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CONTRACTOR INFORMATION:
BUILDING DPvtsalONPERMIT
BUILDING ADDRESS:
PERMIT NO.
20400 STEVENS CREEK BLVD
SOUTHBAY CONSTRUCTION CC
INC 01110068
OWNER'S NAME:
MORGAN STANLEY ORD FL.BLDG
) 511 DIVISION STREET
APPLICATION SUB DATE
11/14/2001
PHONE :
(408)379-0400
SANITARY N0. CONTROL NO.
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ARCHITF.CTIENGINEER:
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
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I hereby affirm that I am licensed antler pmvisions of Chapter 9lcommencing
with5mion]Uq)ofDivision3oflhcBusincasandPmfessimsC°de.andmyliccnu
TENANT IMPROVEMENT.
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is in full force and effect.
A Lie. is bei%
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c.hU,
Liccna Clas<
Da¢_I\��
O
AR 5DECLor�
DECLARATION
g
hall be
I unaeratand my plans shall he axe as public rcrnrdz
p!O
Littnud Prol<ssinnal
DECLARATION
that I aBUILDER
1 hereby affirm the 11. exempt from the Contrns License Law for the
? a
following reason. ?031.5, Co Any city st rounty
oy
and Prowe.
$ 3 3 0 0 0 0
❑
=a
d moll h. or
which Permit to construct. alter, improveh or repair any
- -- - - - ------------------ - ---
3 m
tmemsere
itsissaae. also reuis11healar,
Permits
issuance. also requires theappllcamfm suchperm,, La.dawtemem
pyt�'aS� ibroa q y 2
j�3 CIY��(7 Z"i7r. ,l7�Cl-,f
Valuation
taormsscensed of the C.the Butime License Law
License
the he is Wit Far suatn to the pof Division Husideaaand Pon. Code)
a Code)
ingwiapt lad
Nm,
An, violation
he basis the . Any i
.,,hot be is esempi thEefmm and the
.,,hot a theforain fur the alleged ueicant pen lty
.,_Ii;�l'f
gels
t l
of Section 703 n iv any applicant fora pe(r)il subjects Inc applicant m a civil penalty'
wrnm nmR man Bm[ hundred dollars essan,
10 lAPN 4i'(72�P1bAT I ON
Occupancy Type
❑ 1, as owner of th. property, or my employees with xegcs as their sale comlarric lion
will do the work. and the wucwrt is not intended or offered for sale (Site. ]Bbt,
Heiress cad Professions CWe: The Contractor's Liccna[ Law docs not apply to an
103 — UFER Required Inspections' -
mr of pwary Who builds or improver thereon, and who does such work himself
104 — REBAR
flim. n his own employees. provided that such improvements ate not intended or
_ -
offered F, r sale. IC bow[uer. the building or impramcment is sold within one year or
10 5 — ANCHOR BOLTS
improve for purpaseaf.vile)r will have the burden of forcing thin he did not build or
106 — SEWER & WATER
01.asowner at the property, am exclusively contraming with licensed contractors to
202 — UNDERFLOOR PLUMBING - -
construct the project (nce. 7a4. Business and Professions Code,) The Contractors
2 03 — UNDERFLOOR MECHANICAL .'
-
License law does not apply to an owner of properly who builds or improves thereon.
e wbo ismraets.f°r such prwjecls with . commerores) ficemsed.pursuam In the
2 04 — -UNDERFLOOR FRAME —
Contractors Liecom Law. -
❑Iam� �sit�p t Sit ,H&PCfordo, reason
205 — UNDERFLOOR INSULATION
wed; �kx X Dam t\—\y' s
301 — ROUGH PLUMBING
' ' WORK OMPENSATION DECLARATION
302 - TUB & OR SHOWER
I hereby ath,rn under penalty of perjury one of the following declarations:
303 - ROUGH MECHANICAL
❑ 1 have and will m.irunu..a Certificate of Consent In .elf-inwm fwr Workers
3 04 — ROUGH ELECTRICAL
Compensation. as provided for by section 3700 of the Lebo, Code, for the
Performaned of the work for which oris pant, is issued.
