02040127 (2) CI sun of GUOPERONNO PERMIT CONTRACTOR INFORMATION: kt
BUILDING ADDRESS: PERMIT NO.
10594/10600 DE ANZA BLVD 02040127
'WNER'S NAME: APPLICATION SUB DATE
BYER PROPERTIES 04/23/2002
r PHONE:. NO. CONTROL NO. f
os Z ARCHITEC IENGINLER: BUILDING PERMIT INFO
do O BLDG ELECT PLUMB MECH
'tit C::3 E= U
LICENSED CONTRACTOR'S DECLARATION
n 1 hereby aarn that 1 an licensed under provisions of Chapter 9(commencing Job Description
'� u9 with So,mm7000)of Division 3 of the Bminessand Professi...CWr,.nd my license TENANT IMPROVEMENT
177 is in full force end effect.
s o i License Class Lic.p
13 u y Date Convector
ARCHITE DECLARATION
C g 1 usetl es public recoNs
i Y
I 6 O O Licen Professional
'�,oma� OWNER-BUILDER DECLARATION
1 hcrtby ef0rm that 11. exempt from the Contmemr's License Law for the
t 3 6
following requires
a.(Section]onstr Business and Professions Code:Any city or count ., $20000
Ei{CSC
which«score pesmu t construct,t alcor, p d Mash sw tures
3 Pno an its issuance.Also req th the ngAaof rw sN met.ri7o oirs.Ln to -cat
[bar be acing with
Section
t7W rif isms lshe C mrasin L¢nee lawl e 9 Valuation
(cont n -g iX$amt ]OW)mf DrvrsronJ of the Bu massa dP ofss un C" I 'e l'i49F3t8 �°f,. ,T. p,+!?"a
rims,fi s exeml{ithe f m and the basis fm the allegep.examplbn Anyn id b' 1"
Mrs d 7031.5 HX an,applicant for.permit bdems the eppl a m:av if �'P
ofnot more than I.dW dMXaa(u�oo>. 4jlt 1IO lAPN Ni GDATION ' Occupancye
❑1,downer of the opcny,or m loaves r wogcs as r r Compc�ti _ PIE
will nes: work,- she:vert rs n ¢ dor oRe for a Required Inspections,
Business arta Proves con cense Law does not apply man 10 3 - UFER 9 P
owner of property r improves thereon,and who does such work himself 10 4 - REBAR_,.,
car through his own employees provided that such tmprovemems arc not intended or
oRemid for sale If,however.the building or improvement is sold within one year of _ _ .. .. . .. . .... . ... .. . _. .._-.. _ _
completion,the owner budder will have the burden of proving that he did not Wild or 105 - ANCHOR BOLTS
improve for purpose of sale.). 106 - SEWER & WATER
°Lasowner of Ne p(Sec.7amexclusivelydPrfeisins Co cenxd Cn¢mtsto 202 - UNDERFLOOR PLUMBING
conswn the does
n (Sec.]044,Business mW ed,who
Code:)The Contractor's -
-- License Law does nMt apply ro an owner of property wnM wiles or improve:thereon, 203 - UNDERFLOOR MECHANICAL"
and.who contracts for.such projectswith a Contractor(s).licensed.pursuant-to_the ..___. . ._
Contractors LRense Law.. - "" "204- _ 'UNDERFLOOR" FRAME
of.m.aemt cr5<c. ,B&PCforthisrcson 205 - UNDERFLOOR INSULATION
_ - .is
II °1 Zj'DL 301 - ROUGH PLUMBING
WORKER'S COMPENSAT�N DECLARATION
302 - TUB & OR SHOWER
0 Ihercby ef6wunder,penah,of perjury one of the following declared ons: 303 — ROUGH MECHANICAL
° I have and will moiniain a Cenificme of Consent to Wf-imme for Worker's 304 - ROUGH ELECTRICAL
Compensation, as.provided for by Section 3]00 of the Labor Code, for the
'p,dormance or me work for which this penerit is issued. 305 - FRAME
°1 have and will maintain Worker's Compensation Insurance,as required by Section 3 06 - HOLDOWNS
3]00 of the Labor Code,for the performance of the work for which this permit is
- - s:ued.MyWolmesCompensaronInsurance carrier andPolicynumberam: 307 - INSULATION
Clamej .r, Policy No.: �308ti:=;,SHEETROCK.; - --- - - -- - '
CERTIFICATION OF EXEMPTION FROM WORKERS! S � ' '3'O9 <t -EXTERI OR4•"LATH
COMPENSATION INSURANCE" _
" frhii section need out he completed if the permit is for one hundred dollars 310. -�,INTER I OR--LATH ' •"' tC
IsloO)or less.) _ 311 - SCRATCH COAT
1 cenify thin in thaperfortsnce of the work for whim this permit ie issued,I
313 - ROOF NAIL :. .._ _._ - - — - — ..
