02030059 (2) CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: PERMIT NO.
10465 S DE ANZA BLVD 02030059
OWNER'S NAME APPLICATION SUB DATE
FAR EAST NATIONAL BANK 03/ 13/2002
PHONE: SANITARY NO, CONTROL NO.
E 00 zo ARCHITF.CT/ENGINEER BUILDING PERMIT IN0
u
ad LDG ELECT PLUMB MECI
5 n= LICENSED CONTRACTOR'S DECLARATION escr
Job Description
i2N I hereby affirm that l am licensed under provisions of Chapter 9(commencing n P
mF_LL villa Scnin.70010)=(Division3ofthcPme„ nn,Code.radntylicense T ERMIT.*SO DAYS, EXPIRES ON 04/13/02
j y 17 Isin full tome and effect.
:ee i u License Class Lie.p
Dile Contmemr
a, —A— N'DECLARATION '�!c
1 understand my plans shall he used as public records tiwy ,
i�
i-_O o Licensed Professional -
e iL OWTIF,R-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Convaror's License Law for the
h 2 a following reason.(Section 7031..Business and PrefeWmis Cade Any city or county
rcF O which requires a vanit m cnvamc,•alms improve,demolish,or repair any structure $5 5 , O
i3Q PnortOlLencC.aleq the PPlcant ficamehaardend triple asigned Statement-
that
ttementthat anislicerdod purdambth,provisions ofthe Contractor's License L (Chapmr9 Qty(emormer,in,oiih Ser 7000)ofU ion 3oflhe Burnes{ ndPofpso.s Coael g1p'p( pt1.�_J q�.pf�spV}
f , aluation.. .. .
or,hathe is cseram theiermm-and the basis for the allijed adnpuod.Any violation
of Scaum 00315 byanyapplirnn,for a permit mlb,s,he ticaina to a civil,emil,y
'ofam come than five hundred dollars($500). 10 CPNDATION t occupancy Type
❑L as owner bfIm progeny.or ,my enhployees with wages.me,.1.1c eampemanon,
' .
wilt do the work:and the structure is not-intended'or offered far sale Ise )Ilii, - -
B.slness dad Pmres,la.,Cade tm
The Connh oLicense Law does nm,apply ho as 10 3 - UFER Required Inspections '
.r,nrou n n zn`own ems io'le,or msided] meuch ism who eons such work himself 104 — REBAR
6 P Yecs providedbar s such improvements a ot' t tlm or ,_. _ __.-_ _ -_ - _
cBeredmr,merwcvcn,will
base' , 1e build ar 105 — ANCHOR BOLTS
imnplain. the owner-builder w u nave me mimeo or proJag mm he did mat bade or
mprove for parts.of sale). 106 — SEWER & WATER
c 202 UNDERFLOOR' PLUMBING-
consumer❑namerthe inec p(Spc,y exclusivelyrcontractingwith ted m ,onto "-- -
.i.nswn the ods n (Set,IDW,Business d Professions CotloJ The Con,m thereon,
cent<Laweae. foapply o.sed,nnawnet wtrpmperywho b.acconed,prave,t,totir, 203 — UNDERFLOOR MECHANICAL' '.
Comormo.commms(Law. .projems with e.commnor(s).licensed pursuanLm me
con,m=mraLic<a,e_Law. v, — 204— - - UNDERFLOOR...FRAME- ....._..._. . . ..._..._ . _ _....
❑lamca=mp,nnaersc.” s&PCfor this 2aoa 205 — UNDERFLOOR INSULATION
- ow:"�r ' Lie'e' 301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 3O2 — TUB Fie OR SHOWER
In=rebr M.a,vlur peamty arperjd,Iarm of me mnowmg deduratian.:- 303 - ROUGH MECHANICAL
0 1 have and a ill matn,ain a Cerificam of Consent to selGmsmc for worker's 3 04 — ROUGH ELECTRICAL
ar Compensation; .as,provided for by Section 37W of the Labor Code, for the
Performa.«afineworkfor which his proad isissued. 305 - FRAME
❑I have and w'ill,miimain Worker's Compcnsabon Insumnce.'as required by Section 306 — HOLDOWNS
3700 of the Labor Code,for the performance of the work for which this permit is 3 0 7 - INSULATION
_. issued.M W'orkcYI Compensation Imurince came,and Policy number tire:
"..
carr S r. '.h�PheyN. ' - ,.30$;. �-SHEETROCK .. _ ... ._.._.
