The URL can be used to link to this page

02050106 OF CI BUILDING DINOVIISSIIONPERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT N0. 21265 STEVENS CREEK BLVD MENEMSHA DEVELOPMENT GROUP 02050106 OWNER'S NAME: APPLICATION SUB DATE 3TONESON DEVELOPMENT CORP THE 525 S . DOUGLAS ST. 05/17/2002 PHONE: SANITARY NO. CONTROL NO. o (310) 343-3430 ul O O ARCHITEC(ENGINEER: BUILDING PERMIT INFO U BLDG ELECT PLUMB MECH z Sy i LICENSED CONTRACTOR'S DECLARATION y I healthy Rirro that 1 Am licensed under Job Description Q Z—o Y o provisions of Chapter 9(commencing P F:Cw with Section]IX)0)ofDivision Jofthe Business anJProfessiomCode.and mylicense TENANT IMPROVEMENT a sem; ,in roll torte an efkc,. c �S wce At License Lic.p 3 A. Da¢�. Commno� ARCHITECTS DECLARAT ON f=to O g 1 understand my plans shall be used m public records tcu i p p Licensed Profewimml ore OWNER-BUILDER DECLARATION I hereby affirm Na,1 am eump,from me Contractor's License Law for the C?G follnwiri reason.(Section 7031.5.Business and Professions CWc:Any city or county $85000 O Y x D which requires a permit to construct,altar,improve,demolish,or repair any structure. ou pronto its issuance.Alan Acquires,neapplicant for such Permiuo fileasigr¢d mo mem. - tMfAe:isAlicented paciamna to the Provisional ofthe Contractor'sLicense Law(Chapter 9 r• Irl p, Or,y�ea- Valuation (commeocing.,what Station Division 3of,hA Business and Prefrin,Cale) CCIl's)32. 6)3_. C#,�!-/IZ?s �,2�I1 or mat he is exempt,tiirefr6m nW rhe basis rnr,he all�geE ciemptipn.Any violmion of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty - of no,mom than five hundred dollars(5500) 101 APNPbTftATION Occupancy Type 01,as owner of the propeny,or my employees with aagcs a,their sole compensation, will do,he work.And the aracture'i'not intended or offered-for sal,(See.70 ,' --- 'Business and Professions Code:The Contractor's License Law dues not apply,o an 103 - UFER Required Inspections owner of property Who builds or improvesthereon,and who does such walk himself or hroai his awn empmye«.provided that oath improvements am not intended nr 104 - REBAR ' -offired for-iali.-If.Bbwcbei:t&building or impmvemem is sold Within one year or.... -- --- -.._ ._. - .-- _,'.— . ___.--. _ _, ,11_1.1 ,_-_. _,_. completion,the owner-huilder will have me burden of proving that he did not build or 105 - ANCHOR BOLTS r improve fainin or,ufawef. 1.06 - _ SEWER & WATER 01,as owner,of the p(See.7 am eulusively comracting with licensed contractors m -__- 202 = UNDERFLOOR' PLUMBING__... . ---- ---------___.._ . . icens consumer awproject(see.no�nowneroand Pmr«amissendo:)The camm<mra 203 - UNDERFLOOR MECHANICAL - License Law dace no,apply m an owner of pmpcny who builds or improves merwn, ' 1 ,.andi contracn.for such projects with a camracmr(s)Iiceased.pursuam m.me. . ' - Cotramor,LiceneLaw, 204-- UNDERFLOOR- FRAME___ --- - ❑IamexemptunderScd ,flffiPCfor this mamn 205 - UNDERFLOOR INSULATION Ow.l - 'Dare 301 - ROUGH PLUMBING WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER I hereby affirm under penalty ofyerjury,one anhe following declamdons: 303 - ROUGH MECHANICAL 1. ° 1 have and will maintain a Cori of Consent to a<If-insum for workers 3 04 - ROUGH ELECTRICAL Compensation. as provided for by Section 37011 of ,he Labor Cade, for the perfmmmtee of,hc work for which this .oil is issued. 305 — FRAME �I 1 have and will maimain.Worker's Compensmom Ironical as required by Section 306 - HOLDOWNS 9700 or the LaborCoad,our the performance of the work fm which this Permit is 307 - INSULATION ism d My Workers Compensation niton Insurance career and Policy number art - c (1t�T$1�6pkY�Pa1<yNn'4�1 �4q 'i 308 , SHEETROCK;.; ..." fCERTIFICATION OF EXEMPTION FROM WQRKERS'•• '�.