01080043 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10080 N WOLFE RD . 2ND FL . MAS APPLIED CONSTRUCTION TECH 01080043
Q�yy�t,,�NpME' APPLICATION SUB DATE
Mh'1VLU EQUITIES 2241 CALLE DE LUNA 08/07/2001
PHONE: (408) 987-4970 SANITARY NO. CONTROL NO.
woo ARCHITEC(ENGINEER: BUILDING PERMIT INFO
O BLDG ELECT PLUMB MF.CH
F i ca
Ny
y i LICENSED CONTRACTOR'SDECLARATION Job Description
_o hereby affirm but 1 am liccnssd underderprovisions
rovisions of Chapter 9(commencing TENANT IMPROVEMENT.
wFan with o Section 7")of Division 3 of the Business and Professions Code.and my license
is in full fo,ce and eIf (�2
:m m< License Class Lic,a
:O a U Dae Conwclor
EL
1 3 u.to CHI S DECLARATI N
Om 1 undrmand my plans shall w used as public moods
I O O Licensed Professional
OWNER-BUILDER DECLARATION \(1
o, I hereby affirm that 1 am exempt from the Convector's License Law for the "
t_z a fallowing reason.(Section 7031.5.Business and Professions Code:Any city or county _ S 704
5 F p h,or¢pair any ran come
NN C which 9 Pe . cont wet h p d I'
6prio for mount,th ppl rf ch perm uo file angrred sum m-
mat nl of icard pursuant hilhopioilions fine Contractors License law(Chapn 9 \' 31$12k10$��r 0FY , ' V
0�
uation
(commencing the t '700[1)of Division 3 of the BusinessandProfe.ssonsCode) ,�gj.,`�,�,yj" f t�:
or that be is exempt thenefm n and the buss far the alleged coorrpdaa.Any violation"
ofSmtmr 7031:5 by any upplicam fora permit subjects the applicant m o civil penalty
•ofnamare than rvehanareddollars S500). 101AP'N 1119 MATION i '' Occupancy Type
D Las owner ardor property.or my employees;with wages as their sole compensation, 102 - PIERS r
win do the work;and the structure is not intended or offered for sale(sec.70M,-se 10 3 - UFER •' '1'"
Busincand Professions Code:Tic Contractor's License law does not apply to an Required Inspections'
owner of property Who builds or improves thereon.and who does such work himself 104 - REBAR
or through his own employees.provided that such improvements sure not Intended in .. . .. . ..' _ ___ _
—Ore.2d for sale.If,wwe.er,the bdimprovement .lding or is sale within one year of '105 - -ANCHOR BOLTS �. G0 ','.: . . '.:
ompletifnnr the owmerrfbu;W'will have the burden of proving that he did not build or 106 - SEWER & WATER
improve puryo 1
202 UNDERFLOOR PLUMBING-
C1 Las ow an,of the venport,t esdusively contracting with licensed convenors no - - -
- °nswetthe project(Sm.7aa.Business and ProreasionsCma:)To,Canwaors 203 - UNDERFLOOR MECHANICALrt . I,_ ' ,
License Law does nm apply to ea ownr of pmpeny,who builds or improves thereon,
and who convects for aan projects with a contracmrta)licamed pursuant to me 204 UNDERFLOOR -FRAME --
_
Combat Late. aw.r 2O5 - UNDERFLOOR.: INSULATION
D 1 am exempt under Sm. B A P C for this.ason
o'wna. Data - 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
Ihereby affirm under penalty ofperjury ora<ofthe following declarations: 303 - ROUGH MECHANICAL
D 1 have and will maintain a certificate of consent to self-insure for Warkers 304 - ROUGH ELECTRICAL
Compensation. as Provided for by section 37M of he Labor Cade. far me 305 - FRAME
perfommnceof the work for which this permit is issued.
_-- D l have and(vill maintain Worker's Compt iciAon Insurance,as mquired by Section 306 - HOEDOWNS
370o or the labor code,for be paramour or the work for which this permit is 3 07 - INSULATION
tomed.My Worker's compensation Insurance carrier and Policy number - .
