01100106 - i
CITY
BUILDING DN
PERONo
UPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10080 N WOLFE RD 2ND FL. /fs ���/(p (ui✓ST/�Lr< %e� 01100106
pW E: APPLICVON SyB DATE.
I EQUITIES (SW3-250) 22rf / '�/(C P&2- �•A/4— 10/ 18/2001
PHONE: q q - SANITARY NO. CONTROL NO.
rgC -/ /d'7 - 07o
❑u 2 ARCHITECTRiNGINEER: BUILDING PERMIT INFO
P w oC'1 BLDG ELECT PLUMB ME.CH
=1 O LD
�R�
Z LICENSED CONTRdundersDEarrof ION Job Description
iz: Ihi7")ofthat i1umrimedunderprovisionsofnsCode9ndmmennngf TENANT IMPROVEMENT.
;rnCj with sectiore ameffect.
fDivisioa3 of the Business and Prolcssions Code,and my license
is
in camfull aClaeatM effecv 2 1 (NO PLAN CHECK FEE .
o.6 intense emss Crit o 7 �jOG Y
Dat= contr ter i�6 ORIGINAL PERMIT NO. 01080043)
j LL a0 In Ats H.H LCIS DECLARATION
u� � r I underowned my plans shall be used u,public rentMs
T
i O o Licensed Promotional -
'°• OWNER-BUILDER DECLARATION
uvi I'hemby affirm that I am exempt from the Commuctor's License law for the'
H
r
following mazon.(Section 7031.5.Business and Professions Cade:Any city or county'
C
which requires a l to construct.nher, p I Torrepair ay grvaurc
m m -pns issuance.alsorequirest the applicant fsuch Formal
tofile.sigrcd summers
s
ha"sed puistdrorrf the prosivi,lians ofthCommucho,seem.law(Chapter 9 {'i S Ft Floor-, earl , -I ation
(x .c'ing with.Section'!0110) fDivision3 fin B les,am Prpresswns C°de) ('t_lX�( IYq'y t)s L_0�.
or that he is emmpt therefrom erd the basis for the dleg ckemptwa.Any vmlahon• t
-of Semon 7031.5 by any applicant for v permit subjects me applicant to a civil penalty'
f or nm more man r"e hnnarce d°vara IaSoo>, 316' Il LlIn.b@IU !: t eancy Type
❑1:as owner of the prope y,or my employees with wages as their sole compensation,
will'd°the work.and the strums a is not intended of offered for sale(Sec.7844,•, 101 - FOUNDAT Tired Inspections
Business and Profession Code:The Contractor's License law docs not apply tow °
owner of property Who Wilds or improves thereon,and who does such wmk himself 102 - PIERS
f
err tomo h his own employes.provided that such improvements arc not intended or.
'oR eed�r'sale.If.however,the barring°r improvement is sold within ore year or 10 3 - UFER
completion,the owner-Winter will have the Wrdenofmoving thin hedid not Wild or 104 - REBAR '
improve for purpose°f mla.) I
105 _ ANCHOR BOLTS'
❑Las owner of the property,um 1huatmvdy contracting with licensed Contractor's
is ( 'b�r •.
- wswcr me project Isec.7t3a4,ensmms and Roressiws code:)TM1e contncrors 10 6 - SEWER & WATER i
- License law dont not apply to an owner of property who builds or impmvea therton,
midd who contmns for such projects wish a contractions)licensed pursuant to the. 2 02 - UNDERFLOOR PLUMBING
oi:c(°mvt` tiers B'&Pcrormisrtaon 203 - UNDERFLOOR!-MECHANICAL
ownerDate' 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
Ihe.yafrmtuad,,penaltyofperps"one ofinefollowing dedamtmns: 301 - ROUGH PLUMBING
[I1 have and will'maintam a Ccdifieatc of Consent to rtes-incur=for Warmers 3 02 - TUB & OR SHOWER
Compensation, as provided for by Section 37W of the Labor Code, for the 303 - ROUGH MECHANICAL
performance of the work ssu
for which this pa mit is named.