CERTIFICATION'OF EXEMPTIONFROMWORKIRSI • - .�'` + , 3'09- `-1•`EXTERIOR'-LAT&
COMPENSATION INSURANCE_ - - —
'an. forndcA nor be eeapletee rhe permit is for one hundred dollars
31-0"'=-_INTERIOR....LATH._._.,.. ... . . .._ ... _._.. .—'—. _ .._..
IsloB) ries.) 311 — SCRATCH COAT
,uontry I a,in WE part,", ah anhe w.r for whch cots h;ni .:-...:_:_.31-3 ---ROOF -NAIL =
i'hall no,'mPlo
ad p'so'`in ,e subject iolb<Workers' 501 — FINAL ELECTRICAL'`ENERGY"�
x 502 --. FINAL..-PLUMBING .ENERGY .._. _
—
OTICE TO' A fah king th Rf t fE - y should ,.
b en h w k ret . tp anM
onsL ode ymum ., 503 — FINAL MECHANICAL ENERGY
Z C rano ithcI iu nProvisions arfail x rad,t shelfb a ked._ 504...--. FINAL BUILDING ENERGY .,
'CONSTRUCHONLENDING AGENCY 505 - FINAL ELECTRICAL
1 h by firm that,h o,s much on lending agency f th kormanc<
w p zov.c.) 506 — GAS_ TEST
ti Lnne k for orris m tint' asued(See 309
L Q Lend N .. ,::. . . . .. _
507 — FINAL PLUMBING
U Z linde Add it - - ---
U:O I certify that 1 have read this application and state that he above information is 508 — FINAL MECHANICAL
OW F. aorrc0.1 agree to comply with all city and county ordinances mad state laws relating 5 09 — FINAL GRADE
-r,J m building construction:and hereby a.thoriie mpresemadves of this city to cmc,upon
r w the above-meptomedproperty for mspechiOn purposes 510 — FINAL PLANNING
F., 16 (W vee rosave.indemnify and keep haemless,he City of Cup,adhou again,,
m liabiftie, adgmenu.costs an J expenses which may in any way acme agates,,aid 514 — FINAL PU ,1 0 S
'U Z Cifyi cunsee, c tomtit in .f this permit., � n
A ICmWILE OMPLY N 'POINT 1 /�---�Z_
S RCE RE c q l Issued by: — Date
signmure afAp man Cnmmetar "IRe-roofs y
H ZARDOUS MATERIALS DISCLOSURE
h
•` Will thea 1' at orfuuue Building=ccupaid stoic mhandle haire ous mmol
as defined n the .Type of Roof...... . ,
pea Municipal 1 C de Chapter 9 12 d,he Heal d s fety - —
Cade Sen 25532(m)u I , ..,-Ells. -
All roofs soh 15e-Inspected�pnor to an roofin material
wum ppicamo r, wler =ww= equipment d nen Y g. m&[alleli_., ... .. _
. ,n a ,a = dram tit a a eanrm Bey AAh Quality M gement If a roof Is installed w[halt Irst obtaining an 1 Ion, I'agree.L.remove
I all new materials for inspection g understands and will comply with
1 have a me.na:a d mat rma re all non-point,,"dice regulation '
❑Y
q rcments antler Ch pter 95 of,he -
i he mm Helm&Safety Code.Seniors 25585,25533 and 255341 unders,mor that
dmc bur 'n60Is not c.mbi haves mount.that it is my responsibility to notify the — -- -
.ecup <quirdmema which' zI be met ¢uence of S Cenifierm of - -
poncY.hl .
_ - - Signatu Applicant Date _
All roof coverings to be Class "B" or better "
h zcA I
.-,, :.. .:... ._OFFICE - -
..� ... _ , .