01090052c
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO,
10050 N WOLFE RD
MAS APPLIED CONSTRUCTION
TECH01090052
OWNER'S NAME;
MENLO EQUITY
2241 CALLE DE LUNA
APPLICATION SUB DATE
09/13/2001
HONE:
(408)987-4970
SANITARY NO. CONTROL NO.
RCHITEC,IENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
toa.
CJ L_I IJ UJ
ot LICENSED CON, ACfOR'S DECLARATIONJob
Description
I hereby affirm that 1 am 11cen.ud under provision, of Chapter 9lcommene;ng
p
TI.
wwith Sv,ior7(K0).f D,,isl 3o(Ne BusincR end Profeasians Code. and my liana
pedeBe
L
< i;iin alts u
"e
ADA TILET CORE UPGRADE
D Date rnnlattar
n ARCHITECT'S DECLA ION
GROUND FL.
g 1 anJcrvana my prom shall W used as public meads
xLicensed Professional
y OWNER -BUILDER DECLARATION
-
a 1 herch,naso .(firm that 11. exempt from the Cessions Co Licem'a Law for tk
a (allowing mason. 703L5, Business and Cade: Any city m county
/
on, derans
which rectums a permit ra connmae alter, improve, demolish, any aiuewrt
emit t
fi e. si
$.pr'm to u. rt9 PPI'c tf M1pm 'u II 'grW swemem
C/
- - __. _ _ ._ __.._ _, _
S Ft, Floor Area -. r'-
('r,�,:yi id, �
{/..,{_.�
Vl'Y atlon
Nati ha sl ccnttd lnuwant btl>t Pi^ n IWeC vat tL Lo
,rut.
Division i nth Fusion Crar9
Sec Code)
Icor mere &with a 17000) of s. eMPro(css ons
or that he a exempt thcafrom and the basis for the alleges uempuoe. Any violation
-y ay y'tP. . r.. s.!? , a ai_3 F'
��`.2OO
1 (J
'
of Section 703 P.5 by my opplicam for a permit subjects the applicant to a civil penalty'
of no rome Nan five hundred dollar, 155801,
31 6`EPM%"berr0
i °' I. Occupancy Type
° L as owner of du property, or my employees with wages as Weir sole compensation,
will do the Business'and Profead ssions atmcmre is mreernded-ense Law doeor s
alenot (Stoapply to th;
and Professions Case: The Contmmor'a Limner Low data not apply to an
- 101 - FOUNDATM4bired Inspections "'3" '
owner Who Wilds ornarrates
ownerofh
of who does such wankndeda
102 - PIERS I
videdtat nosh improvements
or though s a own employees. provided the secs vernam mem. are not intended . or
his
i oneoold of
imen
- comrtdlon sthe.ILhawolde
_ _ _
103 - UFER
of prntesold-he
wibuildingvthe did
completion, the ownerbuilda will have the burden of proving Na M1edid not builder
improve for,mlroaofade.h
104 — REBAR '
. ... --- --
OmV. with
of the rySeeny.mn exdimses,
— — --
I05 — ANCHOR BOLTS
muct he Contractor
theoesa.15p,l704;BusinessandPn,whonsCade,Thet.thrtm's
_ dFrom ,si
106 — SEWER & WATER "'• "f" 'T
License
Licenu Law docs not apply Io an owner of propend who builds or improves Neuron,
and who mntmets.ror such projects with a comma...) license] pum,mnt to We
i
202 _ UNDERFLOOR PLUMBING --- — —"
Conlracmr's License Law, t It "'
°IameaemptundcrScC. 'v.B&PCfare;srta_a.a
203 — UNDERFLOOR" MECHANICAL
Oan;r"' '''' "' Bite
204 — UNDERFLOOR FRAME
_WORKER-SCOMPENSATIONDECLARATION
205 - UNDERFLOOR INSULATION
•' Ihereby affirm under aoahyofperjury on, ofthe following aeclprrilmns:
301 — ROUGH PLUMBING
1 n>ve >na will mainmin u'&,tirwdie of Can:ent I. off .i .... e for worker,
3 02 - TUB & OR SHOWER
min, samm as Provided for by Section 3700 of enc Labor Code, far the
rfamiatrce anhe wars Tar wWch Nia pentN•is usual., I,
303 — ROUGH MECHANICAL
❑Inote ..if will maint.eiVarkulCommsitionins mance.as"mmJbyScaiuo
304 — ROUGH ELECTRICAL
' 3700 of Inc Llai, Code for ih iiendiminion of Ih e werk for which III, eirmil,is3
- - -and '
O 5 — FRAME
isw J M W rke C� rt t o 1 Pol y be
- j/�9IHOLDOWNS
alfJ3PoliYNu1J8 LL
- -----..; ;_..—> — --
Cimo- /T��"
IefI.rCERIIFICATTON OF EXEMPTION FROM WORKERS:
1 •'1 307 �'-�'INSiJL'ATION
COMPENSATION TNSURANC1! " '
308",=—'SHEETROCK—...-. _
(Th .. et on ne d rat tic completed !the permil n farone hundred dollus
309 — EXTERIOR LATH
Isioel, teal„.,
m l in tn< e m c<'qi N< ' k r m n m d; I
Y tk .Pe
3'10— — 'INTERIOR -LATH—' ,-' — —
t t9Sryr. lt,up,: I ..