% r 3�Q 9' L�' 'COMPENSATION INSURANCE .1. "' c BXTER'IOR-L'ATH �• _ _. ___ -. - ..._..__.....__.....__..--....._- ..-. _ _3"1-0"=-:INT — (5100)oT Iessbdiva need no,be emnpleted it the permit is for one hundred dollars 311 - SCRATCH COAT ' 'zee try n.,'a.dot'pei f1n lk fillbi lak Permit is soned,I 1 111 - - 31'3.:"--'ROOF—NAIL Compensation Laws of Culifi na. �-�- - - � - - nal) ply Any PeAbecnm .object, mestiver 501 - FINAL ELECTRICAL 'ENERGY .Date Applicant -__ . - _ 502- - -FINAL PLUMBING ENERGY.— .. . NO110E10APPLICANTU.after making this Ceniisme of Exemption.you should 503 - FINAL MECHANICAL ENERGY hcMm mabjec,m the Worker s Comirima,ion provisions arms,Labor Code,you mus, Z C B_ _ __ _mmplywim.narnprovismnaarmia__. _ abed meamvaked. _504 -_ _FINAL BUILDING- ENERGY_. a;> "CONS1RUCTION LENDING AGENCY 505 - FINAL ELECTRICAL " Y gag Y he performance' 't ' nfthe workfor wnchtth that 'r i«ued(se d ear tor, _ 506 _ - GAS TEST _ n 9] CI C) 0. LenderI Name - - - '- AJJ 507 FINAL PLUMBING 0 U p 1< riymtina.<readmaApplication m1 stmeffimthe move' rrmuants 508 - FINAL MECHANICAL " cT. F toner, 1 g t comply,vmall city and ar trod dstatei relating 509 - FINAL GRADE C [) 1.bit shag conswnion and heresy authorircrepresentatives of this wre sc ,o enter upon p. heAbov<-m<nth,ned,propertyforinspectionpurposes. 510 - FINAL PLANNING (µ 1 geeioa c u ann'Iyandk ph' I.'theCty (C p nmoogama rn liabilities.judgments.< r d urn ., anY y .,At.,said 514 - FINAL UB C WORKS V Z C'ry eq are of i of tht p , �. �' .\PI f!ICAYT NU✓' I ND\\'ILL COMPLY WITH A11�n�'PO UT ISSUfd by: Date U ten of!\Pp n no Date ' Re roofs HAZARDOUS antor andling 6, LS DISCLOSURE willtheapplicant 1 , iCod <p ,t.mrtnrl nth health Ad Safety .,,..Type-0f Roof as def ed by the Cupertin Municipal Cud Ch pt r 9,12.a J the Health Ad Safety - - •- --- Cad Sat 25532(a)? r \ti At I ,_ s i, s I :r�',1.fit S• , ❑v a t '. �!"° ' - '" _ All roofs.shall be inspected prior to any rooting material being installed. ..- . w 11 m ppr , future eFinding lp , q p I r a m hien If a roof is installed without first obtaining an inspection', I agree tolremove nth aM arcont manams defined by theBay \ Quality M ,mem at tall new materials for inspection. Applicant understands and will comply with ❑Ye XN all non-point source regulations.; 1 have lead the hazardous areri:ds requ'renens tinder Chapter 6.95 of the Cilifomia Health&Safety C carrion,25505.25533 and 8534.1 undminam that ifmp bnilJing Ams nut a huviamnan,,that it is my respo mnatify the - - -' - - - - - - - - acupam of wh'mh mu.a h mc,prior m ismA?.or a far c of Occupant' Signature of Applicant Date 0wnermAmnori.edA<nt „e All roof coverings to be Class "B'• or better - . - - - - - OFFICE -- - - - CITY OF CUPS I�INO CITY OF CUPERTINO PERMIT APPLICATION FORM �r r e-�0 l APN # Z ,Z7 c> r , Date: Building Address: Z-(2.. 65 9�evmis Cveek' C91jd ¢ 230 ' Owner's Name: S�Oneson teveldamml 0 9p Phone #: CIS- 966-- 11 7k Contractor: r7-, �� n ! o �r ��r,� �e License #: D 6 3 Contact: Phone #: Applicant/Contractor- Fax #: 7A - Q Y I-6 BCONSTAXBQ uil g Permit Info: BUILDING i Bld g 'L D 5' D G (Elect /Plumb Mech J escription: Residential: T&— nan n'1 rove WW,ti f Commercial: Sq.Ft_ Floor Area: n #1? S /Sq.Ft.: w I ELECTRICAL Archit ct/En eer: p'ir,',, Elec 600V > 1000A Valuation: -o BELEC200 Elec Svcs 600V <— 200A Type of Construction: Occupancy Gro 4- Energy BUILDING Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC 1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <— 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING 13INVESTIGA Investigation fee BUILDING BMITIGATC Comm-Housing Mt. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi - Family Res MECHANICAL BNEWMULTI New Multi-family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCONE\1M New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING #- q- cRr o� CUPEQN0 uITY OF CUPERTINO v � °� / " ,/ PERMIT APPLICATION FORM APN #� Fee ID Fee Description Fee Group Building Address: Utzs BAPPLOTHER Other Appliances MECHANICAL Owner's Name: .tJ AaA tofll 6b1A 14W Phone #: k16 (0;5 17 Contractor: BBOILERI License #: MECHANICAL I -0 fist BBOILER2 Boiler> 100K to 500K Btu MECHANICAL Contact: BBOILER3 Phone #: MECHANICAL Applicant/Contractor: BBOILER4 Fax #: MECHANICAL B ding Permit Info: BBOILER5 Boiler> 1.75M Btu MECHANICAL B dg Elect Plumb Mec BUILDING ascription: Residential: BCONSTAX Commercial: BUILDING Sq.Ft. Floor Areal � $lSq.Ft.: BUILDING Archi ectlEngineer: L, Valuation: BUILDING I e247 402 5le A- _ Zoor Mo. M Type of onstra tion. Occupancy Group: Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A nand Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/OXComin/ uasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL 1 BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENS Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mt. Fee BUILDING � i 8 3s-n 1 of 3 4f E- I .Sr, F`r i �oa gm ti 4 a N Z o��o aaad &0 a U 0 �ao� yya} 0 a — y ri 3 in az I a�A v.0 „OU 7' CITY OF BUILDING DVAS ONvo PIES �' CONTRACTOR INFORM, DN: BUILDING ADDRESS: _ PERMIT NO. 21265 STEVENS CREEK BLVD -• TCT TITAN CONSTRACTING TE 02070178 OWNER'S NAME: APPLICATION SUB DATE STONESON DEVELOPMENT CORP THE 12684 HOOVER ST. 07/29/2002 PHONE: (714)890 -6655 SANITARY NO. CONTROL NO, ARCHITECrlENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 1 ' 1 U L:-,-j LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm diet I am licensed under provisions of Chapter 9 (commencing With Section 7NO) of Division 3 ofthe Business and Professions Code, and my license REVISION - -IN HOUSE USE ONLY is liin full fame andeffCet• Lie.a ORIGINAL ##02050106 Date Contractor ARCH1TECf S DECLARATION I understand my plans shall be used as public records Licensed Professional . OWNER - BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5. Business and Professions Cade: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure priorm its issaanre, also requires the applicant forsuch permitin file asigned statement . - , S.q. F,t. Floor Area : , , ; .., a uation thaLhj it;licensed pursuant t the provisions of the Contractors License Law (Chapter 9 (commencing ivith.Sectivn;000 },af Division 3 of the 8usiaessand Professions Code) or [bailie is exempt therefrom and the basis for the al e#d.eFempticti. Aay violation -of Section-703 {S by any applicant fora permit subjects theapplicent to a civil penalty- ofnoLmore than five hundred dollars ($500). umber - , Occupancy Type ❑ f, as owner of the property, ur my employees with wages as their sole compensation, - --will do-the-work, and the smscturer is not intended or offemd -for sale (Sec: 7044, ' Buiipess and'Professioas Code; The Contractors License Law does not apply to an - ""• -'• - -- -- - --- -- - - - — - -- 10 2 - PIERS Required Inspections' '• • ' "� f owner of property Who builds or improves thereon, and who does such work himself or through his own employees. provided that such improvements are not intended or 1 O 3 — UFER olFete'dFoi sale: if, however, tie building or improverrient is sold within aid year of 'cotnpletlon, the owner - builder will have the burden of proving Ihar he did not build or '- t , . r "-- " " "- - - " ""• 104'- REBAR '^ improve for purpose of sale.). 