01030117CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRF'_55:
PERMIT NO.
19333 VALLCO PKWY
MAI INDUSTRIES INC
01030117
OWNER'S NANIE:
APPLICATION SUB DACE-
ATE
r) COMPAQ!
r)
105 BONAVENTURA DR
03/21/2001
PHONE
SANITARY NO. CONTROL NO.
C310 —27 (0-7702,
(408)434-9880
ARCS I I' IECIYENGINEERT1? :
BUILDING PERMIT INFO
- 1
��G V CJN O cV
❑1,1)fr'" 13LECy' PLUMB MIiC1
I—ll I L/I 1=1 1-./ I
LICENSED C0N7RACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am licensed rude( puokiom, of Chapter 9 (commencing
with Section 7000) of Division 3 ml Bia mea and Prafcssions Cade, mrd my license
is infail have and effect.
ADD WALL (INTERIOR)
License Class Lic.p
Am, EC DBCLARATION
use
I unJcrmnJ nfy plan\ used as public raoN>
'
,n NEWIIUI .RUIiCLARA'TION
hercl+y n1Enn Mn I ten cecn,pl Irani the Cnnloreor'a L Icanse Law for the
fulluw'mg ry ,. (Semion 7031.5, Bu, and PwI .....rte Cade Any city o uaty
'
which a peal.a re vonamn, :dtrnal it,, Jmnnlhb, u any structure
'
, it, kux such le a sig
its ....e ea also Ihcappbeunf fin each permit Glc r aLaw
Sq. FL Floor Area
Valuation
(,,iwa Iemmnmm
laIl)Horhe (,,,he Daionanfinec I Llnamefnw(chapter)
mat belshumcdt pursuant
e Bmines Calc)
Sectio 3 ofthe Itminos and
is Section mita) of
ioprofession,.nvi
or that lie a basis Any violation
or thin he is exempt thmel'tom and the basis for Inc alleged
31.5 b applicant I,)
nr Section7031.5vunydreddmn forapem,it sublttuthe upplicammucivil penalty
APN Number
Occupancy Type
of not nanrc n,:a„ five hundred dnBar assn.
0l, a, ownm of the property, or my anpmyece with wage. a, Meir sale compemmion,
will do the work. and the >au umv i, not intended or offered for sale (Sat. 7=.
Business and Professions CWc The Commenr'n License Law doe, not apply a. an
Required Inspections
owner of property Who builds or im,nwes thereon, and who does such work himself
othrough his own enplcyeec. provided that such imprm'aneds:re not intended or
516 — FINAL BUILDING _
uttered It,, tele. IL however, the building nr ingvnvcn,ont is sold witbin one year of
omplc on, the ot.—builder, will have the burden of proving that he did nm build or
-I rotsol. l )
E - fthe pr 1 1y siv 1 1 gisa f J tmemrao
cou
te t t d ] j ct IS 7044 diva nor, J .-. to+, il l ITh C a
peryconte whobuildslice hereat
improves lto
L:aw, dine not apply m nn ownerith
and
sepersonal the
and what, fin .ran prnlscP with u commcu+gsl Ilecnscd pursuant m the
who a
r, Liocr
Cnmfaany.a Liccmc ISec
❑lam em ,ptu cr Scc. B&PCfor this rcmon
owmr 5— (_01_--
W - " ' ENSA'I'ION DECLARATION
O
/
I hereby affirm under penalty of perjury one of the toDowing declrrmionr
1 have and will n dntain a Cordticme of Coment to ,cif -insure for Worker's
C'nmpens nion, to provided for by Section 371X1 or the IaMr Cade, fur the
,well onnauce of me .,,,it f r which this permit is issued.
O 1 have and will maintain Worker's Cnmpensa e"t In,umnce,relmocal by Section
S7( 1B l.1 the Luber Code. tet tau Perlbanantc. of me work lir,which this per nil is
wed. My IS.. km, Conrya,se In.aonnce eu ira anal Policy immher are
Cnfricr: Policy Nn.:
CERTIFICATION 017 E%I?M19lON FROM WORKERS'
COMPENSATION INSURANCE
I Has section need and be cmnpletcd it the permit is (nf one hundred dollar
n Idict) nr leas.)
1 c rdify that in the perfam+ance of the work Air which this permit is issued. I
%hall nut employ any person in any mam,sr so as to become wbject to the Workers
Cmnpcmation Laws of California Date
Apphaant
NIA 1CF 10 APPLICANT: 11; after nuking thla Cerificate of Exemption, you should
bocnnm.mblea'i to the Worker's Compensation , nwisrms of the [.;,hot Cade, you must
famwim comply will, such m visloa.. ns ilia pernfu anidl na decmw mroked.
CONS 'fRUC'1'ION 1.17NDING AGENCY
'
I horchy affirm that have is a cou,no ation lending agency fur the perform rve
IS the work for which this permit is Issued (Sea. NYO. Civ. C.)
I.ender', Name
I.eadcr's Address
I certify tied 1 have read this application and state that he above information is
correct. 1 agree to comply with all city and county nrlmences and state laws relating
to building construction, and hereby aotbarbe representatives of this city to enter upon
the ulwweuacntioned pmpeny far impaction pm,wx,,
(We) agree to save, indemnify and keep harmless the City of Copertimu against
liabilities, judgments, rosu ,ad v,,aws which may in an, way accrue against said
City in a,megaence oIt e grvnu i, unit.
'OMPLY POINT
-3— ( 0
APPLIC UNDERSTAN WITHALLNOxl
Issued by: Date
10, 3-21-oL
-
Re -roofs
SlgaalmvulATPYIt Date
I]AZAR I SOUS MAI'I Ili I ALS II ISC'LOS URE
Will the applleam or future buildingaueupunt suns or handle hamrduus annedal
Type of Roof• '
as definrd by me Cupertino Nlanmi,:d Cade, Chapter 9.12, and the Health and lonely
Code, Seed....2553200'! V
Dyes fLS�
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection. I agree to remove
emit hmardwas air contaminants as detinal by the Bay Area Air Quality Management
Digfmt7 �,/
all new materials for inspection. Applicant understands and will comply with
0Yes i<°
all non -point source regulations.
I have read the hanrdnm materials requirements under Chapter 6.95 of the
Cali fore is health A, Safety Code, Sections 25505, 25533 and 25534. 1 understand that
If the hui lding Joe, ma.,u r c u ¢nnnt One h i, my rv_,pnesthilay m nazilY the
Ocepant of the rcgni m Its which n at + +r m issua v of a C rd icane nl'
ecnpaf 3 21 _0)
Signature of Applicant Dale
All roof coverings to be Class "B" or better
0 ue,1111acut Data
1
OFFICE