02030057 TY
CI
BUILDING DII VIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20410 TOWN CENTER LN # 100 SOUTHBAY CONSTRUCTION CC INC 02030057
�W`1ER'S NAME: APPLICATION SUB DATE
DEKE HUNTER 511 DIVISION STREET 03/13/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 379-0400
e m0 QZ ARCIi1TECT/ENGINEER: BUILDING PERMIT INFO
ce BLDG ELECT PLUMB MECH
<<_ IJ -1
LICENSED CONT'RACTOR'S DECLARATION
.5�? Job Description
j z:C 1 M1<mby a0irm that I am licensed under pmvisions nr Chapter 9(commencing
,nCm withfeaforcead1offect. ionJoftheBminessondProfesaionsCWe.andmylicenx TEMP. PERMIT. (30 DAYS, EXPIRES ON 04/13/0ly
<
is in se Cores and effect.
i 0 U License Class Lic.a
:e,a`s- Dae Contractor
Ie,3 O V, ARCHITECT'S DECLARATION
}-, I understand my plans shall he used as public records
i i O O Littnscd Professional
'x e.,�,, OR iI am exempt
DECLARATION
' 1 mass affirm that 1 oro.Ba,un from the Contractor e:A.,C Law for the
gz a fallowing mason.(Section 90]15,Businms and Profealons Code:Any city secoom, $7 5 3 0
IFC which requires a permit to ronama,alter,improve,ticmdlixh,or repair any stmnum
as
co � . prior to its issuance.also memirea the applicant for such permit to rile a signed statement.
a. that Neil licensed pd¢uent to the p ovisions or the Contractors License Ince(Chapter 9 „ pC pn,1p^ Valuation
-
(commmncin6with Scomn701 of Division 3 of the Business and Professions Cotle) teE Jt' '
or then he is c'xemyt dmi,fom and the basis!ebbe a11,g d exemption.Any violation - '
-of Section 9031:5 by any applicant for a permit subjects the applicant to a civil penalty.
or not more than rive hundred dollars($500). lO�PN""DATION < " pansy Type
01.as ernes of the pmpcny,or my employees with wages as their sole compensation,
will donte'work;and the ifecom is not intended or offered for sale(See.76,14, Re aired Ins actions t":
Besides,,and Professions Code:The Co duff. e License Law does not apply m an 103 - UFER 9 P
owner or property Who build,or improvwe thmeon,and who does such stock himself
or through his awn employees.provided that such improvements am not amended or104 - REBAR
-offend Tor sale.If,however.the budding or impravemem is sold within on<Yem of
completion,theowoer-builder will have theburden ofproving that hedid not build or 105 - ANCHOR BOLTS "" 'a' It, ,r
improve for .W,a uptake.). 106 — SEWER & WATER
_ < i,re,o fern(the propey,arae.dnwebeoim<dng:hnreen d! re 202 UNDERFLOOR--PLUMBING- - „ —
contract the project(Sec.7(vW.Business and Professions Code:)The Contractor's 2 03 - UNDERFLOOR MECHANICAL'
License Law m docs not apply an owner of proixrty who builds or improves thereon,
V : _and-who contractsfor such pmjects with a commearr(s)licensed pursuant to.the. _. 204- = UNDERFLOOR"-FRAME-' -
°" Contmcmrs Liceme Law. 1. -- - --- -
❑lareas n .B&PC for this 205 - UNDERFLOOR( 'INSULA'TION
owned Date 3� /3T 301 — ROUGH PLUMBING
WOR! , 'SCOMPENSATIONDECLARATION 1 302 — TUB & OR SHOWER
I hereby arum sneer Penalty of perjgry one ohne ipnowmg aedam0nnso 303 _ ROUGH MECHANICAL
0 I have and will maintain a Caoirc.m or Consent to,elf-insure for Worker, 304 ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of the Inbar Code for the
Performance of the work for which this permit is issued. 305 - FRAME
❑1 nave Bad will ammein Worker's Compensation Insurance,as required by Section 306 — HOLDOWNS
. c 3200bf the Ladoi Coda.for the performance of Ne work for which this permit is 3 07 - INSULATION
soctl My Workers C n pc t Imuran a 'e a d Policy number arc.
