01050054 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
Bu181gc��DRFs�gISTA DR—O BLD PERMIT NO. 01050054
Gtet§MttINO COMMUNITY SERVICES AM76 j2V61
PHONE: SANITARY NO. CONTROL N0.
1t
G-Z 'ARCHITECDENGINEER: BUR.DING PERMIT INTO
O O BLDG ELECT PLUMB MECH
i ,. U I_J
<
w i LICENSED CONTRACTOR'S DECLARATION jji�bb Dj� Crlph On
jZLi (hereby off rte that,um licensed under provisionx of Chopmr 9lcommencing NEW OFFICE BUILDIp �'�A��D
�t with Section 7")of Division 3 of is Business and Professions Cade.and my licensee
a m y° .is in fall force and a t.
e oc'tt< Liccnsc Class Lic.a
K o d Date Ganva tar 2 2003
=u C t, AR'HITECr'S DECLA AP", APR 0
F g 1 undersand my plans almll be used m public records
um O�f Li :,: Professinnal BUILDING
OWNER-BUILDER DECLARATION uxi'—�'
in 1_hereby affam that 1 am exempt from the Convector's Li.....Lew for the
e.Z foluwing remna.(Section 7031.5,Business and Professions Cade:Any city meminty $312,808
Z F O which requires a permit mm
esweLter,alimprove,demolish,or mu r 6ny umw
cre ..
�3$ prim to!Is issuonce.also requires theapticant for such pertain°Gen
lc a signed statemt- - - - --- - ---- ---------— - --- -
. thetheiilicensed pureuenuotheprovinmsofthe Contnnu/s License Law(Chapter 9 ,s,1 ..,, S Ft.F]oorArea.,_` r, , Valuation
(rommencin8 with Section]000)of Division J of the Business and Rnfessions Cable) t, "�',,t i:..i. q'i t: ` i., r r.J L's
or that he is edfmpt therefrom and rhe buil for Ne alleged exemption.Any violmion
of Section]031.5 by any applicant for a factor subjects the applicant to a civil penalty - , , Occupancy rof not mare than Five hundred dollars WWI. 51 fPP�I51p,� BU I LD I N Occuane Type
se
0 0srofthepropcey.o myeirpleyfevwith sagelailhei,scili,curnmunlion,
will do the work,and the structure is not intended or offend for sale(Sec.70",'
Business and Professions Cole:The Contractor's License Law does not apply t°an Required Inspections,- -'
sswne,of Property Who builds or improves thereon,end who does such wad himself
or through his own employees.provided Nat such improvements are not intended or
.offered for sale.If,however,the building or improvement ie sold within one y err of
completion.the owner-builder will have the burden of proving that he did not build or
improve for puipox of svleJ.
Li stmct thendthe n n am Business d Profession,
"
pr pe % Y 8 with licensed conrm<wm m :•
mnswm the project(Sec.]041,dames s and Professore Cade:)The Conmanor's
License Low does not apply roan owner of pmfcuy who builds or improves thereon,
...'
and who contracts for such protects with.¢canuacmr(s)licensed pursuant to the _. :.. .......__.. ....... .. .. ........__._ ..... __.._ ...._-...__....._. ... .-___ .... .. .. .._
License Lew.
El I am exempt under Sec. B&PCfor this rtason
Owner "'Date•`
WORKER'S COMPENSATION DECLARATION
I hereby of ion under penalty of perjury one of the following declarations:
Cl I have und will maintain a CenificatoW Consent In self-insure for Worker's
���f Compensation, as provided for by'Seelion 3700 of the labor Code, far the
_ peKommnceof the work for which this rrrnit is issued,.
❑1 have and will eminuin Worker's Compcnsnion Insurance,as required by Section
3700 of Ne Lebo,Code,for the perfmoname of the work fm which dust permit is '
issued.My Workees Compensation Insurance carrier and Policy number are: _
Carrier. e— -- tP'�' (:... •a�a. t.tl l'',: .
i C RTIFlC TION OF E TTON IN N RANCU" KERS' t ,
.... �, .. . ION,INSURANCE., � s, , .. v t. . .. ._,_. . .._._ __ .. .. .... __.__....._
` `(This ae ilW need not be completed if the permit is for one hundred dollen ' I t ( `'` '
- (SlinhorleasJit
1 eempl that in the n inamance of the woh for which this pemdt a issued,1 - ,,i t
shall m not alf.. a'ws person in any manner so es to become xubjm m the Wades'' `
Compensation laws of California.Data
Aiiplicarm
NOTICE TO APPLICANT:If,afar making this of th Exemption,you should
fhavoommbwitsubjectrotits k rvompena,t provisions d(rhelaborCWe you must
ouhwuh comply'with such provision,' ot th'epe ,shall be dremed revoked.
