02010113 CITY OF CUPERTINO - - - -
BUILDING DIVISION ��` CONTRACTOR INF l �N:-
L
S: PERMIT N0.
WOLFE RD 2057 02010113
APPLICATION SUB DATE
STORES INC 01/28/2002
SANITARY NO. CONTROL NO.
EER: BUILDING PERMIT INFO
S N Z LICENSED CONTRACTOR'S DECLARATION �®
I hereby affirm that 1 am licensed underprovisions of Chapter9(commencing Job Desc1=11 �AL
;_�5 w <nion R100)ofit nn Sof the Buainessand Pmfessie Cde.and mylicense TENANT IMPROVEMENT w
tin fall fnptsee anr�effe�v // /yd
'O ii,enseClop=j-012G �o�tRra<md -4 Z���o„•� ,:., MAY 212002
ARCHITECTS DECLARATION
y 1 understand my plans shall be used as pmlk records
I>oo LicensedProres,ienal BUILDING
se OWNER-BUILDER DECLARATION
1 hereby affirm tem 1 am exempt from the Contractor's License Law for the
C Z¢ following reason.(S...iun 7031.5.Bmmaxs add Profession Code:Any city or county $32750
❑
which q a permit t construct, It improve,demolish.or repay structureny struc
3 ...terre,at - -- - - — -
thathe is licensed pursuant '
anitthbP to of be Contractors a w(Chapter L La 9 s�2'�Fr.Ap�a[n. n :mak Valuation
(c emm�g th aon 7(1P0)of Dtv 3 f the Basins e e P o Code) I. 0, .(J�
or that he Is exempt therefrom and the basis for the alleges!exam idido Any violation '
of Sections-7031.5 by any appliedmfor.Permit srd arts meeapplicarite,a civil penalty- q
of not mare man five hennaed dollars 101 IN DAT I ON Occupancy Type
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,'And'the structureis or intended ad offered far sale(Scc.7044,' 102 PirsRs - - -
Business and Professions Code:The Contractor's License Law does not apply to an 103 — UFER Required Inspections
r.
owner of property Who builds improvesand whod h work himself s
ono through nemple Provided mt: n improvements t tensa .,..__.,.-.,,_„_104. - REBAR - - _- '
offeredf theowed however.the M1 'avet mp emeni sola 'the notb dor 105 — ANCHOR BOLTS
icompletion,the owner bu leer will have the burden of proving that he aid not hudJ or
mprove for padpost,nr,ale.7. 106 - SEWER & WATER _
Ijlaaowner tuthetee Progeny exclusivelycontractingwmlce licensed 202 — UNDERFLOOR PLUMBING
License
construct the prosect(S 7044 owner d e Professions Codr)np Contractor's t
L pn Law does mtapply manawaedorpropenywho hanas rtnprovevnerenn 203 - UNDERFLOOR MECHANICAL -
Contlo,emabodri seLaw. tractor(,)licensed.pursuant-to.the . ._ -_ ..__-2
..__._.__.
204 -- UNDERFLOOR FRAME _-..
and.who.commcts fon such prolems wu e.con
of .a xemptanae sed ” B'aPcronni.rca,on 205 - UNDERFLOOR' INSULATION
-` O ner e ' „Date .1 P.
WORKLRSCOMPENSATIONDECLARATION 301 - ROUGH PLUMBING
I hereby affirm anaed penaityofperJa4y onbofihefoBowingaeclaradons: - 302 - TUB & OR SHOWER
303 - ROUGH MECHANICAL
❑ 1 neve'and will aioteiti'a'Ceni6caie'of Consent to self-insure for Worker's
Cempeavarka, ea,Provided Im by Section 3700 of the Labor Code, forme 304 - ROUGH ELECTRICAL
performance oRha work,for which this permit is issued. . 305 - FRAME
01hina'andavill m.iniaWok6r'sCom6cnsation'in.urasrequimdbySeetion 306 - HOLDOWNS
3700' f the Labor Cod mi the perfer an fth rk fai which this permit is
iss yWorker' c pe.smi..lametwe canner andPliy..other _ 307 INSULATION
COMPENSATION INSURANCE
.!, Ycc -.
