02010058 OF
CI BUILDING DPESSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
20410 TOWN CTR # F150 SOUTHBAY CONSTRUCTION CC INC 02010058
`WNER'S NAME: APPLICATION SUB DATE
DEKE HUNTER 511 DIVISION STREET 01/15/2002
'110,E (408) 379-0400 SANITARY NO. CONTROL NO.
O s i ARCHITECTIENGINEER: BUILDING PERMIT INFO
OW C LUG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
5 K E 1 hereby rat that I am licensed under °ixims of Cha 9(cmi menein Job Descri tion
:EtW Ya p^v per g
._t, wiltn111f..AMYdof affectsinn3naneeusmess evrnesshmscale.and myeecns< TENANT IMPROVEMENT
ad t.`in tail ruf6na eBea. ��
:
its,
'U �L�y�xjvse Cla Lic.
7Dc Contractof
I u3.LLO G ARCHITECT'S DE RATION �j D'A
U 1 understand my plain.M1all he used as uM1lic records
i me Y `
�O C Licensed Pro(essinnal
'n m that I a&exemptBUILDfr DECLARATION
R:-2 1 hereby etnt that 1 am exempt from the RATION'S License law for the
E s o following mason(Smit 7031.5.Business vad Preassions Code:My city or warty' ®O O
which requires o Pemtil to comtmm,alter,improve,demolish,or repair any stracmre
to nwm in.iominve.alsoreq°Fres flia.,herad fur such .it Elea slgnedstammen, _._.__---------------
to
........... .
that he bi kesved puisukt t to the provisions of the Contractor's Licenx law(Chapter 9 y �yp'f��r�IT�.1 p.�qa
(commercial,wire Section 7000)of Division 3 cilia,Business and Professions Code) LLdllon
or that he is exmmVi medfrotn and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for o permit subjects the applicant to a civil penalty
of not more than live hundred dnnars(s5«I). 1014PN N*TIDATION '' ' Occupancy Type
°I,as owner of the property,or my employees with wages as their sole compenmtion.
will do tire work.and the structure isnot intended or offered for sale(Sec.AWG,
Buimus and Professions Code:The Conuacmr's License law does not apply to an 103 - UFER Required Inspections L
owner of popeny Who builds m improves thereon,and whit data such work himself
or thou. It his own employees.Pmrsaind that rch improvementsse
unot intended or 1.04 - REBAR
offered for sale.If.howavmr.the Wilding of improvement is sold within one year of - - - _ - - - -- -- -
omPletiont beawnela
rbuilderwillhavetherdenofpmvingthinhedidnotWildor 105 - ANCHOR BOLTS • '
improve far"mPnseofsme.l' 106 - SEWER & WATER' -
0
_
❑1,as owner nf,he property.vin exclusively contracting wnh licenmJ mmracmrsro 202 - UNDERFLOOR PLUMBING •'
maswcn the proper,(Sec.AWG,Basin,,,and Ptuessiom CM,:)The Coo 2 03 - UNDERFLOOR MECHANICAL t
License Low does not apply no an owner M property who builds or impmrex thereon,
nna wnu.eaatmc,,far such prniec,a'will a mmavmwnl)fiatnsed pnoa rm".the . - 2 04 " - UNDERFLOOR -FRAME
Cnnwnm's License sow, .
❑limexemp,under Sec. ,B&PC forthisreason 205 - UNDERFLOOR INSULATION
owner Date 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB Sc OR SHOWER
-v I hereby aRt ander penalty of pejuey one of the fallowing declarations: 303 - ROUGH MECHANICAL
(( ° 1 have and will maintain n Cedificate of Convent to self-insure for Worker's 3 04 - ROUGH ELECTRICAL
Compensation. as provided far by Section 37W of me labor Code, for me
performance of the work for which this permit is issued. 305 - FRAME
°I have and will maintain WorAu's Compensation Insurance,as required by Section 3 06 - HOLDOWNS
37M of the Labor cede,for the Performance of the work for which this permit is 307
/xNis/_sym�_ede. ' , r.er.'s.emn-Pcnxarnn Insuranc<catrier nna Pnucnumhr
nr<: - .