F+ Q oLenders Neme h CONSTRUCTION LENDING GE
NC t 's
" 1 h rtb -Rich that themco sauSec. Ind ng agency for the performance
Lar ich this permit is
;ed(sec 3097 ICv.C)
5_Z LendcrY
_ V I cenify that 1 have mad this application and nate rhaphe above informmim is
c&;xn.1 agree to,comply with all city and county ordinances and stem laws relating
V mbuilding consmuction:and hereby authorize reprfsentativesofthis city to enter also
;� W Jho I ones.mentioned progeny Por inspection po,pos y i
n.A, - IWe)'agree to save:indemnify and keep harmless the Ciiy of Cupenino against
li it i!irs,jud uerice cons and expenses which they in any way accrue ageing said
Cory in consequence of the gnming orchis pcmnit.'
„ - PURCC'F D�ERSNAN SA' LCOMPLY WITH ALL NON-POINT Issued by: DBI¢ / ^'
ig rtarAprlmmtrcantmfror :. --.. . to Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Wdl the appl¢em or(wurc buig ettt t
vpa ae Mwd ...............
handle ms rvatecet Type of Roof - - _ -. ,
defned by the Cupen c al C
1 cl Chapte 9 l i and th Health end Safety t
.Cod Schon 25572(¢) t s 1 ,.
as n
°Yes' " .. .All roofs shall be Inspected prior.to any,roofing.material being.Installed.
W Il the applicant furore building ampem uu cqu pmenr or devicee ameh If a roof is installed without first obtaining an inspection;,l agree to remove
eno herardous air coilearr ors I defined by the Bay Arta At,Quality Management
Dixm r+ - all new materials for inspection, Applicant understands and will com_ply with
OYc No all non-point source regulations.
1 have read the hazalloui mareriah rcm
qu reents'undin Chapter 6,95of the
California Health&Safety Coda,Sen olts 25505.25533 and 25534,1 understand that
(the build g❑ not um tlyhu cath em thtt myreponib'I"tymmulfyflin
ccupout bf tfi "'imumm,whi'Wormst,be t prior to iss ane of n Cenific t of
°cup'an`y Signature of Applicant Date_
ro,•e m' g�7rt"? �DaU'— All roof coverings to be Class "B"or betterOFFICE
::,
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
Bu181gc��DRFs�gISTA DR—O BLD PERMIT NO. 01050054
Gtet§MttINO COMMUNITY SERVICES AM76 j2V61
PHONE: SANITARY NO. CONTROL N0.
1t
G-Z 'ARCHITECDENGINEER: BUR.DING PERMIT INTO
O O BLDG ELECT PLUMB MECH
i ,. U I_J
<
w i LICENSED CONTRACTOR'S DECLARATION jji�bb Dj� Crlph On
jZLi (hereby off rte that,um licensed under provisionx of Chopmr 9lcommencing NEW OFFICE BUILDIp �'�A��D
�t with Section 7")of Division 3 of is Business and Professions Cade.and my licensee
a m y° .is in fall force and a t.
e oc'tt< Liccnsc Class Lic.a
K o d Date Ganva tar 2 2003
=u C t, AR'HITECr'S DECLA AP", APR 0
F g 1 undersand my plans almll be used m public records
um O�f Li :,: Professinnal BUILDING
OWNER-BUILDER DECLARATION uxi'—�'
in 1_hereby affam that 1 am exempt from the Convector's Li.....Lew for the
e.Z foluwing remna.(Section 7031.5,Business and Professions Cade:Any city meminty $312,808
Z F O which requires a permit mm
esweLter,alimprove,demolish,or mu r 6ny umw
cre ..
�3$ prim to!Is issuonce.also requires theapticant for such pertain°Gen
lc a signed statemt- - - - --- - ---- ---------— - --- -
. thetheiilicensed pureuenuotheprovinmsofthe Contnnu/s License Law(Chapter 9 ,s,1 ..,, S Ft.F]oorArea.,_` r, , Valuation
(rommencin8 with Section]000)of Division J of the Business and Rnfessions Cable) t, "�',,t i:..i. q'i t: ` i., r r.J L's
or that he is edfmpt therefrom and rhe buil for Ne alleged exemption.Any violmion
of Section]031.5 by any applicant for a factor subjects the applicant to a civil penalty - , , Occupancy rof not mare than Five hundred dollars WWI. 51 fPP�I51p,� BU I LD I N Occuane Type
se
0 0srofthepropcey.o myeirpleyfevwith sagelailhei,scili,curnmunlion,
will do the work,and the structure is not intended or offend for sale(Sec.70",'
Business and Professions Cole:The Contractor's License Law does not apply t°an Required Inspections,- -'
sswne,of Property Who builds or improves thereon,end who does such wad himself
or through his own employees.provided Nat such improvements are not intended or
.offered for sale.If,however,the building or improvement ie sold within one y err of
completion.the owner-builder will have the burden of proving that he did not build or
improve for puipox of svleJ.
