00100135 (3) CITY ON CUPFRTINO
nun.Duvc DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING Atsl a2 FORGE DR SOUTHBAY CONSTRUCT"ID jF.RMll NO001.00135
OWNER'SN1 APPLICATION UB DATE
6%:LIX 511 DIVISION STREET 11/19/2000
ONE: (4013)�r79-0400 SANITARY NO. CONTROL NO.
i
MOO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
PLUMB ME
O -]
'0 Z y= I hereby al ro [tLICENSED at tli enud and,pry a nln�.RACh apter 9 F amM ndny Job Description
F_Coof withS«,innnwn)nrui.isinns°nncBmsInes,andworesinmerW,mdmyE«ns` TEN. IMRV7 PLUS ELECT AND MECH'
am is In full force and effect. _
K w� Limnsc Class Lica
ce
3 a N Dare cnmmm,nr
C a O Q AHC111TEC1"S DECLARA'110N -
•� I undeomnd any plans shall be used as public record,at
/p O Livened Professional
UW NEWHUILD!Ion1'ION
¢ I ansct 1 am eifrom the contractor's - far bit
(_ toll momm (Section]B5 Business and Professions Code:Any city o county
which rets itt consumer,aper improve,demolish, liY structure
liart tissuance, Lsnrequiresthapplicantf hp. 's signed [)
ball 1 t t is I self,
Sq. Ft. Floor Area '
-
/
Vya
o g thy ] The 3 ftp 1 Jprofessions Codl W
�f0of that he is therefrom and the basis for the allege)exemption.Any violation -
ofSection 7031.5 by anyapplicant
for a permit subjects the applicant to o civil penalty
ornm more ratan E.e nanar�d dmlan Iss(ror. APN Number Occupancy Type
°I.as owner(it he property,or my employees with wages as their sole anmpen,mlon, 31.6119030. 00
will do the work:,and the structure is not intended or offend for sale(Sec.7041, -
Business and Pndessmas Code:The Culture 's License Law does not apply a)an ReCured Inspections
oner of property Who builds or improves thereon,and wild does such work himself 101 — FOUNDR I ON
...Shmugh has own employees l rovidrd that such Intpmvenmms nm not amended nr
offered for sale.1t.however,the building rat improvetmma is sold worms one rear nr 102 — P.I ERS
completion,the owmacbmider will have the burden pof proving that he did not build or UFE R
improve forurrye
sofsale.). 103 —
°I,a.,owel,ed She vroperty,am exclusively rommctag with licensed contractors o 1.04 — REBAR
LmW...I the pmjm(Sec.70144,Busies,and Padessions Cndup'flm Cnmmaors
icense Lwdre,no,applyol an ovearofpropeny who huildsorimpmves mercmt, 105 — ANCHOR BOLTS
d who contracts lamm
r such police[,will)a eomndm s)licensed pursuant the 1.06 — SEWER R WATER,mCircuit,rs CircLaw.
C0 lam exempt ander sec. ,B&isCfo.this art.xnn 202 — UNDERFLOOR PLUMBING
Owner WORKER'S COMFF.NSA]'[ON DECLARATION r_2Q13 — UNDERFLOOR MECHANICAL
I tetchy affirm under penalty of perjuy one of the following declarations: 204 - UNDERFLOOR FRAME
I hese and will maimain C,niicma of Consort se)ein,am for W..kcr's 205 — UNDERFLOOR INSULATION
emmposillun. as provided for by Section 37W of the "bar Code, for the 301 — ROUGH PLUMBING
performance of the work fm which this pi m)ii is ismm.
❑lIonic and will maiandoWnrk..aCnotpensationinsurance,asrcgtdredhySection 302 — TUB R• OR SHOWER
eta)or the I annr Cole,be Pae peronnance of the'work for wmah this permit is303 — ROUGH MECHANICAL
issued.MY Workers Cmnpeosanon Insurance carrier and Policy number are:
camper: Pohcy Na: 304 — ROUGH ELECTRICAL
CF.RTIFICAI'(ON OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 305 — FRAME
_ E
(This amion ne�J not be completed if the permit is fm ane hundred dolls. 306 — HOLDOWNS
SI00)mle,s.) 307 — INSULATION
I coldy that in the perionnance of the work for whim do,pcmmil is i...ed,1 308 •- SHEETROCK
,hall not employ any person in any manner so as to become subject to the Workers'
Compemati°nl.aws ifemifornia.Done 309 — EXTERIOR LATH
Applicant
N(M ICE TO A ITUCANT.If,after making this Cerifi lent Escmmiun.youshould 310 — INTER.I.OR LATH
hocoe objets lathe Wndm
al's Cnpensamn 1a
provlsbmot he for Code.yam...... 311 SCRATCH COAT'
lls)
O Cm
ferosimnn»Nywhh,uchpro,;,inns or la,permasbaEledecmedmvrksd — '
P4CONST RUCTION LENDINGAGF.NCY - 3ROOF NAIL 1
I hereby alErtn thm there is o couswction tiding agency for the perfmmunme —
ofhewmklbrwldehthislsco is1..racd(Set.san.Ci,C.) 501 FINAL ELECTRICAL ENERGY
A. ° Lene.'tnud'mxs 502 —' F INAI_' PLUIhIBING ENERGY
D 0 1sclifythatIhave read this application and,mtethat the anweinformatiomis 503 — FINAL MECHANICAL ENERGY
w correct I agree it)comply with nn city nod cmlmy nrdimmces and stole laws relating 504' —' FINAL BU Z LD I NI ENERGY
O f, to hn' m
dding p ,ra.mi,and lureby authw itcreprascomwes al this city..)ewer uon pE
w the aMle-mapopry for inspection pD osses.
a IWO agree
to case.indemnify keep hathe Ciry of Cu nano against 505 FINAL ELECTRICAL
UVY liabilities judgmams testis and espen.ws which may in may'way acerae iii said 506 (+
7� m c'ncncenrmcgrart agofrmspro.. S TEST �1
A PI NT UNDEI S" NDS ILL COMPLY WITH ALL NON-POINT �/� / �V
;c ru"n� I)I o .s 1�L Issued lay: 507 — F1!1!31_ PLUMBING Date !
Signuwm urn ppf)canticnnlr:[cDole Re-roofs I: — ` " _
HAZARDOUS MAIERIALS DISCLOSURE 509 FINAL GRADE
Will tee appraam nr home branding relapse saga.n.namdle 1imilairms mtme"w Type of Roof .
us defined by pm Cupertino Municipal Code,Chap¢.1).12,and the Health and Safety 5]0 — FINAL PLANNING
Code,Secslon 2553Ne)'1
EI yes
All roofs shalkbtrats cfFd t
pe (itRh CF93d)Btodl6r gIdORHS being installed.
wlu the apphant man, defirlmg reapnau raw egnip)eu mde,mea whidt to
a roof is installed without first obtaining an inspection, I agree['o remove
^mit hazardous air conuminams us Jcpncof by the bay Area Air Quality Management g P g
• t^ - - all new materials for inspection. Applicant understands and will comply with
°ie'` �N° . dl n .point source regulations.
I hove rad the hmurdw[,nuuaids ecquironems aide[Cbplcr 6.95 of she
California call[,3 Safety Code.Section,25505,25533 and 25534.1 under-,mnJ that -
ifthebuildingdulis not currently have a tenant.that it is my mspemihility tonality the 1I
uc p t of the regoi ems whic [ t be me[prior m issuance of a Certificate of
., a ey. Signature of Applicant Dale
Owner u .athmtoedl— Date _ All roof coverings to be Class "B" or better
OFFICE