00070010 (2) CITY OF CUPERI'INO �" > ��
BUILDINGDIVISION PERMITsCO. =R"ACATOR INFORMATION ¢
BUILDING ADDRESS: SOUTH BAY CONSTRUCTION CO P
Ot'NER'S NAME: 511 DIVISION STREET PERMIT LS
Pi E: SANITA
(408) 379-0400 BY O. CONTROLNO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUME MECH
0 0 0 0
j o o LICENSED CONTRACTOR'S DECLARATION Job Descri
i 1 heoby sffitm Nal I am licensed under provisions of Chapter 9(Commencing QtSD�LN n tt(lam D
with Section 7001)of Division 3 of the Business and professions Code.and my license la IIS
a in full Tota and effect.
License Class tic.0 TENANT IMPROV
FIyg-. Dam Conlractor OCT 3 1 -ate
N Q ARCHITECTS DECLARATION
2 Jy I understand my plans shall W uvA As public mmumb
a
Licensed Pmfnssiovl BUILDING
t7D OWNER-BUILDER DECLARATION 474/ 6e I�1�A
RX�f 1 hereby alllrm that I em exempt from the Convector's License Law for the
p o qfollowing mann.(Section 703 1.5,Business and Pmfeasiuns Code:Any city or county
$2 which muires a permm m re
it construct,shot.improve.demolish. pair any e.Cie.
prim to is issuance.ido requires;the applicant for well permit to rile a signed moment
2
that M is licensed pursuant to the provision of the Counraclut'l Licom Law(Chaplet 9 Sq. Ft.Floor Area $135)(yNtion
(commencing with Section 7000)of Division of the Business and Professions Code)or
that he Is exempt therefrom and the bas for the alleged exemption.Any violation of
Section 70313 by any applicant for a permit ubjects tins applicant o a civil penalty of 3Y��Tf Il�erpp Occupancy Type
not more than five hundred dollars(5500).
❑Lssownerof Nelompmty,mmyctuploS os with vngese Neirsolecompensation,
win do ihewah,ane Ua nmdurt is noHnvMed oroaemd forsslc(See.704/,Busim... 101 — FOUND
rod Profe cions Code:The Conlractots Llama Law does not apply Io an owns of Af€'el d Inspections
property who builds or improves lhermn.and who doessuchwerkhimaehforthrough his 102 — PIERS
own employees,provided that such)mprovemcna...II endedmofrertd ferule.if, 103 — UFER
however,the Wilding or improvement is sold within one year of completion,the nwne-
builder .wN haw the Widen of proving Wl W did not build m Improve for purpose or 104 — REBAR
gale.). 105 - ANCHOR BOLTS
❑1,ru owner of ct property..Business sinand eonlrwting with:)tensed canlnoon m
censdudthees project 1.an owner of
Profasiov CWe:) Lt. 106 — SEWER & WATER
cense law rims not apply to to own.of properly who Wilde or improve Norton,and
who mnuacu for such pmJecu wiNaconvacmr(s):)ttmeepursuanlmNe Canlnnoh' 202 — UNDERFLOOR PLUMBING
License 1 Am Lasa. 203 - UNDERFLOOR MECHANICAL
❑Ian exempt undo Sec. ,Bg:PCfor Nbrwm
204 - UNDERFLOOR FRAME
nes
WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION
I hereby aIDrm under peaty ofpedury one of dm following dusearanns: 301 - ROUGH PLUMBING
❑1have and will maintain a Certificate of Consenttoself-imum fm WorkeYg Compen. 302 — TUB do OR SHOWER
sation,As provided for by Section 3700 of the Labor Code,for the performance of an 303 - ROUGH MECHANICAL
work for which this permit Is Issued.