Li stmct thendthe n n am Business d Profession,
"
pr pe % Y 8 with licensed conrm<wm m :•
mnswm the project(Sec.]041,dames s and Professore Cade:)The Conmanor's
License Low does not apply roan owner of pmfcuy who builds or improves thereon,
...'
and who contracts for such protects with.¢canuacmr(s)licensed pursuant to the _. :.. .......__.. ....... .. .. ........__._ ..... __.._ ...._-...__....._. ... .-___ .... .. .. .._
License Lew.
El I am exempt under Sec. B&PCfor this rtason
Owner "'Date•`
WORKER'S COMPENSATION DECLARATION
I hereby of ion under penalty of perjury one of the following declarations:
Cl I have und will maintain a CenificatoW Consent In self-insure for Worker's
���f Compensation, as provided for by'Seelion 3700 of the labor Code, far the
_ peKommnceof the work for which this rrrnit is issued,.
❑1 have and will eminuin Worker's Compcnsnion Insurance,as required by Section
3700 of Ne Lebo,Code,for the perfmoname of the work fm which dust permit is '
issued.My Workees Compensation Insurance carrier and Policy number are: _
Carrier. e— -- tP'�' (:... •a�a. t.tl l'',: .
i C RTIFlC TION OF E TTON IN N RANCU" KERS' t ,
.... �, .. . ION,INSURANCE., � s, , .. v t. . .. ._,_. . .._._ __ .. .. .... __.__....._
` `(This ae ilW need not be completed if the permit is for one hundred dollen ' I t ( `'` '
- (SlinhorleasJit
1 eempl that in the n inamance of the woh for which this pemdt a issued,1 - ,,i t
shall m not alf.. a'ws person in any manner so es to become xubjm m the Wades'' `
Compensation laws of California.Data
Aiiplicarm
NOTICE TO APPLICANT:If,afar making this of th Exemption,you should
fhavoommbwitsubjectrotits k rvompena,t provisions d(rhelaborCWe you must
ouhwuh comply'with such provision,' ot th'epe ,shall be dremed revoked.
F+ Q oLenders Neme h CONSTRUCTION LENDING GE
NC t 's
" 1 h rtb -Rich that themco sauSec. Ind ng agency for the performance
Lar ich this permit is
;ed(sec 3097 ICv.C)
5_Z LendcrY
_ V I cenify that 1 have mad this application and nate rhaphe above informmim is
c&;xn.1 agree to,comply with all city and county ordinances and stem laws relating
V mbuilding consmuction:and hereby authorize reprfsentativesofthis city to enter also
;� W Jho I ones.mentioned progeny Por inspection po,pos y i
n.A, - IWe)'agree to save:indemnify and keep harmless the Ciiy of Cupenino against
li it i!irs,jud uerice cons and expenses which they in any way accrue ageing said
Cory in consequence of the gnming orchis pcmnit.'
„ - PURCC'F D�ERSNAN SA' LCOMPLY WITH ALL NON-POINT Issued by: DBI¢ / ^'
ig rtarAprlmmtrcantmfror :. --.. . to Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Wdl the appl¢em or(wurc buig ettt t
vpa ae Mwd ...............
handle ms rvatecet Type of Roof - - _ -. ,
defned by the Cupen c al C
1 cl Chapte 9 l i and th Health end Safety t
.Cod Schon 25572(¢) t s 1 ,.
as n
°Yes' " .. .All roofs shall be Inspected prior.to any,roofing.material being.Installed.
W Il the applicant furore building ampem uu cqu pmenr or devicee ameh If a roof is installed without first obtaining an inspection;,l agree to remove
eno herardous air coilearr ors I defined by the Bay Arta At,Quality Management
Dixm r+ - all new materials for inspection, Applicant understands and will com_ply with
OYc No all non-point source regulations.
1 have read the hazalloui mareriah rcm
qu reents'undin Chapter 6,95of the
California Health&Safety Coda,Sen olts 25505.25533 and 25534,1 understand that
(the build g❑ not um tlyhu cath em thtt myreponib'I"tymmulfyflin
ccupout bf tfi "'imumm,whi'Wormst,be t prior to iss ane of n Cenific t of
°cup'an`y Signature of Applicant Date_
ro,•e m' g�7rt"? �DaU'— All roof coverings to be Class "B"or betterOFFICE
::,