02030056 (4) CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
10440 DE ANZA BLVD -42 SOUTHBAY CONSTRUCTION CC INC 02030056
OWNER'S NAME: APPLICATION SUB DATE
DR. CHIU OFFICE 511 DIVISION STREET 03/13/2002
HONE: SANITARY NO. CONTROL NO.
(408) 379-0400
O OZ ARCHITECT(ENGINEER: BUILDING PERMIT INFO
V BLDG ELECT PLUMB MECH
h<n L _7 I-1 LJ I__7
LICENSED CONTRACTOR'S DECLARATION
> provi,iao,o p g Job Description
z= 1 hcreh� )of that I am ofthecB antler f Cha ter Y and
mmencin P
: f; wnnfllforceandafect, on3nfthcBusinessandProkssiomCodcandmylicentt TEMP PERMIT. (30 DAYS ONLY, EXPIRES ON 04/�y
is in full force and effect.
OOr U License Class Lim,p
i 3 2 Date Comranor
ARCHITECT'S DECLARATION
YS I undcrsuna my plans shall he used as public records
i a o O Licensed Profcssinml
0 o that I am
DECLARATION
'+i='w 1 hereby affirm that 11. exempt from the Cessions o License taw for the
m a following ire,a(Seaton 703 1.5.Business and improve,
de Professions Gale:Any city or county $56000
z o which ts porn a co r a h p demolish.sh o p- y when
es. pilothat hn t I q ism
t f h poo a gaw(Chapter
statement
licensed p rt a n B
e Beat f iM1 C t /s License L ICha mr 9
-
aom 'ng_with seO 7Baq fD 3oftheB st dProfes. cede) `,{);,')'G3 3 4°.{ti.�(4 ?ii,.Ef-,r'ry'„ Valuation
or that he is exempt thetiefromi and the h.,i,far the allegcdbsumpron.Any vmlai o t "
of Sc tion 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of not more man five hundred dollars(s500). 10fIPN"PTbH1DATION Occupancy Type
Dl,as owner of the property.or my nnploycus with wages as their sole compensation, 102 -
will'do the work,and the'sime urc is notintendedor offered for sale(See:7044( - -
Bminaa,and Profession,Code:The contactors License Law doe,not apply to an 103 - UFER Required Inspections, -
owner of pm,dy who mild,or improve,'human and who does such work himself
or through h' employees.p vided that such improvements arc iintended or 104 REBAR
-offered far 1f h t buil d'n n i IJ tn' . -_._._. _ ....__ ...... . BOLTS'.
curt wnofpro a ane build
105 — ANCHOR BOLTS
completion,me owner butidcr will have the burden of proving that he did not build or '
mproveforpurpo.enfsale.). 106 — SEWER & WATER
�l as nwt er of ihepropetr 1 .. y g.. - ._ .. .202 = UNDERFLOOR- PLUMBING. .-._ ...,- ... _...-
,ivel o t t with 1 ce Lid va mrs to _
•onswct the project(Sec.]OW B .' cess and Profess ons GAC:)The Conimcmi s
License Law does not apply to an Owner of property whe builds or improves themon. 203 — UNDERFLOOR MECHANICAL'`, '
` p I carnations)licensed.pursuam.m the.
x umaas fns such tn'cax with a -.
and Lo c
Coma<mrs License law. ,. 1/ 3� .-204... -- `UNDERFLOOR FRAME-.._....._ .
❑lam use pt une�r s': `B&Pemr this mason 205 — UNDERFLOOR INSULATION
L� - DZ 301 — ROUGH PLUMBING
X30 1PEN�,onON DECLARATION 302 - TUB & OR SHOWER
Inereby air ander penalty of derjury doe or me following declarations: 303 — ROUGH MECHANICAL
o I nave Lind will maintain cunifi<me'of Consent idself-insure for workers 3 04 — ROUGH ELECTRICAL
Compensation, as previded-for by Section 37M of the Labor Code, for the
performance of the work19or.whichthispemtitisissued. 305 - FRAME
❑I have and will'maimain Worker's Compensaiion Inman¢,lig required by Scalba 3 06 - HOLDOWNS
r 37M of the Labor Crate,for lite Performance of the work for which this permit is
cued.My Workers compensation Insuance;carrier and Policy mother am 307 — INSULATION
c PbecyN 308 SHEETROCK' _. .r ...
