01030120CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
,FtUiLDING ADDRESS:
PERMIT NO.
0300 TORRE AV
01 ,
OWNIOWS NAMH
APPLICATION STUB DAII:
CUPERTINO CITY CENTER ASSOCIAT
IONS:
-
SANITARY NO. CONTROLNO.
ARCHITECUENGINEER:
BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
CI CI TTI I—1
LICENSED COMBACFOR'S DECLARATION
Job Description
I herchy allirm that I em licensttl under provirior. of Chapmr 9 tcontrocan e,
ufnbe Onsinevv and plot cxsiam Cock. IoW ley license
with Scenforce
and Ole,,vis:nn7
,,,a lull Il+rac and cffict.
Deers cm.., Cons
TI
.
'
BREAK ROOM
Dam Gaememr
ARCIII DECLARATION
NEW
WALLS L( ,
he use
1 uede,.mrd ler plans.nan ere Dew as parole ma„m.
��
1.'¢cnsul
OWNER❑IJILDER DECLARAI ION
ersh, allr.J
1 hemby ailuro that 1 Law for the
Burin from the Contractor's Lien
Cwr Any city
1.. y c
following nmxm. (Section IlDI 5. Business and 1ve.
!l
deeon.
anamr,
wbich counts, o Permit d¢r. nt frove• dnrolis repair any ttmcmrc
L/
t file
Prior to s l censedc, assn rt it) the,havikioa% of for such menne ,o f le License signs neemem
b.issuance. re uire%the
matneiocin,e•Jlatmnanttn
Sy. Ft. Floor.Area
Valuation
X)) ofti,mor,nneaeBrlinc,,andNntaw(Chapter r,Ono
(cit Sea..l IDINI) ul ie nfms Business Orli P..l.
'
Any —Gdel
of he its cwish
b .Any vinlation
or that he is sacs thcm4ort Ilnd ale basis far Thu alleged ea
b nay sum fnr a pem,it nublean rhe nPPlicanl u: x civil penalty
to applicant
of Semon ]Ith
APN Number
Oceupa�r��'�0
n e dreg
or Int lmom man fee nawreJ dollar, ($500).
❑ I. as owner of the property, or my employees with wage, as their sole compensation,
I�•�]rs
36901 O 1 ol Inspections
will do the work. and the structure is not intended or offered for sale (Sec. 7044.
Holiness Dad 11 lesainns Cede:'fhe Contractor's Llcen.e Law does not apply to as
r of property Who boll,-, improves thereon, rml who Joel such work himself
,,, thmogh his naval cm,loyw.. pmvlded than such in:powcmems are not immrdal o,
-
-
offered for sloe. If hnwcver, the Wild ng or Impmvcmum Is sold within now y.,of
completion. the ow,ter-nuimer will have are burden of proving that he did not build or
1.01
— FOUNDATION
improve for purla+a of we.).
102
— PIERS
❑ h as ow, net of the point a l esclu.ively contracting with licemed contractors to
construct the project tsar. 7044. nu, and Pram., s Cndeo'rne Contractor.
nnuds
- 103
— UFER
Lice se law dos urn apply to an owner or properly who or imot s thereon.
:rod leho c,ainaws nor such Inojeets won a rnmrocon(s) heensw par, uare to the
104
— REBAR
Commso License, law.
01 at„ e.ctnpt trade, Sm. . B A P C for this,uowar
105
— ANCHOR BOLTS
owner Date
106
— SEWER & WATER
WORKER'S Co MP12NSATION DECLARATION
202
— UNDERFLOOR PLUMBING
Iblotchy :dfnmander pcoailyofparluryoneill the fouowingdeelarani'an.:
203
— UNDERFLOOR MECHANICAL
❑ 1 nave and win maimain a Cenifcate of Comm, to self-insure for workers
204
— UNDERFLOOR FRAME
Compensation, as provided ler by Secaoa 3700 if the won Code• for the
terrurtnaneeonhework forohienthis permit sissued.