❑1 have end will mainan Worker's Compensation Insurance,As requited by Section 304 - ROUGH ELECTRICAL
5700 of the Labor Code,for the performance of Our work for which this permit itIssued. 30FR
My Workers Compensation Insurance ems ro5 — FRAME
Carrier: Policy
Policy number art: — LDOWNSCarrier:Carrier: CERTIFICATE OF EXEMPnoN 30 5 FROM WORKERS 307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
m laaj is seelim nerd not M completed if the permit is for one hundred dollan(g 100) 309 - EXTERIOR LATH
1 cenify that In We performance of the work for which this Permit is Issued.I shall not 310 - INTERIOR LATH
employ any pawnin any manner..as in beeome sub)auo tbe Workcti Commalion 311 — SCRATCH COAT
Laws of Califoroia.Dale
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT.IL offer making this Certificate of Exem don.you should 314 - T-BAR CEILING
become subject Ins the WorkeM1 Compensation provision.of the LaWr Code,you mus,
70 forthwith comply with such provisinmmthis permiuhallWdeemed mwkcd. 501 — FINAL ELECTRICAL ENERGY
�y CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
I hembyalrnm that lhert Is.consvucthm lending agency for Nt perrormarcc of 503 - FINAL MECHANICAL ENERGY
Z r.v the work fm which thispermit is lased(Sec.5097,Civ.C.I
r]G `""dr'Na"" 504 - FINAL BUILDING ENERGY
jz 1<nderanddme 505 - FINAL ELECTRICAL
J 0 1 certify Nu 1 have coed thisapplicationand coon ty ordinances Sam Nn the aWve m minlun Ix
y U cortccL 1 agree m comply wile all oily rod county nuand sea ewe reining l0 506 — GAS TEST
U building conswctioowdhereby orIMPOtbnrim tepmsenatiw_s of this City to enm upon the FIN PLUMB G
asave-mentiomd propcnY for Insptmi9n purpoma
(We)sgra to...indemnify and kap burnfleas the City of Cupertino against 0 84FI L
fn Ilabltifiq,Judgmena,cath and expenses which may in enywysmuc egainel aid City
J 7 in eanxquencc of Nc granting of this permit. 5
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINT Issued by:5 9ING Date
SOURCE REGULATIONS.
Signature of ApplicaRe-roofs 514 NAL PUBLIC WORKS
HAZARDOUS
ODamAZA
HUS MATE RIALS DISCLOSURE 7ypeofRob�6 - FINAL BUILDING
Will No applicant or(Muni building occupant nm oomeheNm omaterial
U defined by Ne Cupertino Municipal Code.Chapter 9.13,ron d the
e Hulth and Safely
code. yu ONO 33s53(a)7
OAll roofs shall be inspected prior to any roofing material being installed.
Ye
Will the applicant or future building occupant use equipment or dcvias which If a roof is installed without first obtaining an inspection,I agree to remove
o.mll haardous all mmaminanls es defined by the Bay Area Air Quality Management all new materials for inspection.
Dimicl7
❑Yes ONO
I hex mW Ne hvatdous mareriaartquimmcna under Chapnr6.95 ortw Cslifor-
his HeatNASafey Carie,Secdum35505,35555md355M.1underuand NUlf Nc Wilding
does not currently how a mnan%Nn it is my responsibility to madly Ne occupant of,he
mquimmtnts which must he met poor on lssuame ora Certificate of Occupwcy. Signature Of Applicant Date
Owner ar.amnome.gen, Dam All roof coverings to be Class "B"or better
r oUx
GGRYTT�C xYrxYr�' n� '!I�n,uY I.ncnnnr�IC�u I SOUPI�ICvn":,ICirr I� _
OK. ,
PERMIT N0100070010 "RS INC
PERM TYPE COMML-TI 16922 FORGE D0.
^ 1*2"^ I.N�.S,�P'E C T _ P ,rte= Loo�up
+ LD"N' H,I ..;T"O� RY
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INSP TYPE NO INSPECTOR .INSP DT RES NOTES +
505 5 H '7..':'3 CC 1410/31 OO C_P,
. 50715 2-CC t 10131/00' P
508 s 3 CC 10/31/00 P
516 ' + �5CC " T�RT/nn. P
i164t+CC. 1003/00-
516
0%03/00 516 3 CC 09/28/00 C
504 I. ]5 �� 09,25/00 R U48
505,E t ++ ,2.j)5
a ill. 09/25/00• R + .N " 4
507. 1 OS '1�' 06/,25/00. A + a�
SOB w 2 35 09/25/00 R
516 2 ]5 09/25/00, R
.AD ,.`06/31/00' C
Por-F50 }T HIGHLIGHT CHOICE PRESS <TABY FOR DETAIL,, <ESC> TO EXIT
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