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CITY OF
CONTRACTOR INFORMATION:
ONPERMIT
BUILDING ADDRESS:
PERMIT NO.
1N'NER'S NAh1E:
APPLICATION SUB DATE
SYMANTEC
PIER 9 THE EMBARCADERO
02 14 2002
PHONE:
SANITARY NO. CONTROL NO.
(206)447-7672
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LJ I--1 1:--,1 I_1
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm ,M1at I am licensed under p,orisions of Chapter 9 (commencing
with Section 7") of Division 3 of, he Basin and Pro`csj'' Cade. end lily I cenve
i. mr,9maaadcR 66d 7�
TENANT IMPROVEMENT
LicpnsYLlass Li p
comm 3 6C
CHITECT'S DECFiCRATlO,
�gy �t
FINALE®
I and rdlan my pmna.nan lie asm os raphe rccoma
APR 0 2 2002
Licensed Pma1w.r it
OWNER -BUILDER DECLARATION
-
I hereby affirm ,bat I am exempt from the Can,na..... x License Law for the
following recon. (Section 70315. Busine.vi and Prefes.ians Cale: Any city or county
which requires is permit to construct, eIn, , improve, demolish, or repair any swcum
B U I LD1 NGS 4 0 o o o
__._.._..
primm its issmncaalso¢quheslheappliwm for suchpemd, to Gleasigned smtcmem.
S . Ft. Floor�Area.Y. <;:,
C.i JC�,Aia-
Valuation
chat mixlieEnsd pursuant to the p{otWoms onhe Contractors License Law Khali
(commencing with Sectio7")of Division 3 of the Businessland Prpfaaions Code)
than he ii ffemfrom'nnd the baste for the Any violation
,s d}x,,
3:6i9 010 2 0 : 0 0
or c:empt alleged ai inptio",
-of Scamp 7031.5 by any applicant for a permit subjects ,he applicant m e civil penalty
afoot mare thao five hundred dollars SNO0.
APN Number
� •., Occupancy Type
101 — FOUNDATION
pro,ii > > P Y g acct
°1. as owner of n.ter my cmloms with woes as their sole compensation,
_
- — Re uired Ins ections n ' 'I "
q p , c
will do the work. and the structure is nmrimcnded or offeror for naic (sm. to ar
' Code: The Convenors Low assn not to olf
Pny
Who b
aw . and w work himself
own�Biner of pro
rofpmperiy doesaeantintedor
103 — UFER
n howevem. provided m 'l ra menu are ,m emended or
employesorimprovnatsuch mgamhc
ore for
blrerearor neve. If. howeven the Wilding- .. mens a>oia w min one icor or
at tmvroe
.... _.....,.. -. _ . _ ... ... _-- ....._..-- _
. 104 - -' REBAR . .
the owner -builder will have the burden of proving that he did not build or
105 — ANCHOR BOLTS
itplaian,
mprove for purpose trade.). _
10.6 .-_. SEWER --- &._WATER- ---------'
°fano c cold ap:npcW.lot es,h ivclycontractingwiW'r ensedcodvlto
construct the project (sm. 70 al Business and Professions Coder The Contractor's
202 - UNDERFLOOR PLUMBING „
rT ,.
License Law duet no, apply to an owner of property who)Wildslice old Proves as
2 0 3 - UNDERFLOOR MECHANI CAL
I thm
.and who,wn,acu.for such projec,a with n comrecmr(s) IittnuJ.Puts uam to We
.___ _ _._ ....... _ _
Contractor's License Law.
` "
204 — UNDERFLOOR FRAME ..
❑ 1 nm exempt under See. -' B & P C fonhis reason
1..
205 - UNDERFLOOR INSULATION
owh2t' Date
" WORKER 'SCOMPENSATION DECLARATION
301 - ROUGH PLUMBING
�- Ihereby afnrmunder penalty ofr<rjmryone othe following declarations:
302 — TUB & OR SHOWER
'a
3 03 - ROUGH MECHANICAL
° 1 have and will maintain cenAmm of Consent to self -insure for Walker's
Compensation, as provided far by section 37W of the Labor Code, for the
304 - ROUGH ELECTRICAL
performm¢e of the walk for which Nis permi, is issued.
