03050133 -CITY OF CUPERTINO ,ss X
BUILDING DIVISION PERMIT eC€UN1tACTORINFOXiIVIA.TIQ:N ;
BUILDING ADDRESS: JOHN SUTTI & ASSOC . INC. PERMITNO.03050133
OWNER'S NAME: 500 AIRPORT BLVD. #110 PBy`lIT VM8/2003
E` (650) 343-4244 SANITARY NO. CONTROL NO.
ARCHMICDPI4GINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
300 LICENSED CONTRACTOR'S DECLARATION
U 1 beaby from the,I am licensed under provisions of Chapter 9(commencing Job Description
n� with Sectmn7 f Divi
)oon3ordm Bust essonlZroftenimatiCasin andmyiicensen
❑y Limum an nrceca `�
2 License REVISION-SERVICE COUNTER/CEILING CHANGE Q
$ CI L
Dam c a DELI HOOD AREA
dcnund my plem ehl Mu¢D pub]to me to, ORIG. #02080065/REVISION 403030076
Licensed baraby Professional
3 u
5g03 Oan lam exILDERempt
DECLARATION
ContuON
2 o O I herohy.(Section
11. eaempl from este Gonion Co e:enseAny C Law for IM
C p 0 which r g mason.(Snit t 7 o ones.Business and Pmfeui demolish,
Cale:Any city or county
re
$fii which its
issuance.Permit re cnnswe,a@e Impmw,h Permit t ore pair any umetum
5isn prior Niucensedaimrequites tMvisio of for mchmon'taicense ned Law(Chapter
£ 0 Nmhcisan¢dpmction7r of
the Of
mncmlandPnulawrChapler9 Sq.Ft.Floor Area Valuation
i?
(commencinghaisxe pt therefrom and
of basis for
h the Business and ProfMys Cale)or
y�$ Net he b exempt therefrom and she bub far We alleged exemption.Any violWon of
Section 7031.5 by airy applicant for a pamlh subjects the applicant in a civil penalty of APN Number 006*fty Type
MI mom Nan Rw hundred dollars(M).
❑I,Na moflhepmpeny.mmyemployeawiN MUNeomlecompenuuon,
will do the wort,and the awclYR b not intended or oRereM for We(sec.7044.BuaiM••
and ProfnstOu Cade:The contractors Liana law don out apply a an owner or Required Inspections
property who butIMverimRo es theman,and who doessuchwork himself orthrough his
awn employees,pmvided Net such improvements K not intended OoRered forsate.If. 101 — FOUNDATION
however,Ne building or improvement Is sold within ane year of completion.Ne awner-
builder .will lues the burden of proving thin he did not build or Improve for purpose of 102 - PIERS
a1e')' 103 - UFER
❑1,as Owner of the property.am exclusively contracting wish licensed contractors to
commuct she project(Sec.7044,Baines and Profession Code:)The Com uclor's Lt. 104 — REBAR
came Law does misfit,man owner of property who Wild.or improves Nemon.and, 105 — ANCHOR BOLTS
who contracts for such projects with a contractor(s) m th
clor(s)licensed"mount e Commerce. '
License law. 106 - SEWER Sc WATER
❑ lamesemptunder Sn. .B&IRCrorthbrcaon 202 - UNDERFLOOR PLUMBING
Owner Date 203 UNDERFLOOR MECHANICAL
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one or she following declarations: 204 — UNDERFLOOR FRAME
ew and will maintain a Certlflate of Consent in self-insure for workers Compen. 205 — UNDERFLOOR INSULATION
n,u provided for by Section 3700 of the labor Code,far the performance of the 301 - ROUGH PLUMBING
work for which Nis permit is issued. 302 - TUB & OR SHOWER
❑1 haw and will maintain Workers Compensation Insurance,a required by Section
3700 of tho labor Code,for the Performance ver the wart for which this permit is issued. 303 — ROUGH MECHANICAL
My Woikees Compenu11 lnsunna amu and Policyn mbar aro: 304 — ROUGH ELECTRICAL
Cam . ByN...- 305 - FRAME
ERTTFICATEOFEKEMUROMWORKERS'
. COMPENSATION ANCE 306 - HOLDOWNS
(Tbbsewmncedwtwcompletedif Nefermilisforonehundaddollan(SIWI 307 - INSULATION
orters) 308 - SHEETROCK
I certify than in the performance of the wok for which this Permit is issued.I shill not 309 - EXTERIOR LATH
employ any person in any manner so u N become subject to NN
e Workers'Compensan
lawsof Celifomla.Date 310 - INTERIOR LATH
Applicant
NOTICE TO APPLICANT:If,after making this Cenieate of Exemption,you should 311 - SCRATCH COAT
become subject to the Workeb Compensation provisions of the Labor Cade,you must
7Z forthwith comply with such provisions or this permit shall be damcd revoked. 313 — ROOF NAIL
Z� CONSTRUCTION LENDING AGENCY 501 - FINAL ELECTRICAL ENERGY
I hereby affirm Nat them Is a Conswction lending agency for the permrmanec of 502 - FINAL PLUMBING ENERGY
the rwhich this pennhb97
issued(Sec. Civ.CJ
Landersder's Name 503 - FINAL MECHANICAL ENERGY
31 Q
2W Lenders Address 504 - FINAL BUILDING ENERGY
DZ
I minify that I have road this application and sate that the above information is 505 - FINAL ELECTRICAL
L Fcorrect.I agree to comply with all city and county ordinances and fate laws misting to
U building conswction,and hereby mthoda mpmssnauwt of this city to entel upon Ne — GAS TEST
W above-mentioned property for impaction purposes. 0 FI
(We)fierce to taw,indemnify sad hcp hannlw de City of Cupertino against //nee
tiZ incoiucctencmcna.cosuand ofpouesunit. may inanywy mrnmagainst aidCity I C ICAL
U z inconsegnenceof N.cowsng exthis penses whi Issued by. �7VY
w, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT - 5 Date
SOURCE FOUL ON . _
Re-roofs 514 INAL PUBLIC WORKS
S Appli VConoselor OZ Oate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will
the applicant or(mart building accupant nom of MMIC hvalloes material
as defined by Ne Cupertino Municipal Code,Chapter 9.13,and the Health and Safely
oM,Section 23333(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future wilding Occupant true equipment or devices which 'If a roof is installed without first obtaining an inspection,I agree to remove
baardous air canu annanu a defined by the Bay Area Air Quality Management all new materials for inspection.
❑Ycf u
1 have mad the hvarilms materials myuiremanu under Chapter 6.95 of the Califor.
nia Hcal &SxfcyCodc,Sceuons 25505,25533 and 75534.1 undersand thin if dte building
don not cumene,ham a tenant.that it is my responsibility to nouly Ne occupant of to
rcquiremcnu hich nbemelpnurtossuancearaGerbil, .roe paney. Signature of Applicant Date
owner¢. ori, agent 'Date All roof coverings to be Class"B" or better