00060129CITY OF CUPERTINo
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BILDING80H" STEVENS CREEK BLVD
WEBCOR,
BUILDERS
PER'm°" Nf000B0129
DWNEWS' ft`PERTINO CITY CENTER ASS
CIAT 2755 CAMPUS
DR
APPLICATIMLA8W12000
.USE:
(415)349-2727
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG. ELECT PLUhIR MECH
IJ CI J J
LICENSED CONTRACTOR'S DECLARATION
Job Description
herenY *),,fDha I oro.flhn J ,ins, provisions afCbupsb 9 rd., vense
wink an3of me Business snJ Pn,fcssinm Cole. and my license
oneland
TEMPORARY PERMIT
full effect.
in full home and cffea.
Date . Clar_s Lla. tr
Contractor
AiCr'S DECLARATION
1 unJem:uW my plansr, .00II hall as public mr+rJs
,
Licenvw Professional
OWNER -BUILDER DECLARATION
I hereby al int+ than I am escmm fmm the Contractor s Liecn,c Law for the
billowing rearm. (Secdnn 7031 5, I1n,inans i 11'aeca, au Code: An, city 01110U.",which
requires a permit to construct, alter, improse, dnnolish, or repair any structure
prior to Its issuance, also requires the applicant for such penninn file a signed smtenmot
that he ish,rn,Idpa.tn+m nu hepoo,oor,onhccontmctoe,LiameLaw rChapmt9
Sy. Ft. Floor Area
Vat IUaIif$I>1
(rot mnci ag with Section 70(9))ofDlvioIn 3 of the Business and Prol .. on, Conlan
or they he i, exempt therefrom and the basis for the alleged excmphon. Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
A
Occupancy Type
of an aomtnan rise +anew eounrs (ssa)k
ry&Vl6j
9. 00
❑Lan wnerof the progeny. or myvtnployces with si,pswt their sole nnnpcnsation.
.
will Jas the stok, and the fracture is not intended or offcmd for sale (See 70,14.Btnines,
does
and Prnfe\xi)nx Cade: The Canlractn., Lifeco,, Law tin apply to an
101
— FOUNBATr���fspeetions
r of progeny Who hold, in in,pnwe, thereon, and woo Java such work bim,elf
Orth ughh pl Y p Jed,l t h p eua, am no, intendedor
'al'
102
— PIERS
off,md for safe11 M1 th hiAlding ... ....provernent'is old year of
„nplt f,co.ner-hatoldc, 0II due burdent Inovingthanl I'I (b'ld,r
103
— UFER
arpirtwe for purowul I )
-thl
104
— REBAR
01 f the po"on, lr lig . d n thaw
,annet the project (se,. 794. 11a.hics,: ,d I „R„on, C,sl,.) Ili, Cin acs r,
105
— ANCHOR BOLTS `J
License Law does not apply to an owner of proper, who handles or improves ahem..
and who contmcta far such projects with a contactor(,) licensed pursuant to the
106
— SEWER $' WATER �P
Cnntmmor', Lleoavr Law.
❑l.tn exempt ander see. _ .uNram nti. re.,,
202
— UNDERFLOOR C
owwnate
Owner
203
— UNDERFLOOR MECHRNICAL e_ \
WORKER'S COMPENSATION DECI.ARA'I'ION
204
— UNDERFLOOR FRAME w
I hemby arfian trader pe..hyof perjury one of the fallowing deeloutionx:
205
— UNDERFLOOR INSULATION
❑ I have ase will u Certificate 0f Consent m Lansurc Inn Worker'sthe
301
— ROUGH PLUMBING
Cnmpensaion, as provided for by section ntxl or the Lamer c«m, rte me
pooped
pernrn+anceoftheworkfor„hichthispem+itisissued.