305 — FRAME
° I have and'wdl'ma idam workers Cumpensdtmn In....... as mgaired by section
3 0 6 - HOEDOWNS
per! rce of the work for which this is
3700 f thembar Cad f th mvnpermit
d Myw keraCompensation insurance ca rtlu and Policy are
307 INSULATION ....... ,.,. ,, -,-
ZQl C PdteyNa LL utl
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3081` LSHEETROCKi':?'\•
{ICER'IFICATION OFC%EMPTRSN PROM WORKERS
coMPENsnnoNINSURANCE
,
.____.....309..._ ..EXTERIOR._LATH__:._..__
1 (Tri s'sectio'm need nm be completed if the Permit is for one hundred doll.
310' - 7I'NTERI OR LATH'-
($lWjurleaa.), I'
._.....311. - SCRATCH_COAT .:_... _.. _ -
-
c n fy tot h , pert rm lice of the work for which ,h perrmt . -ea i
,
313 - ROOF NAIL
doll hot employ a y lie n in an, manner . vs to hecom bject ra ,he Walenk
Compervaiton laws of California.ate "
501 - FINAL ELECTRICAL ENERGY
.Applicant .. _
NOTICE TO APPLICANT: IL diet making this Cinificam of Exemption, you should
502 - FINAL PLUMBING ENERGY _ ..
become subject o the Worker's Compensation paysions of the labor Cade, you must
503 — FINAL MECHANICAL ENERGY
or with such pmvisinn.v this remit shall be deemed revoked.
fndhwi,h damply pe
__. ...--. --.
504. FINAL BUILDING ENERGY--- ;;, ; ,•_._ _. _. _.
'CONSTRUCTION LENDING' AGENCY'
"t hereby amen that Were is nconsuuchim leading agency for the performance
•'
505 - FINAL ELECTRICAL -
of the work Tar what this rtni, is issued (sec. 3097. civ. C.) ,, . "
LchdassNanm:.'...,,- _ .... ..... ....:............_,_
_. ..506'-- GAS --TEST_ ......_._. _..�..----- --....._..._. .-
I<ddm'sAddless "-" _
507 - FINAL PLUMBING-'
• 1 cleftify that I have mad this application ad shhe that the base information is
508 — FINAL MECHANICAL
6 rrecl. I agree to comply with all city and county ordinances and sum laws milting
I. building consruction, and hereby athoriu'representatives of this city to enter upon
509 — FINAL GRADE
the above-mentioned property for inspection purposes.
(We)dgmem a ... , indemnify and keep hamilcu rhe City of Cupertino against
510 - FINAL PLANNING
liabilities, judgments, costs and expenses which may in any way recent against said
City inconsequence of,he gn ming of permit.
514 F NA P WORKS / ((]'v
APPLICANT UNDERSTAN W COMPLY WITH ALL' 'ON POIsn'
..` ' ..._ 'J
r
IssuedI Date
Y
s / CE REGI( , / �, L
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t ofA IPf nVC l
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Re -roofs
` MATERIALSDISCLOSURE
Will heppTic t teubmhi dimg pant dlalt l I
Type Of Roof _ ... - e•-: c
as def ed by theCupn no Municipal Code. Chapter9 12. lid the Health and Safery
Code
, •, t ••
, Is E l
Section on 255321aj
°Yp4 '"" " ° "�!
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All roofs shall. be ins e.ct_ed prior to a_n roofing _material beim installed. . . __._.
Will the applicant or futurebuilding p nt use equipment or devices which
If a roof is installed without first obtaining an inspection, I agreetoremove
,.it Imitations 6, mmminrmams as defred bythe Bay Am.Ar Qlalty Management
District? `.,
all new materials for inspection. Applicant understands and will comply with
°o .i.".• D"�'
all non -point source regulations',
I have mad the hazard us materials requirements under Chapter 6.95 of the
,Califom d Health & Solely Coda sections 25505, 25533 and 75534: 1 understand that
F bel lel' g does not torte tly have a t a , th t l a my m pons b lny m nauly Ne
cc ni f th'requi c t "ll as, be t p' t he is. a c ofd Ccnific c of i
o6ci
l
°` p°"`y
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Signature of Applicant Date
- -
All roof coverings to be Class "B" or better
„e