Came I CERTIFICATION OF,EXEMPolioPTION FRQM`W KERS I 4' 309^I - '"EXTERIOREO ' -.
tik+l;
_. _
'LATH
31`0.1 - '•INTERIOR LATH
(Thr sect do neeJ not be completed f the permit Is for one hundred aollarx ”'
ISIoO)o le
ss.).. .,. , . .. n ....,...,n.. ..... . -:. ..,,. . ' 311 - SCRATCH COAT ".
-_
I(sen bry dht4ainnthe
nf 'Ararat ,
0
fh
n
ord --' ..-- . . -e.:_ ON
shl oa py any pe on y ma e m beam subject to he Workers
Compen ion Laws of Celt ts.Dart 501FINAL ELECTRICAL
,7._-...E.N. ER
G.
-Y
.
Applicant . ruf.- 502- FINAL PLUMBING ENERGY------
NOTICE TO APPLICANTIf,aft ment s encpt you should
pbeeotres Meet tothe Worker's sC moansationproons ofthe
Labor
Code,you must 503 FINAL MECHANICAL ENERGY
thsuchpro ns tpermit eoked forthwithcomplywi504 FINAL-BUILDING ENERGY,
CONSTRUCTIONLENDINGAGENCY
> 505 FINAL ELECTRICAL; l!
..._.... �_.�. _`_..,.....-I--
I
amIfor ntnm P< tssuacSe309TC
Uwork , : _- _506.- . _GAS. TEST. ...__ ..............
LaAaarers' .:Z
.._--
507 - FINAL PLUMBING -
�.7"� Iertify that l have ad this irp,fiernics.and stale that the.1swe information is 508 - FINAL MECHANICAL
W Ey 'correct.I agree to comply with all city and conmy,milinances and state laws relating 509 - FINAL GRADE
O [) rubuilding t cit n and hereby ante z representatives of this city to ent r pan
� fid the nb.,c-.enii.ncd pr perry for nspectinp ry 510 - FINAL PLANNING
Ae (Wo) g Bios a nde ify and keep h Issme,Cty fcupeninodgainst vvv
Ln liabilities,judgments, tad expense which y ,n any ay accrue against, ata 514 - F I NA P C R }S
�.) z CA
e sequence of theg m gof III t \`G�
A LICA UNDERSTANDS AND W I COMPLY WITH A{.L 1fON pOIIST°'
uRCEOGuI:Anods �, i,'; 7�� Issued by: Date
g
;_Will the70
Pepplieam ofDumre Wilding odcuLantDs CLOD t Date Re-roofs
vrhandle hazardous material Type Of ROOF -. ... -.-..
. . . ..-.� .. ...-
❑Y ❑No': q SURE 5 f ty ..... .... ...
me or
- - - as d fin a b th Cup run M n teal p ' ,, x
,1
(al ) - -All roofs s >' --'a 7,
cast a5s3a hall be inspected pr or to,any roofing material being installed...
y e t .a t t an
Wn the applicant or future building caper use equipment or devices which If a roof is installed'without first obtaining an inspection';'Pagree tdremove
) oy'AmaA Quality Management ,
dna:a ae is<o t m sant,as definedall new materials for inspection. Applicant understands and will_comply with
b the p __. .. ._ ..-_ ,_ -,.
` bf ❑avealth&Sefel CodeYe, , Terms requirements
under
1 ter 6. all non-- SOULCe regUlatlOns
I ha a cad the et rode,in terms mrementAnd 255 Cha red 6.93 of the t
C y stand that
.the tIoftdpes enot currently have a iremetswhihmu rte tlis to issuance
a 'nificfy the -
oc m f the regmrem m which must b et p 'to i nce of a 1. .1 ateofeau '
p y _Dac� Signature_ofApplic�Allroofcoverin Dat
/ w �/ ?— e
a .
a. 0 or eAlh..z age, coverings CO be Class B Or`be[teC
r .OFFICE -._..-. ... .. . _ . . _. ..,....._. .. .-.. . .._._ _.-.