105 - ANCHOR BOLTS . owner. oft heproperty, amexclusivelycontractingwithlicensedcontrac torsi TO'6` _- SEWER &'WATER �l :- •' " .. '�[. construct the project (Sec. 7044, Business and Professions Code:) The Contractors License Law does not apply to an owner of property who builds or improves thereon, 202 — UNDERFLOOR PLUMBING ' — anQ_who•conlracts for such.projeets with a contmcror(S),licensed pursuant to the Contractor's License Law. _.. _. _....2 0 3 _ UNDEFtFL[OOR- MECHANIGAL _._ ... .... ..........,_......_.___.._ ... _ ❑ I am exempt upder Sec, B & P C for this reason ' .,m .., „ .., 204 - UNDERFLOOR' `FkAME' owner 'r "Date ' 205 - UNDERFLOOR INSULATION - WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING I hereby affirm under penalty of perjury one of the following declarations: 3 02 — TUB & OR SHOWER ❑ 1 haSe'iM will maintain a Ctettificaie of Consent to self -insure for workers 3 03 -- ROUGH MECHANICAL Compensation, as provided for by - Section 3700 of the Labor Code. for-the perfdm once or me Work for which this pemrit is issued. 304 - ROUGH ELECTRICAL ❑ I have'andwill mainiain Workers Co'mpensariori,Insurance asrequired by Section 3 05 — FRAME -3700 of the labor Code, for the performance of the work: for which this perodr is , . rssucd. My Workers Comperi §anon [nsuranre camtt'and Policy nuns ' "` 3 0 6 - HOEDOWNS e; i. }, ; r,. ....., �Pol icy 'No:• _, _ - _ 4'i.,i12;r.:,i4'' CERTITICATION OFE7tEMPTION FAOM,WORKERS';? .. � '- 3 O 8,. '- �''- SHEETROCK° ' ' COMPENSATION INSURwNCE•i' °, � • �� ,. 3 0 9 ' :' XTER'rOR' LATH "' `• r ' - nebd not be'completed'ifthe permit is for one hundred dollars ( or less.} E1110 . — y 310 INTERIOR LATH .['s, ct'a r,. .. . ... r 1. . in performancea ti'.... rw' . �.. _ - -- 1 -- - 3- 1 -' SCRATCH ;C4 T„ . -'.:: :. __.. -. (,._• .:.. SIMIT P � .' P�• Yrx Y s '' as`mf be omehsub'est to the Workers' 313 - ROOF NAI`Ti-° h Cooiniat at on Laws of alifor° m Ciamaenner lasab;ecr - -- - - - - -5 01 . - -- .FINAL.• ELECTR I CAL .: ENERGY . - . - -- - - - - - • -• -- •- MICE NT: If, after making this Certificate of Exemption, yeti should ti to the with Workers Compensation provisions of the Labor Code, you must 502 - FINAL PLUMBING ENERGY f llwh comely such provisions or this permit shall be deemed revoked. ....___.- ...,.. ,. -... 5.03..- ..FINAL.....MECHANICAL-- ..__ -. _.... =•:' "r rcoNSrxlrrnONLENDINGAUENCY 504 — FINAL BUILDING ENERGY Ihrreby affirm that there is a coasimction lending agency for the perfdrmante of the work for which this peril[ is issued (Sec. 3097, Civ. C:) - • 505 — FINAL ELECTRICAL •�- Lender a Name - � � � Lender's'Address_ - _ � __ 5 0 6 - GAS TEST .: y - 1 certify that I have read this application and state [bat the above lrforntation is 50 7 -- FINAL PLUMBING' `c6rrcn1;3 agree, to• con r piy with all ciry -arid county, ordinances and state laws relating [o building comtructien, and hereby authorfxe representatives of this city 10 enter upon 50 8 - FINAL MECHANICAL the above- mentioned property for inspection purposes. '(Wa)'agtee ta'save, indemnify and keep harmless the City'af Cdpeninb against 50 9 - FINAL GRADE liabilities,.judgmentsr costs and expenses whiclt may in any way attic against said City inconsequence of die granting of thispermit. ' "' 510 - FINAL ING f �� • � IPPI;ICAIT . UND8RSTANDS AND WILL COMPLY WFM AEC' `- &- POI4T' SOtRCi REGL'LATIOtiS.., 514 