerrcnt, _.__..
that he,abanud Purses'noslm po zio,u of the Conuactoh Licenulaw(Chap,er9 , f, Sq.,Ft. Floor Areg .=,l - r ,, uauon
(emnummetng with Sen ]0)0)of Division 3 of the quid.T{a irl Pormso...cartel e (,'4'i.\.-`9l i Lht`.•ll_ 5..a J.
or that he is ciemyt mcrefrom'nW the basis for alleged ekamptioh.Any violation ` _
of Section 70315 by any applicant for a permit subjects the applicant to a civil psmalry -
at not mine than five hundred dollar=(ISM). A um fir ! Occupancy Type
D I,as owner of the propcny,or my employees with wages as their sole compensation. I _
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Baines end Professions Cade:The Contractor's License Law does not apply to an 102 - PIERS Required Inspections
nv of property Who Builds or improves the em,and who does such work himself
m ill is a e ovidea that such improvements am not intended or
10 3 - UFER _
offered for rule. r vita' se
or ant nay .
Completion,the er-buuder his e 4 REBAR
0
improve rat Fur of rale.). `n ` t 105_ -_ ANCHOR BOLTS
as:war,of rtbely' sex ting with Ii se .. . . - 106 SEWER & WATER -
0111.
conawn the tr n"Ce 71304 ras am'wrrraaionaac nt 202 - UNDERFLOOR PLUMBING "
License Law d r apply 1. fP'p•pent who Wilds.q,mpro- t on
and wbr contra Seca wits alrontrwmrtame+gd pu it
ear. 203 - UNDERFLOOR MECHANICAL
Contractors Lic 1
Dl am e.rtnpt under Sed. .B&Pefmi ison 204 - UNDERFLOOR' FRAME '
Ovmer Date 205 - UNDERFLOOR. INSULATION
WORKER'S COMPENSATION DECLARATION 301 - ROUGH PLUMBING
Ihertbyafrrmunderpenalty ofpr,jo,one ofthefollowing dechratiens: 302 - TUB & OR-SHOWER
D L have ado will maintain a Certificate of Consent to self-m we for Worke : 303 - ROUGH MECHANICAL
Compensation, as provided for by Section 37011 of the Labor Code, for e
penfomtan o of he work for which this permit it issued. th304 - ROUGH ELECTRICAL
D 1 have dna will maintain Worker's Compensation boursom u toquired by Section 305 - FRAME
3700 of the Labor Code,for the performance of the work fur which this permit is 306 - HOLDOWNS
issued.My Workers C Pe t n Insurance ad Policy morme,am
lc'„Lk trlQ .Po1cyN lJC1.(,61o0 I- „ 30,7 L-INSULATION-• - "---:.' •, �... _ .. ._
:CE CATIONOFEXEMPDONFROMWORKERS'I 3 Llr.k 1308 tII'SHEETROCKI. 1fDr
COMPENSATION INSURANCE; . . .. ..., '
309,i=,•';EXTERIOR"LATH
(Ibis Beetroot dem ma hc�Completed if the permrt
s is far e hundred dolhin 310 - INTERIOR LATH
(SI00)mless.)
-311--- SCRATCH :COAT ;
ceniry that in the performance of the work rot which This permit it issued.I 1 ,r :r•' .
shall not employ any penin in any manner so as to became subject to the Workers' 313 - ROOF NAIL'
Compensation rnlsw=oredaomia.DataAppl501 - FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT If,after makintidd,Certificate of Exemptions you should 502 - FINAL PLUMBING ENERGY
become subject to the Workers ComPenaotion provisions of the I-abor Code,you most
O forthwith comply with such provisions or his permit shall the d«mm revoked. .5 O 3 - FINAL MECHAN I CAL. ENERGY
F �
CONSTRUCTION LENDING AGENCY 504 - FINAL BUILDING ENERGY
' hcrtby affirm that there is a consw lrr lending agency for the perfoinsina
of the work fur which this permit is issued(Sec.31197.Civ.C.) ' _ SOS FINAL ELECTRICAL
Lmdcrs Name y.l'ice` - -. .. ..' 506 GAS TEST . . ..
o z Lender's Addmrs
U O I awry that I have rad this application and State hat the above information is 507 - FINAL PLUMBING
I-, cancel.1 agree to comply.with all city and county ordinances and auto laws relating 508 - FINAL MECHANICAL
O U ,to building Conswetion,and hereby auumsize representatives of his city to enter upon'
the above.metnem
hmeppropyI mileelitar mirp.sea, 509 - FINAL GRADE
a' (We)same to save,indemnify and keep harmless the City of Cupertinoagaini —
fn liabilities,judgments,wars and expe•-<which may in any way accrue against aria S 10 FINAL P I NG
U z �AppCity in consequence of the granting of aha permit S5
ti SOUR10ENtUNUE kNPj�NDWILLCOMPLYWRHALLNON-POINT I$$uedby:4 N WORKS Date
101,4 Sigwmne of Airplicapi/Conwchor J..' dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Wal Th uplmcam future building occupant ante m handle ban-.ma mudefird Type of Roof -.—.. - •. - .
as defined by,the Coperfirm Municipal C Chaps 9 12,and th H of Health and Seely .., -
Cod Section 255331x) °e Eq;f.t evl is r: ' r.: . ! ' Is } +:'� ',s . I it..r..
aura .• Leo . _- All roofs shall be inspected-prior.to.any roofing material being installed..
Willthe applicint'orfuwrc building rccupam useequipment or devices which If a roof is installed'without first obtaining an inspection, I'agree to remove
emit hazareomeLir Contaminants it 11, by he Bay Arca Air crudity Management'.
Distinct? - all new materials for inspection. Applicant understands and will comply with
Dyes all non-point source regulations.
1 hove read the Imnardoua..'crisis requircmenrs under Chapter 6.95 of the
California Health'&Safety Code.Sections 25505,25533 and 25534.1 understand that
ifhe building ares not currently have a tenant,that it is my responsibility to notify the
occupant rf the rcquirtrnenu which sn 1 be raPiior to issuance of a Ce ifcate Lir
psI Signature of Applicant Date
- ,; All roof coverings to be Class"B"or better
- Owner err authrrixJ agent .Daatt4 g
OFFICE