00090047 CITY OF CUPERTINO
BUu.nuaG DIVISION PERMIT CONTRACTOR INFORMATION:
IIUII.DING ADDRESS PERMIT NO,
21l S1EVENS CREEK 1 QD DPR CONSTRUIETTONINC 00090047
OWNER'S NAME: APPI.ICNI'[ON SUB DNI 17.
0 Pl4nNc S. TW f i DR 09/11. /2000
PHONE: — __ SANITARY NO. CONTROL NO.
I
ARCHI FEC iENGINEER: BUILDING PERMIT INFO
BOO B /LUE 'ELECT PLUMB M[CH
F NG LICCNS!D CONTRACTOR'S DIiCLARAI'ION _.lob Description
OZ_ 1 hereby uftinr Ihm I um Ikc-ed under prwi,innn of Chal9(eonm¢neing
w lm Scaion700d of Dgivirinn Sof the Btstr,,and 11 t.p..ons CmIc.undn,y license
mea
;shave anddf� TENANT IMPROVEMENT
ee C 6 Lturnur Clues �lJ Lic.p —1
ca O a U Dae Ia 1 k 11 I f_�p(] S DEC A�� .tS_� 10 r1
5L03 a G ARCIIIll be u S .,,obliv TION p j{-` r
� lundmmnd n,y Planx,hallbeused a.public m,aN. ��'I�\II //, fl "-Y .,
w p p I.iemued proe"ionxl L LJ,
(WNI!Rl BUILDL'R 1 Lhe RATION �/ �q�
1 hcmby.(lira that 1 1. cxctnpt Br,n,me Co i...is Code.1.iAny ly.. fur Inc FEB 0 ( (•(/(/
fna,hi reason.perm..,J on s,Il. he, aw11•rnfro,ions , Any sly olcounty
ca
O which mryim,a pcnnit n,cungma,al,cr,in,provr,dcnuli>h.or npair.nny,Imaurc
paartn it,S,uunec.also rectum,ffiv.,licnm lbrsuclh((cerit..file,d,red,mlfnanl
thin he is licensed pan,wmtmIt.pvowiet<of me cnmmctot,l.iccam,1,.(Chapter o Sq. Ft. F r Valuation
(commencing wills Section 70mo of Division 3 of Inc Business and Pmfessimn Code)
or than he is cxempl IheacTrom ami the psis lin the alleged exemption.Any violation 1 1
of Scaion 703).5 n
5 ny any applicant for a Pen;,subject,the applicant to a civil penalty
of not more than live hundred dollars($5001. APN Occupancy Type
°L as owner of the propeny,or my employees with wages i,their sole urmpn„a,iun,
will do the work,ae sunmm
ci,not iare Ird of offered for sale(Sea.7044.
11u,ims'anped Pr..m.nd th.n,n.C,tle:'Ihe cumrtto,,uc.,,,v Law a,re,•am apply loan
uwm - y ' Required Inspections
r„of Pr, nny Who buildse �pm: improves therms,and who doe,such work himwll
agh
his on em,loy, sdded than such inmrove,nenls are not intended or 101. — FOUNDATION
offend for sale.If.Iuw, r.the wilding nimprovement is sold within one year or
completion.the owner-builder will nave the hrdcn (pro,ing that he did no,build or 1.02 — PIERS
improve for purpose of vleL
°La,owneror,ne pmveny,am exclusively enmmning with licensed contractor,to 103 — UFER
aomtmm flue project(sce.'nu4.Bane.,and Pmre„ion.Code.)no Coann emr` 1.04 — REBA R
Licesc Wed does cent tgq,ly to a,owner of property who mild,nr improve,more....,
cent( who,om,meU i..r...d. ...,deet,will,a.m,waefan,) licensee Pttr-ound to he
n. 1,05 — ANCHOR BOLTS
c ,n ,Umn ,e I's..
