01010063 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING A DDRESS: � 1 PERMIT NO.
10341 BUBB RD SOUTHBAY CONSTRUC ION 01010063
OWNER'S NAME: - APPLICATION SUB DME
V ST ENTS 511 DIVISION STREET 01/17./2001
HONH: SANI9'ARY NO. CONTKOI.NO.
(408) 379-0400
—0.09.O ARCHITEMENGINEER: BUILDING PERMITINFO
u C '— ,•,', dL ELECT PLUMB MECH
yai
ZS!:- IherebyalElrmtNSED thatIamliNnscdundelrpmi"d,n.fChaper9(commencing Job Descript' n t,f– withSection]IM1U)ofDivi.ion Sof he Beonw,,lend l�lm�p,C Cod cl licenve
¢ in full force nnJ
aC 6 Liccnw Clan I.if.N_
" LL Date ;p� SDECItnr �>1p _$ INTERIOR DEMO FOR ONE FLOOR"
LL la.O S III'I'IiCT'S DECIAR
e– I aIle rand my plan,hall be used as public accord.,
csf l
ce p O Licensed professional _
o'°•o OWNER BUILDI R DECLARATION
\TION ']
a=v ng so affirm that l nes m C tract C tette
t Z 2 folk lib IS t ]U31 5 Business and P f Cudc Any city county
F� wh I 9 pe l _t 1 .It p J I'.1 p' y.t uure
i Cam prnl t I. y- .11 'Dpl' If 11 11 tilekvl:el sort
that he islicensed, It m p nn c t t e 1 c bol cluipter _ Sq. Ft. Flo A� Valuation
loam g th Slit ]IMP) fir i [th B .--e, lidew r:. Code)
mduanhe"s cunpl twretr,mand Ill,ha.n fie, [at alleged lee,pt nu.Any volati I
ofSection70315 by any applicant or a.limit stmjecu the applicant n,a civil penalty P $.{� �@
of out mare thanhandled APNNumb er Occu an
❑1,lex owner of the and
the s ler ray cis o t in with doges as ed f ode le(Sm.
will en the work,and the structure i.not intended or,c[,me for sale(Sec.]o of
owes13. m..and I',Who h ld,o me coetmaor.,and w Lad doe.,oat appy h,an 3572@@@�:g6iwd,Inspections
r of pmprnY Who bunds lir intpmoe he, lee n,and who encs m n wink intended
or '
o erred o his oda employees.werbuilding
that aleph improvement
is sols ore not ine su or —completion.
lin Bale.IL nowuilde the wilding lir hard,.
omens n.wed within moi year of -
ampm to,,. owner-wader will nave he nnreen lir proving that he til not Build lir 1 01 — FOUNDATION `
nrynrve fir purpnne ol'valcl. , '
°T.as owner at the pmpeny,am exclusively ennlraaing whn licensed commemr.to 10'2 — PIERS
eon.tmct the pn'leel(See.7044,Ruane,,Bad Prof r..I..,Camp:)The Can lmemr's 1 03 — UFE R '
Licenw �
Law da ,nal appy to a.,awned or paopcvly dna hold,lir i upnovc,theneoa. - 1 @4 — REBR R
and who contracts for such with a cultralicensed pursm uant the
Contmcq,Is,License Use
❑Iane exempt ande,Sec. nNPeb,rlhis rea,nn 105 — ANCHOR BOLTS
Owner Date 106 — SEWER fl WATER
WORKE R'S COMPENSATION DECLARATION
I herebyIBrm under _ 202 - UNDERFLOOR PLUMBING
a penallyafperjuryoneofinefollowingdcdaram,n,: 203 — UNDERFLOOR MECHANICAL
iI I have ;fill will mlelnln'm a C.dfeste of Consent w sill mare fir W nosy,
0 —
nmpen.mica, us pmvidm for by Section 3)1X1 of the Labor Cole. far me 204 UNDERFLOOR FRAME
k37W
anee afthe work for which this pemtit i.i...on. 205 — UNDERFLOOR INSULATION
e and will n aimdol Wode,'s Cantpcnwron fl,canee.as rel by Seednn
the labor Codr.for thedam onnence of me work lin which illi..crud,i, 301 — ROUGH PLUMBING
M nker,eom ali m,araN� anePURernumherare302 — TUB & OR SHOWER
oi " �� 303 — ROUGH MECHANICAL
COMPENSATION INSURANCE 304 — ROUGH ELECTRICAL
Thisseotion need nnI be mngileord if the permit is fir one hundred dolim,lle.,.) 305 — FRAME
1 certify mal in the performance or the work far which tai,,pemtil i.issued,I 306 — HOLDOWNS
.hall not employ any person in any manner so a,to become subject to me worker. 307 — INSULATION .