:,I _
hie not employ any person in any rmanrier so as to beeome subject to the Workers
-
311 — SCRATCH "COAT
en... . .. .,... -
Cmr,aryafiun laws of CdUmi.. Doer- .. ..Applitzam!
- 313 — ROOF NAIL
NOTICE TO APP LICANT If. Bcr making NSCertificate of E%<mDllon yaq aWda
501 — FINAL ELECTRICAL'ENE RGY
became sub ect ler the Warkcrs Compenzamn provisions of the tabor Chile, you mu.a
ban h 'comate witn,d<n Pawi,mns nr con p it _ en W emmed m,oked.
502 — . FINAL PLUMBING ENERGY
'CONSTRUCTION LEND& AGENCY. •.
l hereby bairn thio there is icnnstiuctioh lcnding'agen<y forme performance
503 — FINAL MECHANICAL ENERGY
of wan for which 'his pempt is issued lad. 3w7. Civ. C.(„
504 — FINAL BUILDING ENERGY
_
-L<ndir'sName”" ''
� LenJe'r's Adtlresi
--
SOS — FINAL ELECTRICAL,,.,
••
506 — GAS,TEST
minn is
, I ceaifY t o q..ple ¢ad ails citymw,mlaing
end on and,mm Nae sat d stat laws
armedngecmroctimDlrwith ,n styand countysentmi
507 — FINAL PLUMBING
,iand,In,
IOWildingcenfimeion.,iM1embyzuthtion'm,dumatives of Nis oily to enar upon
s7 the abo(We) lioncd propendfmimpcai manes. ,
508 - FINAL MECHANICAL
lo,
y!W<ldgrFcroscostsadex,reandAmphamay,inanywaoacrueaeinstsaid
509 — FINAL GRADE
q ,liabilities, sequence roses and which may _in end way accrue against said
ng or i
C City inconuqucncc of Ncgsomingof thispermit."' -
PLL ATUNDE STANDS "DWILLCOMPLY 'WITH AL NON -Pt
NA P ING
twxy _
.11
Date
Issued �l
c) AQ�W 3112k4_
Signature at Applicam/Commcmr .. I, Date
HA9 RDOUS MATERIALS DISCLOSURE'
Re -roofs
.. WIItheup'Ph, t or future building occupant tom handl reconditionmaterial
Type of Roof -- - - --
as defied b the Municipal Cad Chapter 912.ad IM Health and Safety
y
- I
'.s -j,,,, art <;'-,�� 'n t
Code Section 255].1.)
°Ycs r 1, �"
All. roofs shall.be,inspected prior, to any roofing material. being. instal led. .
�r W,II the Pplcv Iorf t Witding pant use c9apmc t devices s wch
If a roof is installed without first obtaining an inspection; I'agree'to remove
emir I d t m t as de ned by the Bay Area Air Quality Management
EL Dia c. — . -
°Y °
all new materials for inspection. Applicant understands and will comply with
all non point source regulations..
;I'h ive read the fi.A d ua mmarial"., irtnunts under Chapter 6.95 of the
t
Califomto HFaIW 4 Safety code 'Sections 25505.8537 and 35534; I understand that
'
if the building h . a., crrently haveoa t Lha t is ra,respon. bftymnotif, he
a2f P m !
.n 9'IeI�fe Certificate o
-
Signature of Applicant Date
is
All roof coverings to be Class 'B" or betier
ow,
.. OFFICE