INSULA'TIONMr07' (. , — SHEETROCK .I _ � Y . Py .D31o1 -h {''CERTIFlCAG EXEMPTIONFROM WORKERS' l309{131'EXTERI6R'L
ATH
COMPENSATION INSURANCE s,a
....; .,,_.
- -
_.. . .. _
-310'" ;INTERIOR' LATH' ----
'(" (Thii section need not he completed if the permit is for one hundred dollars
(slom°rless.l 311 - SCRATCH COAT
I certify that in me n in ainy m n the work for which this petite Worke.I
313 - -ROOF NALL
shaHint employ any person in any manner so u m become subject to,he Workers 501 - FINAL ELECTRI CAli ENERGY
ACompensation Lawsnrcnhromia.Dme g c< p • - - 502 - FINAL -PLUMBING ENERGY
NOTICE -- — '-
A t
NOTICE TOAPo the Work , n kin thsco,sm,fth Ex ,Code,uunnas. 503 - FINAL MECHANICAL ENERGY ,
becomes comply the sukatsCampanian..pro onsll the Lebo revok you mus
O C
forthwithpnmply with such pro,. .arm pc tshall6cJ teed revoked. 504. FINAL _BUILDING ENERGY:..- .
'F CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL '' "
1 harchy affiin m
l there ism ainswcumi lending agency for the ahot ,
vnee -
Fp7. btmework for which thopetl,ishotted(Secl3097,Civ.C.) 506 GAS TEST _
o a °C6 Name
mify - 507 - FINAL PLUMBING
Lenders Addrea . p
U p 508 - FINAL MECHANICAL
1 canee to c1h ectal pylic, d state chitalaws information
w r
correct.l1 agree m comply m e city vnd re ordinances estatelows enter
upon 509 - FINAL GRADE G
'O•V to above-mentioned
pr:andhertbyoumonmreposentativcs of this citymrnrer upon
' > A. me abn(Wmentioned_pme.ndemnfy adkepurp°sea. , 510 - FINAL PLANNING
Qat (We) e. expenses
hiep hmay in
he Cityofcruengadirta.at
U Z City in co judgments,pmts sed i n ofthi whimh may in any say accrue against said 514 - FINAL PUB I C WORKS
U � pro in mynsegampe none grunting nnnrs petit. ... G�
APeeeeLICANT UNDEk$ N NDWILL COMPLY WITH ALL NO -POINT ' Issued Date
RCE REGIRATI ^/�1 J y'
Stgnnmrt olApPli vcnntm r' �t<I Re-roofs
HADAR bfA LS DISCLOSURE
.. •.• ,. Will the apithcant orfulure building occupant sore of handle huurdous material Type of Roof .._. . ..... ........- -_ __
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety 1`_ _„_ * T f.:; .l
Cade.Section 25532he' ,r '+ s
All roofs shall be inspected prior to any roofing material.being installed.__.. . .
Will me applicant or future Building occupant use equipment or devicas which If a roof is installed without first obtaining an inspection,I agree to'remove
emit hmzrdooi air ornmarnnms os defined by the Be,Area Air Quality hfanagsmnent
Chime,' all new materials for inspection. Applicant understands and will comply with
°Ye °: - all non-point source regulations.
1 have mail the heinrdoui materials requirements undo Chapfe,h95'of the
California Health&Safety Code.Sections 25505.25533 and 25534.1 understand that _ ..
if the thudding does no,currently have a terrain.that it is my responsibility to notify the _
ocmpvnt of the rt which mus,be met pnor10 nssuan Florissant,of
porter. Signature of Applicant Date_
° y6o -
ownmp numndng—
Grim aedagam All roof coverings to be Class "B" or'better
. . . . _. . OFFICE