compensmion law.of California.Dale
Appheam 308 — SHEETROCK
NO'l'ICH'1 D APPI.ICAN n If,after making this Ccnilicum of Exemption.you should
Z
Become subject ,the Wol Compensation provisions ofthe labor Code,von must 309 — EXTERIOR LATH 0 hIll In'lumpy with .,It provisiam or permit nhall IN,datmed rcroked.
F � CO.NS'1RUCIION LENDING AGENCY
310 — INTERIOR LATH
Ci 7 Ihereby alHnnthat them isaconstruction lending agency for the twifermeucc 311 — SCRATCH COAT _
of the work for which this Penni,i.idued(See.3w],Civ.C.)
0. c Lente„Name 313 — ROOF NAIL
. 7 z fender:Address
U Chat leavere;tanti,appueallr, oil.rttmthat dwa wehtn,r,n:ttitn i, 501 — FINAL ELECTRICAL ENERGY
ri E. correct.1 agree In Comply with all city and county ordinances and,late mw,mlaling 502 — F INR LUMB NG ENERGY
V to wilding construction.and hereby annual representatives ofthi.v city to enter upon
y W the abs ocntiancdpmperytbrinspectionmrpo 503 — FIN L ECH ICAL ENERGY
A. (We)affirm to sort,Indemnify and keep harmless the Clly of Culs:rliou against
lin lidlili¢.jedgnterl..co and exWhy ,ayacemeagam.t,aid 504 — FI'NA BUIL ING ENERGY
V Z City in ace c n A
APPLICANT J TAN ,ALL NG POINT 505 - FAN RI A -7eRnor+ 1, Issued by: �j. /en"are. • "°"rterip
ae Re-roofs507 — FI RL PLUMBINGILV'.ANIII]I15 [ '
.. Wile a e'a am lir famm wading my it om'ha m Waste na..ndaa,mammal Type of Roof
a.Jefuum h}the
Gaf+nlna M1lunicipel Cs,de.Chapter 9.12,and the Health and Safety 508 — - F NAL MECHANICAL
Conk,SmI In 2559.1.)? AL ppqq
°Y" °N° All roofs shall be ��/G`�ted r �[jJ�V�,y�p 5Q'f" 1G I being installed.
Will the applicamur to...huilding oweapanl nxeynipnmm or J°"eO"which Ila rOOf lS installed 0U151 sl d6Cl ilSn�ff' DE �`�
ems Lwordoue air Call leflails as Jetmcd by the Bay Area Air Quality Management ,F d �('eC,tO remove
all new materials fo;P4�pec�fioFi.I.*`ica5i�n�51 3i11 comply with
❑Yes IJ No all non-point source regulations.
' I brve read the hmcoun,mat,nak Imano,ol under Chapter 6.95 of the -
Californio HeaIb&Safety CoJe,Smtions 255115,25533 d2557A.1 undenunJ that
fide building,1 1. a Isurly a I'll, tb nit u "aamm,iht I.pff
cunlnf lhne' n r(uwl WWII l t ,.nee loluyenfoapane. ` Signatures of Applicant Date
lieroraoll ori, Iagent — — — , /- All roof coverings to be Class "B" or better
OFFICE