01040020 CITY NC DEN
DIVISION
IL PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERM..'NO. 01 040@20
20735 STEVENS CREEK BLVD .
OWNIiR'S NAME: , APPLICATION SUB DATE,
STEVENS CREEK/CUPERTIN1 ASSOCI 04/05/2001
�PIIONC; SANITARY NO, C(1NTR(II.NO. '
pc Z ,\RCIEITCLT/CNGINEr:R: '
BUILDING PERMI'E INTO
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$N l.IccrvMSD colvrRAcmR's DI:c1,nR,vID" Job Description
OZ=p 1 hcrcnv alnnn that I mn lieenmd under Pr..vi,i.nx of ChuPBr 91en1nmmdng •
FmL-J with Smtinn?fAMIEnfDivi.i..n Sof the Bueincss and Vmfavions Gxlc.and myliccnw
oflhuro.reand=ff=et. T -NANT IMPROVEMENT
�lity IJlen.w cla.x r I.ic.a
C: Doc Correa...
ARCHIN be ow us rahiRAT1(lN (''�r p
ne at ; 1 undenrnJ nhY Plan,small he meA us puM1lie'raconh V ///1
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OWNER-BUILDHIt DECLARATION ! v/
ce o m I hereby alnrn that I am exempt fmm the Convwtor's License Law for the l/
1-Z o- Ilmewiny mea...n.(section 7031.5.Brines,Ane Profession,Cale:Any lily n,county
R o .111111 mquha o p+mit u,a0n,1mN6 aha,Improve,demolish,or repair iLay xtrneture
n
3Po prml t 1. np th rrr tl :uhp 'tt fl �.Eal (t...at
hot he is licensedpn. It he Mwvacm,offficContractors lactose L (Cn pm,9 Sq. Ft. FlAVal a i
phone, g wm Sufian 700),I D','m, Jtl'(he 11 -,and lroteestnt Core) Floor Area t ` yb000
ex
or that he is empt therefrom and the bad,for file alleged exemption.Any violation
of Section 7031.5 he any applicant for a permit.abjeas me applicant to a civil Penalty
of no(from(Ilan the hobell d..Bar..cs50n. - APN NumberOccupancy Type
D I,.,.wall ohut
the ppery.or my employees with wager a,their wle reconciliation. 32632054. 0@
.111 do the wod.,.,,,it the structure ix not intended me offer)for all(See YIUJ.
Business and 1) m,d..rrs code:rhe Cr un,m r',Limo.:Law aoa our Appy m an Required Inspections -
owner of pnrpcny Who builds..r improves mere..,and vvnn dros such work himwif 10�, :FOUNDATION
nr mnrgh his own cmployeea,provided that such inhpm cmients are not imperial or i
offered for sale.B.bo.mve.,In,handling I,,Impmvemem i,sold within....c year mf 102 - PIERS
,shortener.the ov.r,tomihkr rill have the burden of proving that be did net build nr
p/y'R,tpumexeor.aw'l' - 103 —{LIFER
ryT.as owner of prpeny.all exclusively contracting with licensed commrmr.r 7.04 - REBAR
�m,vua the Project(Sec.7044,Business cad Prum,,in I,Chep The Counsel-
iau�ml.awdo,,u^lapplytoamowacr..tpe,riv hebuildv..rimpc.mremh. 105 .-' ANCHOR BOLTS
and who contracts for such projects with a amvsmd,)licensed pursuant to the
Cmmoo,ba,LicemrLa. 106 - SEWER R WATER
o l aenpo.i set. .B.9pcb"I'ma.: 202 -( UNDERFLOOR PLUMBING
(1-nilly-,ym e.�U4 ✓Mrensnnorv'DI:cLnannDar
wURRlars co—nvuN 203 — UNDERFLOOR MECHANICAL
I hereby affirm under penalty of perjury on of the td[rving declaration 204- - UNDERFLOOR FRAME
0 1 have and will (maintain a Cenirca(e of C ohaent to seB.imsare Ibr Worker's 205 _ UNDERFLOOR I IVSI ll.-taT T ON
v C'ompemaion, a, p...Wild for by Section 3108 of the IaMh. Coil, for the
perms„oe^nheworkhawhicnlni,pammoi.,umJ. 301 ROUGH PLUMBING