_ SHEETROCK ---- ._.. --
atl¢r.4tr�/�7� ol yN..: / ��.2 �'7.3�Ot ry n, fist k r v . .vs..l .:, 'D
f''if CERTIFICATION OF.MEMMON FROM WORKERS'. - L.tJ3• sS�./ XT•ERIORe"LATH'zl 1
COMPENSATION INSURANCE ' -" :i -- 31.0— :INT;ER3IOR--LATH-- ' =--- - - - -
(Thoaseethm need not be compinedd the perms,is far one hundred do][. 311 SCRATCH COAT tl:..•n;.
[51BD)anra..) 313 --• ROOF NAIL _. . ..;._.
.nfy;wn in He crbmit work far h h this permit ed,L. 501 - FINAL ELECTRICAL
rsnall of employ any Pe n in any manner so as to hewn a object to the Workers'
Campemaion Laws or Cahfom;u,Daae 502 - FINAL PLUMBING ENERGY.-
..Applc t _ .. .__ .
NOTICE TO
.Q�. APPLICANIf f igim crtfcYte ofE pt you should
503 - _FINAL MECHANICAL_ ENERGY
eWQbee s 6ttothk C pnkaro provisions ofthe ab Carter,you most
bh 'mmply with such or this ermshalar dmedrtcked. 504 - FINAL BUILDING ENERGY, ------
_b
"
•• CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL ^ "
1 hembypfr,m that there is a construction lending agency for the performance 506 - GAS TES T
'of the work for which this pevmt is sided slice.3097.Civ.CJ '
ly:q larder's Name' - -507 - FINAL PLUMBING ' -
�.Z lsndEra;Adore:.. - . , —
U�O . 1 repay so."Imply
have mad this ii,ficatioeand sone that the awva inf car cion is 508 FINAL MECHANICAL
ha E,,,, 2odcct.1 agree to wmply with all city and county ordinances and state laws miming 1 509 - FINAL GRADE
'O U the Wngconsarcdpm,ndhertinspecorimksaws. vesofthiscinymcmcrup°n 510 - FINAL PLANNING
me above-memionca Pmpcny,for inspection puryous.
Ir„ q (we)agreeno swe,irWemuify and keep hamlcss me City acupeli io against 514 - FINAL PUBL C WORKS
Vl liabilities,judgments.casts and expenses which may in any way accrue against said
U.Z Ciry inconsequence of the germing of Nis pcm,it. I
SPPLICDilB,ANr 'ULDEBO SDS DWILL COMPLY WITH ALL NON-POINT' Issued by: Date D
SignamicTpplicanJCommnor Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
W II me applicant o Ration,wading occupant store or hande nmsrdous materiel -Type Of ROOF
-- as defi dby me Catan Minn c/tlsal Cod Ch pt 9.12.and melHeilm ands ftY 4 1't' ; 't c'> S Y •',_I°s• -��"
Code Sm on 25581) t 7)a w; , '1 xAs. _
All roofs shall be inspected prior to.any.roofing material being installed.
Will he applicant far..welds goccupant usew P n rdevice. hien If a roof is installed without first obtaining an inspection, I agieeto remove
,.it h mrd as cot t Rn d by th Bay Area A Quality Management
Mol? all new materials for inspection. Applicant understands and will comply with
Dyes r "° all non-point source regulations.,
k x 1 ...
I have read me'wzadous-materials r lmormcros ander Clat mr 6.95 of the
Califomia Heilm&Safety Code.Sections 25505;25533 and 25534.1 understand that
if the building does not currently have a lenant;that it is my responsibility to notify the
occupant of the mquirements which must w t prior Rs issuance of a Certificate of.
:7 °" p r' - /J Signature of Applicant Date
C _Te
Ale/Z All roof coverings to be Class"B"or better
{{ Owner morizcd agent' Dae
�i,
":i •..... . .[. . ' . . . OFFICE -