F NA WORKS Issued by: D Signs tuie;ofApplieant/Cnntractur Die'": Re -roofs HAZARDOUS MATERIALS'DISCLOSURE; . ' [tic zpplican[ or FutuigbuiTdinaoccu 5nf score anhsadle baiudous mai idol o P Type of Roof. - as defined _ the Cupe[tino Municipal,Code. Chapter 9.12, and the Health and Safety Code S_lmri 25532(x) ?,, - .. ".: i E=7 yes �''" '. :;:, QIVo:.' �: t�,•.. Q i All 'shall be ilispected.prior.to.any,roofrng material.beino .Will the applicant or future building occupant use equipment or devices which If a roof is installed' without first obtaining an inspeeti6 i;'I` agree to remove emit hazardous air coniaminartts as defined by the Say Area Air Quality Management O(auict? all new materials for inspection. A_ pplicant understands and will comply. with Dyes - ❑Na . all non- point'SOiirce regulations. ` I have read'ncc haiarifoug -materials requirements under Chapter 6.95 of the •Califtiroii Health & Safety Code, Sections 25505.25533 and 25534. 1 understand that if ebuildingdges notcurrendyhnveatenant.•that it is my responsibility to ua[ifylhe occupant of die requirements which must be met prior [o issuance of a Certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class "B" or better owner or authorizedspent.. Dale stUM I O n�IONN PERM CONTRACTOR INFORMA N: BUILDING ADDRESS: PMMrr NO. 21265 STEVENS CREEK BLVD MENEMSHA DEVELOPMENT GROUP 02050106 OWNER'S NAME: STONESON DEVELOPMENT CORP THE 525 S. DOUGLAS ST. PHONE: (3 10) 343 -3430 VnOa z ARCHITECIIENGINEER: . I-; seas LI a W �a" y z LICENSED CONTRACTOR'S DECLARATION OZ , '- I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busiucss and Professions Code, and my license a g is in full farce a effect a ¢ License o Lic. a t� 3 u Date o Contraetar 0. [- o ARCH CfECT S DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER•BUILDER DECLARATION y I hereby affirm (hat I am exempt From the Contractors License Law for the F z C following reason. (Section 70315, Business and Professions Code. Any city or county x [a which requires a permit to construct alter, improve, demolish, or repair any structum ° prior to its issuance, alsorequires the applicant for such pennit to rile asigncd statement that heiS.liccnscd pvrstt7stgiq the provisions of the Con[racices License Law (Chapter9 (eonirrieacin jwith Section 7000) of Division 3 of the Business and Professions Cod" or that he is exemptlherefrom and the basis for the allege4 exemption. Any violation --of Section 70315 by any applicant for a pennit subjects the applicant to a civil penalty - of not mare than five hundred dotlars (5500). ❑ 1, as owner of the property, ur my employe" with wages as their sale compensation, - will der the work, and the structure is- not intended or offered for salc'(Sec', 7044, Business and professions Code: The Contractor's License Law does not apply to an owner of property Who builds or irnernves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered foe sale. If. however, the buitding at idprovement is sold within ode year of eamplction, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ 1, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7&W. Business and Professions Code:) Tho Contractor's License Law does riot apply to an owner of property who builds or improves thereon, and who contracts for such projects with o contractor(s) lirxnsed pursuant te.lhe. Contractors License Law. • Q f am exempt under See. , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compensation• as provided for by Section 3700 of the Labor Code, For the performance of the work for which this permit is issued �rI have and