308 ;— SHEETROCK sass
camti'l ct- "PReyN (.'.'; . 309' '—'FTEXTSRIOR' LATH''
., CERTIFICATION OF EXHMPI'ION rROMtWORKERS
COMPENSATION INSURANCE ""- ' 'O
— — ... — — — 3'10-:.--;INTERIOR"—LATH--...... -----
t•"(This section need not be completed if the permit is for one hundred dollars t). •a.i:..ti?. ,)hl'
(s1B0)orlm,.) 311 — SCRATCH COAT
co I<nr that in the perform offs k for which
tel Paminis formal.e war .": ... 3-13 ROOF' NAIL••._.-
di t mplyyanype. y rs1' 501 — FINAL ELECTRICAL 'ENERGY
mpenmtton laws of California,Date
Applicant. - S02— — -FINAL PLUMBING-ENERGY
NOTICE TOAPPLICANI':If,atter making th is Certificate of Esemption,you should 503 — FINAL MECHANICAL% ENERGY
become subject o the Worker's Compensation pmvisions of the Labor Code,you must
Z z0 rdnnwanComply wah,a<nprdvi,innsnrthis nemit,nae eeemedeevokea' _504 FINAL-BUILDING-ENERGY,
P.!4 " CONSTRUCTION LENDING AGENCY . .. " 505 — FINAL ELECTRICAL%
I hereby am ffirthatThere'is a Construction boiling agency for the rooformanZe
W 1< ions" lhn' pe t edrs e 3r»9 Civ. 506 - GAS TEST -
A of the work far which _. - - _- _ .
Lead N
a Z �w Add 507 - FINAL PLUMBING.
V'O - 508 - FINAL MECHANICAL
y have read this application and state that the above information is
W.F.,. 2orrcn.I agree to comply with all city and county ordinances and state laws mbding 509 — FINAL GRADE
IJ to building comtidetion:and hereby authorize kpresentatives of this city to enter upon
} r7 the above"mentioned property,for inspection purposes.. . . 510 — FINAL PLANNING
r0. (We)agice iosave,ind<mnlryand keep harmless the City or Copeuinoagaimt
"tn liabilities.judgments,costs and expenses which may in any way ace agodust said 514 — F INA PUS-LIC WORKS
U,Z Cityin querecafthegmming of this permit. ��
"' APPLICANT UNDERS 4 AND WILL COMPLYWITH ACL NON-POINT'" Issued by: ! Date
SOURCE REGUI:ATI ." " ' Y'
�% ��-- .Ia, �
Signawre of Appli v ntmet 't - ""r- ' ' ',,.'t _atq Re-roofs
HAZARDOUS MATERIALS DISCEOSURF
II'the applicant or future building occupant imre or bandle bzsrdous mamtial _Type of Roof .. . .
as defined by the Cupertino municipal code Chapter 9.12,and due Health and Safety _ - '• '- "" '
Code,Section 25533(a) t I '? 1 t'•
arts ^^:' " t All roofs shall be inspected prior to any_roo.iing material being,Installed._ —Will thce'liers.,o far..W(ding occupant use equipment or devices which If a roof is installed without first obtaining an,inspection;I agree to remove
Lith hazardous air contaminants as defined by the Bay Am.Ar Quality Management
oGtfict'! 19�uo all new materials for inspection. Applicant understands and will comply with
GY` all non-point source regulations - - -
-'1 have read the hazardous materials us incments under Chapter 6.95 of Ne
California Health&Safety,CW e,Sections 25505:25533 and 25534.1 understand that
fth-bmld ;hu,
oes not currently have aten tbrail, ty mspo bityto notify the
Occupant nt f est be met pot xu c -f Certificate,of
` p y Signature of Applicant Date
own tali a 3�i3� . Signature.of
roof coverings to be Class ..B„ or better -
-'.': OFFICE ... . ._