shall alit employ any person in any manner so az to wcome sabj1m the workers' 5 01 — FINAL ELECTRI CAL"ENERGY
Camps,"To
Laws of Califomie:Date'
_applicant —502 '--FINAL PLUMBING ENERGY --
NOTICE TO APPLICANT:If,after making this Ceniacate of Exemption,you should `
Become subjecto the Workers Compensation provisions ofthe Laver Code,you must 503 - FINAL MECHANICAL ENERGY
0 Cv forthwith comply with such provisions or this pconitshall bedeemed revoked SO4 FINAL BUILDING ENERGY_-- .
CONSTRUCTION LENDING AGENCY SOS — FINAL ELECTRICAL
j I h - by firm th t th r Construction)coding agency for Ne performance 506 - GAS TEST
wa Londe s Address ,_work for nth perm t :sued(sec 309].Civ.C) . ..
.Z -Landof er)comfy that _ .. __.. ... _ . -. _.... _ ... .. _..
' 507 - FINAL PLUMBING_
U O have mad this application and stale that the above information is 508 - FINAL MECHANICAL
W:�i correct.I agree to comply with all city and county ordinances andthi come lows relining 509 - FINAL GRADE
O.V m atsnve-menswnl propeahercinspeconaereposemetives of thiicity to enter upon
y P. the abov ed agree to save,property and)mtion pWonde 510 — FINAL PLANNING
F ;P.0 es,j agree to save,and c indemnify and keep harmless Ne City of Cupertino against
U h liabilities,judgments,casts end expenses which may in any way.eccrue gafnn saip 514 — F INA PU I C WORKS
U City in consequence of the granting D this permit.
APPLICANT f,$TANDSM'DWILL COMPLYNTTHALLNO -POINT' Issued by: Date O
r3lyt ce>:e 2
_ SigniumcofA ican onwemr r"" "' 'Date` Re-roofs
/9 HAZARDOUS MATERIALS DISCLOSURE
W II/hc applicant or future wilding occupant store or handle harvtlom material . 'I�rpe of Roof -
es defined Jthe Cupertino Municipal Code Chapter 9.12,and the Health and Safety ,
Code.Section'2502(e) /t,' ,, -. ,r I t .• 3 .
❑Ya N°: - '-i^' I __All roofs-shall-be inspected-pnor-to any roofing_material being.installed.__-
W II the app)cat or-future buil-din'S'nucupitim.use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
-mit he rd a an cont ant nod by the Bay Area A Q ahiy Management
D,amet] _ all new materials for inspection. Applicant understands and will comply with
l °Y^ all non-point source regulations:, t
I have rend the hasmdoux materiels regmrements under Chapterb 95 bLthe
California Health&Safety Code.Sections 25505,25533 and 25534.1 understand that
ifthe wilding d x,run dutrently have a tenant.that it is my rtsponsibiliry ro notify the _
occupant of the r quiremenb which man w met priono issuance o[a CeniOcate'of
+' Occupancy. '
Signature of Applicant Date
? owner or 41mmorni agent- Dme All roof coverings to be Class"B" or better
OFFICE