will maintain Worker's Compensation Insurance, as required by Section '37DO of the Labor Code, for the performance or the work for which this permit is issued. My Workers Compensation Insurance cagier and PP,oliic�cy number are: + `- Cartier ti �Pbliey Na,: II )C4r tJ'{��01 N 14 CERTIFICATION OF EXEMPTION FROM WORKER$' COMPENSATION INSURANCE (This section need not be tampleted if the pennit is for one hundred dollars (SI00) or less.) I certify that in the performance of (he work for which this permit is issued, I i shall not employ any person in any mariner so as to became subject to the Workers' Compensation taws or California. Date j Applicant NOTICE TO APPLICANT: Ff. after making this Certificate of Exemptlon. you should become subject to the Worker's Compensation provisions of the Labor Code, you must 0 t forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm than there is a construcmion lending agency for the performance > of the work for which Ibis permit is issued (Sec. 3097, Civ. C.) C4 A Lender's Name - Z Lender's Address V 0. I certify that 1 have read this application and state that the above information is �+ P: correct 1 agree to comply with all city and county ordinances and state laws relating 0 L) to building construction, and hereby authorize representatives of this city [o enter upon >. 9 the above - mentioned property for inspcctian purposes. E-t .r (We) oeree to save, indemnify and'Icetp hartaIcs5 the City or'Cuperdno against rr C12 liabilities, judgments, costa and ex ses which may fn any way accrue against said -g,.) Z a City in consequence of ti of this permit y�T ~ AsPPL1CAl�w _ND WILL CONIPLY WITH ALf�+' i01 " 1 igngu—re of AppLj ,SntlContfactor Date , HAZARDOUS MATERIALS DISCLOSURE Will die applicant or future building Occupant stare or handle hazardow material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Cade, Section 255321 #? - ❑ YesNo i Will the applicant or future building occupant use equipment or devices which Milt hazardous air contaminants as defined by the Bay Area Air Quality Monagemen . District? - m ❑ Yes. 4) No 1 have read the hazardous aterials requirements under Chapter 6.95 of the California He'a ectiens 25505, ?5533 and 2553 4. ]understand that if the buildinave a tenant, that it is my respo ' ' [o notify the occupant of ch must be met prior to issuance of a iris a of Occupant' ' Owner or authorized a_ent a APPLICATION SUB DATE 05/17/2002 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description TENANT IMPROVEMENT $85000 101 ` PNib�ATI ON 103 - UFER Required Inspections ' 104 -- REBAR _ 105 - ANCHOR BOLTS 106 - SEWER & WATER 202'_ UNDERFLOOR' PLUMBING - " - 203 - UNDERFLOOR MECHANICAL 204-- UNDERFLOOR FRAME -- - • - - 205 - UNDERFLOOR INSULATION 301 - ROUGH PLUMBING 302 - TUB & OR SHOWER 303 - ROUGH MECHANICAL 304 - ROUGH ELECTRICAL 305 - FRAME 306 - HOLDOWNS 307 - INSULATION - 30.8- ;-- ;-- SHEETROCK ' 3 0 9 - EXTERI'OR `' LATH 3Z0' INTERIOR -LATH 311 - SCRATCH COAT 31.3• -- -ROOF- -NAIL — 501 •- FINAL ELECTRICAL-ENERGY 502 -FINAL PLUMBING ENERGY. 503 — FINAL MECHANICAL ENERGY _504 — FINAL BUILDING ENERGY-_ 505 — FINAL ELECTRICAL 506 — GAS TEST 507 FINAL PLUMBING 508 — FINAL MECHANICAL 509 — FINAL GRADE 510 — FINAL PLANNING 514 — FINAL PUBIsTC WORKS Valuation Type Issued by: Date Re -roofs ..Type of Roof All roofs shall be inspected prior to any roofing. material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Applicant understands and will comply with all non -point source regulations. Signature of Applicant Date All roof coverings to be Class "B" or better OFFICE