,nlr71 at under See .]I&PcInfix ma.n., 1.06 — SEWER & WATER
Owner Date 202 — UNDERFLOOR PLUMBING
WORKER'S COMPENSATION DECLARATION
203 — UNDERFLOOR MECHANICAL_
I hereby aflirn,under pe..ahyof perjury nncofthe fullowingdeelmatinns: 204. — UNDERFLOOR FRAME
° 1 have and will maintain it Certificate of Consent to wl6inwn for Worker's
C..tnp.n,adm,, t„ provided for in, Swf m
ni.... 3700 of Lancer Code. for ole 205 UNDERFLOOR INSULATION
,w.I unitnit,of theworkbewrdfli,pemtili,i,nted, 301, — ROUGH PLUMBING
°l have and will in;dmadn Worker'..compensation h,.wrnce.as,equlmd by Seeni — TUB & OR SHOWER
of the Lahr Ctdr
e,tit the perfomance of the work ln iwhich this Penni,i, d,IL2
issued.MyWorker's Cntnpcnration Insurance Caricrand Policy number are 303 — ROUGH MECHANICAL
Carrier.L�Te�eL'—PnreyNo.:b..1), 5 1o7aI_ 04 — ROUGH ELECTRICAL,
CERTIFICATION OF EXEMPT[OFROM WORKERS' �+ _
CUb1PENSATION INSURANCE 305 — FRAME
'Ihi,xeric....mdoa,be conillcted it the lmrtnk is fire one hundred dollar, 306 HOLDOWNS
R I alp m Ic,s.7
1 verify sat in me d..nmanve of the work for which this perms is i...vd.I 307 — INSULATION
,has mel employ any IMm i in any manner it ax to N Iuum hire,to me Workers 308 — SHEETROCN•
Compel,mum Law,of Caldiuma.Date
Applicant 309 — EXTERIOR LATH
NOTICE TO APPLICAN'F.11,rice making this Certificate of Exemption,you should
becumewh,""the Worker'%Cnmpensminn prnvi,ion%of the Lahr Code.you mus, 31,0 — INTERIOR. I ATH
Q p fnnhwi,h comply with such provisions or this Introit shall be deemed mvoked.
z _ 31.1 — SCRATCH COAT
F r✓ CONSIRUC'ITONIJiN DING AGENCY _
oG � herrn, hi,n,matubelei...e„n,n„ct".3097ltCeC.) rn,n,e1•ni,rntattce 313 ROOF NAIL.
of the work N for wnlch nth I,crmit t,.,,aid(Sec.91T)7,civ.C.)
yz Lcodrr,Namv 501 — FINAL ELECTRICAL ENERGY
0 Ic..dvranddns, 502 — FINAL PLUMBING ENERGY
V I mnify man l hate read this ap and
my ordinances
rdi ffint ances a ahvc inaw%%dace i..
e E crew.Eagmemcomply with eucdyandc..u,msenunanenandaatememe, ung 503 — FINAL MECHANICAL ENERGY
O U mhw - _t t db nr m e n „ •,ran: lye , ❑,..
r m
the above-..,of d propertyf ttf 1 ha 504 — FINAL BUII_�yP� hIERGY
r Zl
(We
tag t v f 'fy Isee,h d..-II•Cty fCp t .ktst 1'•�q�/
m 1:b1t its M
„,. redo elrrl.sn ,t in 505 — FINAL_ ELEC R� .
U z eiyL'ANTONn' , v nL �•[+�
�•'•n APPL 'ANT UN It .COME ,Y WITH ALL NON-IY)INr •' - f A����7J
OU - REGU1Issued by: .: G Dale�Signamn of ,e Re-roofs _ATERIA .'DISC1.OSURE508 FINIAL MECHANICAL_wR m, ilding lice ,el ate or handle h:ranwn,material .Type of Roof 504 — FINAL GRADE
as dclined by the Cupcmno Municipal Code.Chpmr 9.12,and the Health and Safety
Code.Section 2$532(x)'1 5 t
ElYc, �1.1� '— Frhplb�l o ,1-1 R�4FlrZ nr,
AlLroofs shall bel spected ppPi to nyy r x mg aterial being installed.Will hi, ”h.,,ttlnrinmtehadmng..c,cehaIuse v,lmousnt..raevice.whidh It'd roof is instal1�c�IwiihouNf�i 66taFi)h1 f�•aktns��IC1iMhSl agree to remove
calif hanrdous air ummn,in:nn, defined by the lby Arca Air Qualhy N1anagenteni '
Owner? - all new materials for inspection. Applicant understands and will comply with
°Ya` °� all non-point source regulations.
1 have read the hunolow,materials rcquinnmmx under Chapter 6.95 of the
'rBfomiu Health k Safety Code.Sections 25505.25533 and 25534.1 understand,hal
rdebuilding doe,ura currcmly have ,.tit lis tnYrc,prm..bilitym unity
cnpan rf the rc rm,w'nlcn w',p n n.'u u.n1v of a Cenill of
ovenpat
I—it,/� Signnturco(Applicant Date
9 All roof coverings to be Class`B”or better
OFFICE