01 have and will maintain Worker's Ciampi Insurance,u,required by Section 302 — IUB & OR SHOWER
:3710..r me Lanor Cale.Ir the performance of the work for%such this permh i, �0 - ROUGH\MECHAN I CRL
issued,My Worker Congvasaien 1p-ranee m
carrier and Policy nub ?er arc: t
Carrier. Policy No.: 304 - ROUGH ELECTRICAL
CERAlIFiCA'1'ION OP EXEM11 FION FROM WORKERS305 - FRAME I, '
COMPCNSGI'ION INSURANCE
his sell alcdnco�c..mplredifihepinnaiishr..obundreddraha, 306 — HOLDOWNS
(SI0(Eorle.a.) 307 - INSULAT'ION
I certify that in the perlbrmanem oI the work lin which his permit is i..,.ed.1 308 — SHEET ROCK
shift nth anploy any Person in any nunner so:u to become subject to the Wallop
C.mpcmation Laws of California.Ilrc 309 - EXTERIOR 'LATH
NOTICE
unl
Nf ylmesTO APPL1cANT.IL aBcnnrsationis Certificate of the Labor ode.y unfold ,310 - INTERIOR (_ATH
becmnes. suply the arch ',G,mpnsuhnnprnvisionts slur ebe,o;nCale.youmaw l i - SCRATCH COAT
Q Q farhwim cnmhply with such provixiuns lit thin permit,Ihnll be 311..7011 revoked.
L f/l
CONSTRUCTION[.ENDINGAGENCY 31.3 - ROOF NAIL
I Imrcby 011 thea Imre is a c wraion leading agency tin the perl'onna in, —
olthe work for which this pepairisissued(See.3097,Civ.C.) 5@1 FINAL' ELECTRICAL ENERGY
Lender's Name,
FJ Z lwodcr'sAddress 502 - FINAL PLUMBING ENERGY
Q Imnifymahlhave readtbixaplibein...ds,all hot meaMxeinformation is 503 - FINAL MECHANICAL ENERGY
;a. P: amm,, I (,mc t qty with'll
F, ty aU 1) 1 c I' late hreng
-� NAL BUILDING ENERGY
0 mbulJg ( tat dh by m.. ,re. (told ,cityt tpn 504 FI
W (W ) b t .. Jh ly Ik ph Ale..theCity l'Cpnymw 505 FINAL ELECTRICAL
he above intentionalproperty f .lval pum,a
(n cost,and pe see,Ilath a>in may a,allue against.said 506 - GAS TESL" /
U 7 City in rar,eyucnce of the granting of this perm..
APPLICANT
UNDERSTATIQ�ANDS AND WILL COMPLY WITH ALL NONPOINT Issued by. 507 _ FINAL PLUMB IN(jate
.'I gnulure orApo pcomraor Uam Re-roofs
l
HArARUUus MALI RIAI.I""'IOSDltli Type 509 — FINAL GRADE
wntheapphra.,of..tam budmpgrccvpmt alto mrhanele nazvmra.mumrial T sof Roof
:n Jelinc:l by mm CupcAno Mainei pal Cmle.cnx"let
9.I2.and the flcahh and Safe'y 510 - FINAL
F'1_AtdNING
Erle,S,,hmm25532(a)? o No
0 Yes All roots shall be inSiLfted-pri6rliNky rb21l19g-i1iQerWPWq installed.
Ail merhpheaotormirebuidio5occal,tal us,mmripanen or dcv ice.wnieh If a roof is installed without first obtaining an inspection, I agree to remove
emit hamrduu,air contaminants as defined by the Bay Area Air Quality Management
District? all new materials for inspection. Applicant understands and will comply with
DYe, C1No all non-point source regulations.
1 have mad the haaurdo o,materials rcyuimmem,under Chapter 6.95 of the
Carlori,Health&Safcry Cmil.See,1,25505,25593 and 25534.1 and...wnd that
if the building Jams not currently have a tenant.(hat's is my re,pm,ibili(y to notify the
cupant of the"aimneme which mot nc met prior to i....moe of o Certificate of
Ocup:umy.
Signature of Applicant Date
reraodher; Agan Dale All roof coverings to be Class"B" or better
OFFICE