03080166�Q
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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
'LgONTRACTOR�INFORMATION
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It LDING ADDRESS:
SOUTH BAY CONSTRUCTION CO
Egpyr "x'03080166
OW NF.R'S NAME:
511 DIVISION STREET
PERMIT ISSUE DATE
INC
40�- Z qq-5zoU
(408) 379-0400
SANITARY NO. CONTROL NO.
ARCIIITLCTI`pINEEN: �
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BUILDING PERMITPLUMB
L ELECT PLUMB MECH
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LICENSED CONTRACTOR 'SD RATION
Job Description
I Nimbly affirm that 1 am licensed under provisions of Chapter 9 (commencing
p
wish Sc lion 7=rDivision Sofmc Busineaaud Professions Code.entlm ccnu is
Ll BN mmcamerrec ,� 33(9 ,"�
License Clus Lic, x
TENANT IMPROVEMENT
FI�A�E®
Dam Contractor
RCHIrELTS DECLARATION
I moderation my plans shall he used as public records
JAN 2 9 2004
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby o1'fnm Nm I am exempt from on Conuacmr's Lic;nu Lawfor the
BUILDING
following rcmnn. (Seedun 7x131.5, Business and Pmfeuions Code: Any city or county
which requires a permit to conswn, alte, improsc, demolish. Or repair any structure
prior to its issuance, also requires the applicant for such permit to Bic a signed statement
that he is licensed puuvanun the provisions car the Commetor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7") of Division 3 of the Business and Professions Code) Or
that he is exempt dretefmm and the sues for Ne alleged exemption. Any viNat)an of
32610046.00
APN Number
Occupancy Type
P Y YP
Section 7031.5 by any applicant fora Permit subjects the applicant a a civil penalty of
not more than rw hundred dellars(S500).
0 1, as owner of the property, or my employees with wages as their sole compensation,
101 —d
Ins ectlo DS
p
will do the work and the stemomIsom intended or offered for sale (See 7W, Busineu
Profesalona Coda: The Ommnors License Law docs
and not apply in an owner or
property who buildsorimproves themon,iodwhodoes ochwarkhimulfarthroughhis
102 -
PIERS
ownemployces,provided nhatsuch improvements., am otendetloroWred rnrule. If.
lO3 —
UFER
however, the building or improvement is sold within one year of completion, the Owner -
builder. will have the burden of moving d u he did not build or improve for pupae of
104 -
REBAR
ala
FOS —
ANCHOR BOLTS
❑.L u owner of the property, am exclusively contracting with licensed contactors m
waitron the insect (Sec. 7044, Busineu and Professions Crede:) The Contricmr's Li.
106 —
SEWER & WATER
mase Law does not apply to an owner of mropuny who wilds or improves thcmon,and
'ZO2 —
UNDERFLOOR PLUMBING
who contracts for such projects with a clumommr(s) licensed portion to the Contractor'.
License Law.
203 -
UNDERFLOOR MECHANICAL
❑ 1 am exempt under Sec. . B & P C rm this mason
204 -
UNDERFLOOR FRAME
Data -
WORKER'S COMPENDFIONDECLARATION
205 -
UNDERFLOOR INSULATION
I hereby from under papally of poi am of he following declination:
mt
301 -
ROUGH PLUMBING
I ham and will main inua Cenifcate of Consentto selGinsum for WorkeM1 Compel.
302 —
TUB & OR SHOWER
, for due pernce of the
on, u provided far by Section 3700 of the Later Coderfams
303 -
ROUGH MECHANICAL
Iner
k for which this permit is issued.
3O4 —
ROUGH ELECTRICAL
I ham and will maintain workers Compewttion Inanum. mquimd by Section
0of the Labor Code, far the performance ofloe work forwhich this permit is Issued.
30,5 —
FRAME
Worker'sCnmpens iianlnsunnttcarticdPaI wrare:
306 -
307 -
'HOEDOWNS
INSULATION
CERTIFLATEOFFXEMPr FROMwoRKERs'
COMPENSATION INSURANCE
308 -
SHEETROCK
(Thismminn need nmwcompletedlOhc permit is for one hundred dnllaa(111X))
309 -
EXTERIOR LATH
of ICaa.)
I ccnify that in me termrmance of the work to, which this permit is issued. ) ahee nut
3 10 —
INTERIOR LATH
employ any person in any manner an as in become subject o the Walk,n'Campenenlon
311 —
SCRATCH COAT
Lawso
of
Laws r California, Dam cant
313 -
501 -
ROOF NAIL
FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT. If. after making this Certificate of Exemption. YOU should
become robjecn to the Workers Compensation previsions of me labor Code, you must
forthwith comply with such prnvisinn or this permiuhall be deemed revoked.
- 502 —
FINAL PLUMBING ENERGY
CONSTRUCTION LENDING AGENCY
503 �,7
FINAL MECHANICAL ENERGY
I hereby affirm that them is a coramlion lending agency for the performance of
504 -
FINAL BUILDING ENERGY
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name
505 -
506 -
FINAL ELECTRICAL
GAS TEST
Lenders Address
I campy that 1 hese read this application and sum that the above information is
cording 1 no comply with all city and county and stem laws to
507 -
FINAL PLUMBING '
wilding eonswction, and hereby euthorire rtprrxnutives of this citymcnmr upon the
ons nuOrdinancesiof r u,m t
FIN MEC CAL
abovcmemiond property forimnifyian
to xacepha.
(We) agree ro cave, indemnify and ke;P humless me City carCupcnina egeinu
liabilities, judgmenu. costs and eapemses which may in any way game against said City
in consequence the this
Q 9
5
FI
NG
of grana ng of permit.
APPLICANT UN S7A DSA 1 COMPLY WITH ALL NONP INT
Issued by:5
C WORKS Date
SOUR RE w
Re -roofs
Type of Roof
_ lQ/NV
EI names a h.mU on -c' rte
HAZARDOUS MATERIALS DISCLOSURE
Will me applicant or future wilding Occupant store or handle havmdmn pounds]
defined by the Cupenino Municipal Cade. Chapter 9.12. and The Health and safety
Code. Section 35532(a)? m
y.Will
All roofs shall be inspected
prior to any roofing material being installed.
If a roof is installed
without first obtaining an inspection, I agree to remove
and applicantcar rmnmr tlJing ottupam u equipment or devices which
a naumrma.ir eonmmina defined by the Bay Area Air Quality Management
all new materials for
inspection.
strict?
Yes
1 have mad the havmdnus materials requirements under Chapter 6.95 of the Cali for.
nimFiorillo& Sammy Code, Se 255f 5J d25514.1nndcaund that (the building
dors not curt; y hose a rat, m it' m expOnsihiliny u notily the m:cu
mquircmcn i• oma anaorac;nifiaateofc7c y�l�c
SignatureofApplicant Date
All roof coverings to be Class "B" or better
ter am teed agent D