0 have a ad will rrwinuin Wotkx,*x Cona,mation ltscorance,as mi,iired by Savona 304 - ROUGH ELECTRICAL
3700 of the Lothar Code.for the parfn.of the work for which this permit is 3 05 - FRAME
ismeii My w hers cqTpinjapon_Timurroicoand PducymucoIn rn; ..w•,,,. 306 -HOEDOWNS '. , _ __.,._ ,_._ .__ ..
cin ' =FYAY6 riMl
Policy N _. _
/��2 �. y .....,...._ . .
CERT IFICATIONOEEXEMPIION OM WORI(HRS! Y t �30+71'=� IN$UL'AT-ION i'.Z`+•
e .. .. COMPENSATION INSURANCE .._--_-- 308—I. ..:SH'EETROCK-'_,.,___ _ _ . _ _-.. ._.- _ . ..._._ _ .. .
(` 71
_
P 309 EXTERIOR LATH
' (Thii union need nm M completed Wife permit is for one hundred dollars _
a100)mima.) _ - 310 - INTERIOR LATH
. .;.1«^ifythat inthe pi:rr°rrameaormldotkfor which this p=routisiamedrl 31.1 - SCRATCH ''COAT
shall not employ any person in wy ma ner so as to become subject m the Workers'
Cnmpeovoin owsoAfpplicand fCalifornia.Datt° 313 - ROOF NAIL
•
NOTICHTO APPLICAhFr If.after trading this Certificate ofEactophon.you should 501 - FINAL ELECTRICAL'�ENERGY '
become subject to the Wo ime,Compcnsation provisions.(the labor Code,you must
O C forthwim comply with such provision or this permit shut!W deemed revoked.. 502 - FINAL PLUMBING ENERGY
CONSTRUCfIONLENDINGAGENCY' 503 - FINAL MECHANICAL ENERGY' .
1 hereby affirm that Nerc n,o coosvuchma lending agntcy for the pnrformwce
:> arm;work far which hi,permit is toned S.300 7.Cis.C.) 504 - FINAL BUILDING ENERGY
Lenders Name' ....• .. 505 - FINAL ELECTRICAL .. .•. - -. -
= Z Lenders Address - - - - t. 1, 1. .
U,0 506 GAS. TEST
1 c ni ify that 1 hove read this application and state thin the above information is 507 - FINAL PLUMBING
W E., correct.I agree to comply with all city and county ordinances and state laws miming
O.0 m Wilding construction:and hereby authorize repmeenurves otthis city to enter upon, 508 - FINAL MECHANICAL
p� me ebo(wo)iqueempmpcny(ihifyind oce,houni
re,, (We)hgmet,coniandexfywdkhichano,inmywyoran,.,. atsait 509 - FINAL GRA
0 liabilities,judgmenta,emu and upensa which may in my way eurue agdnxt said
U �, Cry in canmyuVLAof N granting of this permit. . . 51 NA NG
APPLICANT NDERSTAN AND WILL COMPLY WITH ALLNONPoINT Issued�s - Date
t lILAT10N .. .. 9
stgs adu o"A,i`naam,Vo� ia/� '_. .,Do" Re-roofs
' HAZARDOUS MATERIALS DISCLOSURE'
bin me applicant citmtam Wilding'occupant store or handle b:imdommatend Type of Roof,
t as defined by the Cupertino Municipal Coda Chapter 9.12.and me Health and Safety I .y,_ �. , .t a 4 w,,A-
Code,Section 255321er'::,, t f: end; .1.j i u _ s i _ `.•t ' _..
. 'oYas ' - .�•:�". „ �;•,It.:.. ' ,.All roofs.shall-be,inspected prior to.any.roofing material.being.installed._ . . _ ...
Will the applicant or future building t esu equip t or dwiccs which r`•
" pP geccaPa^ ^rc^ If a roof is installed without first obtaining an inspection, I agree[o remove
emit hazardous ter contaminants as defined by the Bay Area Air Quality Management
Disuictp - all new materials for inspection. Applicant understands and will comply with
Dyes ' `'°: all non-point source regulations. r "
I neve lead the himad°us maiends requirements under chapter 695 of On,
'California Health&Safety Code,Sections 25505,25533 and 25534.I understand mat _
;if,me building does not currently have a tenons mat it is on,ra......bility to isudy the ,
occupant of the requirements which must W met prior to issuance of a Cer ificam of
_°" Signature of Applicant Date
All roof coverings to be Class "B"or better
Owner or vuthonzed agent',:r" . . - Date
OFFICE