302
— TUB R OR SHOWER
❑ I not, and ill maintain Wndrrl Compensation Insuroncu, as required by Scc'lion
303
— ROUGH MECHANICAL
3700 of the labor Code. for be perram.me of he work f.. which this pemth is
issued. My Workce%Co:npemation lmuruncc carrier and Policy number arc:
304
— ROUGH ELECTRICAL
Carrier: PoicyNo,
?05
— FRAME
CERTIFICATION OF EXEAfPIIOS FROM WORKERS'
COMPENSATION INSURANCE
306
— HOLDOWNS
e aotn,Lh,d ita permit is for w handled dollar,
Innis section new not the m
307
— INSULATION
($ 100) or les,.)
308
— SHEET ROCK
I ecnity mat in the pemaoaan- It the w ter which this perndn is is,ard. I
,hall out employ say p tis u. in any Benner so as na necoow n.hjea a he Workca'
309
— EXTERIOR LATH
Compensationlayrnrcao Nie Ube
Comresnt_7,sw (-lf�
310
— INTERIOR LATH
rvm"IcegonPl ICAN', Ltit erta',gmiseerdficaneona plia,,yo„sm,nln
is of the Labor
become subjca u, the M'arker's CumP :pmvisin bs Code, you must
�,11
311
— SCRATCH COAT
fonhwi th comply with ooh pm,isinn, or this pewril \hall he domed revoked.
31.3
— ROOF NAIL
CONS them iCfION LENDING AGENCY
Ink affirrinwhich Inas mentis construction lending agency for Inc perrommnce
501
— FINAL ELECTRICAL ENERGY
of me Work for which tn6s hermit i, h,aea (see 3W7, ei.. C.)
for
PLUMPING ENERGY
I"ole,
502
— FINAL
Under', Address
1 ecnily that 1 hocmad mlv and tate thus the info-mation
.11yand.,
ni,
t nq by 'J ' ec dsear . tuTrg
I. ti ton J h by mor po tie, f 1' try I ter upon
the asove-n n J property f ge ia purposes.
/
,We) a,,.,,, JJ y laidAeph I:. heC y fC Kn against
'
'm
503
— FINAL MECHANICRL ENERGY
liabilities. jadgnwntn.eo,lsaaLCCme against,aid
City in consequence of the granting of this permit.
ND WILL COMPLY WITH ALL NON-PONT
504
— FINAL BUILDING EIGY
APPLICANT UNDERSTAND
'IONS. 1
Issued by:
BOUNCE REGU b- to^cam'
Re -roofs 506
— GAS TEST
sgnasare ornppl;am Co.tr nr Date
IIAZARDOUS h1 ALS IyISCLOSURE
Will the appfi„+m or«mor building occtp:int eom or handle nn.:nzmas mancrial
Type of Roof 507
— FINAL PLUMBING
a, defines try the apeman nwni<ipal c„Je, cnapmr 9.12, ane nee ue.hh and Surety.
Cale. Section 25532(.)'
0\'e,
All roofs shal 8
— I Irl �� �^p
s ec QjI,I��}�(��jOT'td h Afih1'fi1 6rial being instilled.
Will the applicant or future M1uiliing,ccupant trm equipment or d,ouss which
If a roof is ins CU
wlt Ul'I1TS�o I n Inspection, I agree to remove'
-mit huznmaua air mmnminanna m define) by the Day Area Air Orality Management
'oion,t'
all new matere`tf A%r
TnsFe�tl� LAFi i Pistands and will comply with
1 'o
OYea
all non -point 5Qr4e
Pegd1aT..iNAL PUBLIC WORKS
1 lime mad the hazardous materials mquiremenav under Chapter 6.95 of the
Cullfomin Hutllh h Suleny Cute. Section, 25505, 25533 and 25534. I anJentand thm
.
if the building Joe, nm vamently hove . senator. that it is my mspnnsihility in notify the
-
omcupant of the requirements which must be met prior no issuance of a Cenificam of
Oce I,.
y¢y�. . 2D -0
b
Signature of Applicant
Date
"B”
awtf roe`ma Date
All roof coverings to be Class or better
and