02050015 cJ BUOF GDIVISION
PERTNNO
t PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10081 N WOLFE RD APPLIED CONSTRUCTION TECi
q y 02050015
DMENLOEEQUITIES 10050 N WOLFE RD, SW2-28 )05`/ 02/2002
'HONE: SANITARY NO. CONTROL NO.
(408) 252-9990
O te z ARCHITECTIENGINEER: BUILDING PERMIT INFO
m F BLDG ELECT PLUMB MF.CH
a IJ I'U I__U I---.I
S N= LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that 1 am licensed under p ovisions of Chapter 9(commencing
'yrs with Section 7") fDivision 3ohneBasine dProfeasin Cod and my seen. TENANT IMPROVEM NT/OFFICES
m I is in full force and effect.
s z u a License CI Lic.xurti�.h�"fG{—
'O O Date Comm%
3u"e CHIT ECT's DECLARATION
O I understand my plans shall Is,used a.public records
i
5�
i p o Licensed Professihnal
ac
�f e hisLL OWNER-BUILDER DECLARATION
m i9 w 1 hereby affirm that 1 and exempt from the Convector's License low for the
1-z following revwn.(Section 9031.5,Business and Professions Code:Any city or county �G, $250000
Sed-O which requires a permit m conatrver,alter,improve,demolish,or repair any awcture
6 3$ plt t ,al requires the applicant
pplicant for such Pe,mtu filesigned statement.
•,
poo s licensedpars II the prov,,mrs of the contractor LicenseLaw(Chapter 9 a ,• ., " - '
Val
(commencing With Seen..]OIXI fDona,mr3ofthe BusinessdPadid, u-ation
or chat he is exempt thcreGom and the basis for the alleged om rorAny viola
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firm
-of Si ttion 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty
of not more than five handled dollars a5W), 1 O 1APN NN314MAT I ON Occupancy Type
❑l.so his me of the propeny.armyemployees with wages cut their sole aompensmion. 102 PIERS
wit[do he work,aad'the awcture is nor intended m offered for sale:(Sec:I., 103 - UFER Required IOspection5a
Busmi,,and Professions Code:The Contmetla
or's License w docs not apply to an
a
vena,of property Who builds or improves thereon,and who does such work himself 104 - REBAR
or through his own employees.provided tom such improvements arc hart intended or _
offered iSale.wncow£vderthe im,mvernand of proves.mrd he did one year or 105 ANCHOR...-BOLTS "
completion,provec, aownerfb ailcd'r will have the burden of proving that he did not build or 106 - SEWER & WATER
improve purpou n
"0 L as owner or me properry.am tacki'vely contracting whit beenud eonremivam- 202" _..UNDERFLOOR PLUMBING . .. .... ........_ ..
construct the project(See.]Bw.Businass and Professions Cale:)Thecontaamr's 2 0 3 - UNDERFLOOR MECHANICAL
License Law dive,not apply m an owner of property who builds or improves thereon,
and who contacts for such projects with.contract.,( licensed.pursuant to the .. .. .-_ . 2 04 ---UNDERFLOOR -FRAME - -...
ense Lam,
Olamexcmptttunder5ec. ' .B&PC(a,this reason 205 - UNDERFLOORINSULATION
= Owner Date' 301 - ROUGH PLUMBING
WORKER'S COMPENSA'fIONDECI.ARATION 302 - TUB & OR SHOWER
• Ihereby afrmsunder,penalty ofpery6c,one othe following docliatmns: 303 = ROUGH MECHANICAL
n I have and will maimaia.Certificate of Consent to seE-Inure for Workers 3 04 ROUGH ELECTRICAL
Compensadoa. as provided for by Seaton 37W of he lobo, for r the
_
performance ance of he work far which this perm,is issued. 3 05 FRAME
❑I have and will maintain Worker's Compensation Insurance,as requited by section 3 06 - HOLDOWNS
37W of the Labor Code,for the performance of the work for which this permit is 307 - INSULATION
issued.My Worker's Cam nsmion Insurance carrier and Polio number arc:
a. 15!322273.. . .. 308 - :SHEETROCK
Carii 101n r' 'Policy Nat ,'i •.'M1 ,.
, ' CERTIFICATI N UI'EXEMPTION FROM WORKERS-'- 3 Ot9 '.-;%EXTER'I'OR LATH
OMPENSATI- INSURANCE , . — -330.<'--INTERIOR--LATH-'--_.,.. . -,. ..
(This uctioria ed not he completed athe permit is for one hundred dollars 311 SCRATCH COAT
(SI00Im less.)
313 — ' ROOF NAIL
1 cempl that in ibe n in nimnme a rhe work fur which this perms m carke;1 t -
':han not employ any person in any manner so as m become subject t tog workers 501 - FINAL EliECTRICAIJ ENERGY
Chat namidlawsofCaOfomia.Dam .502 — -FINAL PLUMBING ENERGY .
'Anprcan' -
NOTICG'10APPLICANT:If.ofmrmakin.tit„ CcnlfcamorExemptiomyoushoul0 503 - FINAL MECHANICAL ENERGY '
become
wbjact 1.the Vs riser'a Compensation provisions of the laborCde,you mull
ZC mnhwithcomply with such provisions orthis Permit shall Wdcemdrevaked. 504 - FINAL FINAL BUILDING ENERG]
fn CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL '
> I hereby affimt Itim there is a crnstm,inn lending agency for the perfnmmnce 506 - GAS TEST
�.,.. of atW
e work for which this permit is issued(Sec.3 ],Civ.C.) _
y.p Lender,Name-- 507 — FINAL PLUMBING
zLenders Address ,
v O 1minify that lhave'rcadthisepplicationand stamthmW
theaveinformationis 508 - FINAL MECHANICAL
PW. , eme et ree m m
1.gcomply with ml gity aad chanty aminaaces aad nota laws relating 509 - FINAL GRADE
O U to Wilding construction.and hereby autNoma representatives ofthis city toenter upon 510 — FINAL PLANNING
Wthe abase-commanced property for inspection purposes.
a tWr)mom tomom.Indemol,end keepharmmssthe City of capmarmcigaiaft 514 - FINAL PUB IC WORKS
IG, liabilities,judgments, In,and aspect.which may in any way commie against said
t.7 i City in consequence of the graining of this permit.
APPLICANT UNDERSTAND.iAAND WILL COMPLY WITH ALL NON�POINI' Issued by: Date
l/ UL
O.C6bILAJ�kAMIT� S• y
Signature of ApplirotAblerreas Data Ke-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will,theapplicant or faire building occupant'store or handle hmsNous material Type of Roofas defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code:Section 2553200' 1
' .' %I1 �•.`r )
All roofs shall be Inspected phot'toroofing material"being installed. _
Will the aapplicant future building occupant use componento devices witch If a roof is installed without first obtaining an inspection, I'agree'to remove
emthaa duo air cotmoms as defined by the Bay Am.Ail Quality Management
•o.t era all new materials for inspection. Applicant understands and will comply with
°res ❑No "" '”, all non-point source regulations.
1 helve read the haailrdous materials requirements under Chapter 6.95 of the
•California Heelth&Safety Code.Sections 25505,25533 and 25534.P understand that
if the building don not curently have a tenant.chat it is my respormibility m nmify rhe
oteupem of the requirements which must be met prior to issuance of a Ceniftcate of
Lpromy. Signature of Applicant Date
- eo S ato2
Owner or andamricedagennt r Date All roof coverings to be Class "B" or better
... .. .- .. .. -' OFFICE - -