3 05 — FRAME
❑ 1 have and will maintain worker's Compensation Insurance, as required by Section
3 06 — HOLDOWNS
3700 of the Labor Code, for the performance of the work for which this permit is
3 07 — INSULATION
issued. My Worker's Compensation Insurance carrier end Policy number are;
_ __ _. -
'camR: aS 6"h,, ORcy'Ne,C) 122.2V
308'.— ,SHEETROCK - ".,W
t }'\• % 1�3�0 f �-EXTERIOR '-LATH
cean�Uir_1-P�VIION FROM WORKER
COMPENSATIONINSURANCE,. '
9'`
_ . _..-310: =,"INTERIOR `LATH
-Miss.) sOksnineed not bccompleted ithe permitisfor one hundred dollars
311 — SCRATCH COAT
Is 100)wr les _
313 — ROOF—NAI_L —. .. _..... —
" I verify that in the performance of Inc work for which this permit is N,ard, 1
'shall not employ any pcaun in any manner Of as m become subject m the.wo,kers•
501 — FINAL ELECTRI CAli 'f'
ENERGY
Compensation lawsnrc,hramn. D"`
A - -
Applicant
502 — FINAL PLUMBING ENERGY
- -
NOTICE TOAPPLICANT. If. miermaking lhis CcnifcateofEmmplion.yoa hould
503 — FINAL MECHANICAL -ENERGY
become subject to the Workers Compensation pmvisions of the Labor Code. you must
C
fieflosith comply with such previsions or this permit shall be deemed revoked.
5.04 — FINAL BUILDING ENERGY .... ....
CONSTRUCTION LENDING AGENCY
505 - FINAL ELECTRICAL "
1 hereby affirm that them is a construction lending agcmy for the pcifomt.
- '
-
506 GAS TEST
ofinewmkforwhichthispermhislswed(seE.309].Gm.c.) .
_
Lender's
507 — FINAL PLUMBING
0
ddress '
Lend -
508 — FINAL MECHANICAL•
1 E.,
1 cenify that 1 have read this application and state that the above information is
otrem.I agree w comply with au,[ity and county ordinances and state laws waiting
509 — FINAL GRADE
1'V
W
mbidding coomedIn.andM1ertbyamnbriRrtpeass.. .esofthiscitylocmc(upon
the above-mentioned pmaddth for y authooa pugnstin
510 — FINAL PLANNING
As
(We)as,mems...: indemnify and keep hannlessthe City ofCiperin..,urst
514 — FINAL PUBIC' WORKS
' V)
liabilities, judgments, costa and expenses which may in any way accmc against said
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City in canuquence of the graining of this permir.
APPI CA t ERST D WILL COMPLY WITH ALL NON POINT'
'
IssuedDate
y
30 t l IT obs t
Signature ,ofAppliwnUCnntorem- - ,Dart
Re -roofs
'.' HAZARDOUS DISCLOSURE
" Will the applicant or boom building occupam mm or handle havadou, material
Type of Roof-
'.
asdefecA by the Cuperino_Municipal Code, Chapter 9.12. and the Health and Safely
.-k , .a._r 1 ', , s•,
Code Section 255321.)? t
C) Yea - ' ''•(.'°
,
r . _ 1
All roofs shall be inspected prior toany roofing, materialbeing installed..
Will the applicant m town building Occupant use equipment or devices which
If a roof is installed without first obtaining an inspection; I agree to remove
mail hourchwa air contaminants m defined by the Bay Arta Air Gustily Management
District? -
all new materials for inspection. Applicant understands and will comply with
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all non -point source regulations.
u
I nam[ Rod the hazardous materials lequimmenls under Chapter 6.95 of the
California Health &Safety Codc: Sections 25505:25533 and 25534. 1 understand that
_ _ -
H the building does not constantly have a tenant. that it is my responsibility to notify the
oCCYp➢nl of the RQYI,em[n15 'len must be mel pea, In ias°vnee nr a GenlfiCalt Or
°co° `i - • -
Signature of Applicant Date
_ _ -
All roof coverings to be Class "B" orbetier '
Owner or aulhwr,ed.,car - Date