205
— UNDERFLOOR INSULATION
❑ l haocand will maintain Worker's Coml:eneminn Insurance, as required by Section
301
— ROUGH PLUMBING
3700,1 the [..,bar Code, for rhe Performance of the work liar which this formal is
saw. Nly workers Onlife.::limn hisciance carder and Vuliy o:rml-1 me:
302
— TUB R• OR SHOWER
Carle° policy No.:
303
— ROUGH MECHANICAL
CIiRTIFICAI'ION UP EXEMPTION FROM WORKERS'
COMPI NSAr1ON INSURANCE
304
— ROUGH ELECTRICAL
(This section need not Iw completed if the permit a for one hundred dollars
305
— FRAME
S IBB err I'll.)
306
— HOLDOWNS
I crfilykill tothe iformnmcoftheworkRewhich flu, nitl,i... ed. 1
shall aol employ any person in any manner w as It, Mcnme subject to the Workers
307
— INSULATION
Co ntem,nion'wws of California Ilan
Applicant
308
— SHEETROCK
NOTICE to APPLICANT: If, after neking this Committee of Exemption, you should
Memne.uhject m the Worker's colelarecfon provision% of the Labor Ctaa, you must
309
— EXTERIOR LATH
lanhwith enmply with such pnry ieioe. or Ilii,,mait e1,.Il be dor revoked,
310
_
- INTERIOR LATH
CIINS'I RUC'I ION LENDING AGENCY
Ihot aninn,hatthem i.aconstmehonleading agency lot the performance
311
— SCRATCH COAT
of the work for which this permit is mued (Sec. 3(N7. Cir. CO
lender's Name
31.3
— ROOF NAIL
Under, Addles”
501
— FINAL ELECTRICAL ENERGY
II".re that orale mah all. hand..:,:,mlenana mat,naanootlaws ntiolt in
roto. I...... m y with all city and woolyacr innnco ..ad hens htws'rd:n ng
502
— FINAL PLUMBING ENERGY '
en:rap
iobuildingsennmeinn.:rod, fori aeelion rtprtsentatives of Ilii, city u)voterury+n
rify
(e.,,,e,dc1.
503
— FINAL MECHANICAL ENERGY
adknpmp,eee.
oe,inde against
(We) agmc ns.cost and c indemnify and keep hamleas the City of com, against
liabilities,judjurocc fthe which rtay'in any way acerae against ,aid
504
— FINAL BUILDING ENERGY
ruJegofthi
City in CANT etme W the granting D this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: 505
y'
506
— FINAL ELECTRICFi�te
G, Is
SOURCE REGULATIONS.
Re-roofs 507
— FINRL PLUMBING
Signature ofnppfcanvCnmmemr Dale
Will the appinHAZARDOUS
la,� orfu ur� Wild ng ocl upona ue in handle ha rvJnu, manenal
Type of Roof
yp 50B
— FINAL MECHANICAL
as defined by the Cupemn, Municipal Code, Charter 9.12• and the Health and Safety
Code. Sco 255321a1r
Cl yet, ❑No
p� tt
All roofs shall b%�S..TIS ected,FL�A a material being installed.
Will hoc Ria icantorfuturebuRdogoecapomuFcequipmeotmdcviceawhieh
11'a roof is install itF—iou
l(6ta 9U1fY�.yff tion, I agree to remove
:mit hazardous air comamlmmns as defined by the Hay Arca Air Quality Management
Monett
all new nlatcrials;%lins'ISeLfi
7Wppll2.=aWLFkQrsWfi1RH& will comply with
6''e^ 0N
all non-point sou c regulations.
fi95 sur the
I Iron mad the Innmda6 re node, C. o
u der Ch
I to
-
505lmmcmn
Ilederd Safety Gala. Savvaonal,
understand the
Culilu ,y Coll,. 5, 25579, 1 un
/�D/
if the building ones not currently Im,c a cram. Ilial it is my re.punsihi lily m notify Ibc
—�
capon of We royal fronts which rest be net prior u, issuance of to Cenifeare of
Occupancy,
Signature of Applicant
Date
All
roof Coverings to be Class `B'• or better
Owner Dee
or authorized agent
OFFICE