03060029 CITY OF CUPERTINO �"` ` �' ' °'
BUILDING DIVISION PERMIT .CONTRACTOR,INFORMATXQN .
BUILDING ADDRESS: RUCTION INC PERMIT Nc03O6OO29
10950 N TANTAU AV
WNEWS NAME: 1450 VETERANS BLV PERMIT195W,I@3/2003
ISER PERMANENTE
'NE:
^^ (650) 4 /4-1450 SANITARY NO. CONTROL NO.
tJ r
ARCHITECr/ENGINBER: _
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
YOO LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that l am Hem. d under provisions of Chapter 9(rnme
mncing Job Description
With Section 70M)of Division 3 of the B/�yness and Professions Code,and my license la REVISION TO PERMIT #,03020072
in full In a effect.
_mom` o:�nfeC co'" r Y ROOF SCREEN, SERVER ROOM AND SEP. OFFICES
ARCHITECTS LARATION
sy7
ImqMd. pi public ommis
3Q,s e.
Licensed sf ionel
0 -BUILDER DECLARATION
I hereby.(Sect that 11. exempt from m,Cssion C's License Law for the J S
o o (allowing remora.(Salon]1noure Business and are,der 11 Code:Any city or County
r.. - C
$� which its sam•permit re cumtmcs,filer,Improve,h Permit t or epaigairy,mmon,
groprior to itsitated pu=AnLgo the ProvisiosOfcant for mchpermi'mrimasigmdatatemcnt
< ihnhcincingwiffi tion" )ofDiviion3af ftButm ,Li¢orenin CNp¢r9 Sq.Ft. Floor Area Valuation
a�es IZ he I.e xem it Scetirom and on basis
allege exemption.
An irons Cndc)or x'83
$ Net Section
u exempt therefrom and the buts for be cts the eumpnt to Any violation of
.I. 7031.6 five
any red dant for(a permit subjects he applicant m e civil penalty of ppj�j�j her Occupancy Type
not mom man raw hundrtd dollen(a500). 3 16 O 9 O�6 . 0 0
❑I.a owner of the property,ser my employees with wages u heir anon eompensadon,
will the the work and that,structure is natmounted or opened for We(so.70",Business dIDS Inspections
and Prefew ons Code:The Con. ro
arYm s Umnse Law doe,not apply an Owner or 101 — FOUNDAp���iVe P -
propenywhoWild,or(mpmvea heresen,and who dmes,uch work himselfm warough his
102 — PIERS
own employee+,provided that such improvements art not intended orogen d fm We.Ir,
however.he building or improvement is sold within one year of completion,he owner. 103 — UFER
builder will Mw he burden of proving hat M did not build or Improve far purpose of
,ale.). 104 - REBAR
01,as owner of the property,am exclusively contracting with licensed eunimcton to 105 - ANCHOR BOLTS
construct Res,pos"i(Sec.7044,Business and Professions Code:)The Commutes U- 106 - SEWER & WATER
cone,few does not apply in an owner of property who Hailes or impmm the con,and,
who Contractsfofor projects with a comntrrlicensed nsed pursuant m he Contractor's 202 - UNDERFLOOR PLUMBING
License law.
O taro exempt antler See. .B A PC for this reason 203 - UNDERFLOOR MECHANICAL
He Deo 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
I hereby afRm ender pemlty of perjury are of the following declarations: 301 — ROUGH PLUMBING
O llaswandwlllmainod aCe rinwof Cortuntmulf-insumfor Wor es Compen- 3O2 — TUB & OR SHOWER
inion,as provided for by Section 3700 of he Labor Cod,.for he performance of de
work for which his Permit is issued. 303 — ROUGH MECHANICAL
❑I hoe and will maintain Worked Compensation[me==,as required by Section 304 — ROUGH ELECTRICAL
37M of me labor Code.for he peeormana Of me,wart(or whim this permit I.issued. 305 — FRAME
Mj)�Workers CompcmWOn iwnrce atr�,�and Poliry number tie:
ca>tiy/Uwter6 FsaNfa+s•/PA P,1�ry Nn.:�o8c�y3 306 - HOLDOWNS
✓/ ceRTIrTCOMPENSATIONINPRANCE ERs• 307 - INSULATION
COMPENSATION INSURANCE
(This section recd not be comfleedifthe Permit is forms,hundred dollars(SIM) 308 - SHEETROCK
mien.) 309 - EXTERIOR LATH
I Certify that in the performance of he work for which this permit I,issued.(aiull not 310 — INTERIOR LATH
employ my person inmyConnor anasinbecome subject mthe worker:Compensation
311 - SCRATCH COAT
Laws of California.Dam
Applicant 313 - ROOF NAIL
NOTICE,TO APPLICANT:IL after making his Certificate of Exemption,you should
become subject o he Worker's Compensation provisions of the labor Code,you must 501 - FINAL ELECTRICAL ENERGY
.7. 0foMwithcomplywith such provisions orhisPermit mail Mdeemedrooked. SO2 — FINAL PLUMBING ENERGY
Z s CONSreisaco NLEN01NGA0ENCY 503 - FINAL MECHANICAL ENERGY
[.+ Thur which thi sen demissued(See,3 lending agency for de performan¢of
C> mewekmrwbmnhlepermiusissuca(Sm.7097,Civ.C.) 504 - FINAL BUILDING ENERGY
W 4j Undoes 505' - FINAL ELECTRICAL
Z)z L,nder'a Addmas —
U O 1 certify that I have mW hi,application and stsm Nat me above informal]..i, 506 GAS TEST
(y Fcoven.I agree to comply with all city and county ordinances and state laws mlating m 5 — FINAL PLUMBING
V building eomWNOn,and hereby ammonite mprtaemstim of this city m enter Open he
above-mentionrA property for inspection purpmes, O8 FIN MEC CAL
(We)agree m save,indemnify and keep barmkv he City of CuPc.ino against
9&F
FIN N
IA liabilities,judgments,costs and eapmves which may in any way scene against said City
V 7 in consequence of the grunting of his Permit. 51
F7 APPLICANT UND RSTA S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR R LA
(a I'S`03 Re-roofs
Si num Of Ap ie n cmr Dam
H DOUS MATERIALS DISCLOSURE Type of Roof
Wil pplicam or future building occupant stem mlundlchuallous materiel
as defined by he Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
.ode.See'.n 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use qulpmenl or mrvims which If a roof is installed without first obtaining an inspection,l agree to remove
Crab hazardous air contaminants as dennW by the Bay Amo Air Quality Management all new materials for inspection.
DiWict?
❑Yes /1417.
I have read the bacanous materials requirements. r Chapter 6.95 of the Cali for
nice Hevhh&Safety Code,Sections 25505,25533 am125534. Jemmed thattrue building
Does rmEmo aly ha tenant,that it is my respmnsihilby m tifIr comport of me
ON Metaw�lcn .,y r prior 1.Cou...isCcrtiO w cI"Lacy Signature of Applicant Date
0 es. Dam
All roof coverings to be Class"B"or better