CERTIFICATION OF E%EMPI'ION FROM.WORKERSa t :.i v'" s3R3'd "yi!"EXTE RIORm, LATH,
COMPRNSATIONINSURANCE
'
Thisseelion attcd not be completed'(the permit is for one hundad dollars
310"
($100)an In's) t 311 — SCRATCH COAT
,Aarib,xni,j Yy in any m.in y reninomarce n,,to swork
�ofar
beic me bject rntee w�.%�ai ,SOI:. — ..:FIROOF
NALNAIL
ELECTRI CAL' �.. -�..-.
Co Ipc sation'Laws ofCalif m..Data 'ENERGY
Applicant 502 -- FINAL -PLUMBING--ENERGY... ... .
,NOTICE TO APPLICANT If, fi ret king this C rif as ofE pion hould
Q
z becamesublcnmtheW A Conaksou previsions of the Labor Code.you 503 — FINAL MECHANICAL' ENERGY forthwith comply with s h provisions or thisperm t hall rte dM rt You n Lia
°k a. .- .. 504-. .- FINAL. BUILDING .ENERGY_..._
CONSTRUCrIONLENDI\G AGENCY - " 505 - FINAL ELECTRICAL '
1 work
farnxhy hickfirm that themis ed(Sion led g agency forthe pe forinance t
Lender's
ora for winch this pe t s issued(5 Tin]cw.c.) ' 5 0 6 - .GAS TEST
G Q ' Lend ,N me - ._,.-. .s
PAdd
507 — FINAL PLUMBING
D z
1 my that I hd91city
applicationd to to b 'fi fors 508 - FINAL MECHANI CAli
>.fes' Er c filen l g t on,a m ell inu J ne ordinances d state laws l ting 5 0 9 - FINAL GRADE
rJ t building construction, dhereby m nue p i Li es of this city to upon
>. 0. meabo to I.,Instant,far
yandogpryo 510 - FINAL PLANNING
,est.V) es judgments.
te indemnify fy lid keep harml Sitio City fCupcman agammt
(abilities se,-race coo de o es pe<nmv anywya< gainstsamg 514 — FINA PU IC WORKS
V z. City in canseyuen<e of a gli lit ng f thiw hi t (/
APP RCS RE , ERSTA YDS AND WILL COMPLY N'fl'H ALC NONP INT'
s once REc Ns i Issued by: Date
Z
I.M.M. pBc coin . .. :. .,. ,-:.: _. Re-roofs
-\
HA re il Cade Ch t store
a dndle Heahh and Safe,,
' ..''bull th' ppiicahi or metre Wilding Occupant eo handl M1azvd al Type a,der d by the c penin MyP - _... . .. _...
Cddc'Sect 755J3(a)? P t P 't A; s '•• . 3 + I e . . r: . . .
o Yes' ! \e I. ' ` !, !i All roofs shall be ms ected nor[o an roofin
P P y g material being installed.
i wTlme prl amort Wilding l tuiequipm t e ice,wncn If a roof is Installed without first obtaining am inspection';I agree too-remove
lith dourm !,`mmnan¢as defined by the By Arca Air Quality Management
N< all non-point source regulations. - - _ _and will comply with
._ all new materials for inspection. Applicant understands
t ml h ere d Ne hays. met nils q rcmeots uncle Ch pt 695 of the -
Cahfom,a Health&Safety Code Sections 25505 25531 entl 25574 l undemamtd that
if me budding does not cuocndy have,meant.that it is my responsibility m notify the
asomant of the rcqui hifh must be met poor to issuawc of Certificate;of
- .. � - �- 3 oz . Signature of Applicant Date _
:' Owner or N°^xedagem D to All roof coverings to be Class "B"or better
•_I _ .I OFFICE- - .. . . -. . ... _ .