01050131 (2)r
1
L
CITYILDING DI ERTINO
SION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
20425 STEVENS CREEK BLVD.
SOUTHBAY CONSTRUCTION
01050131
OWNER'S NAME:
APPLICATION SUB DATE
hill TRAMMELL CROW CO.
511 DIVISION STREET
05/14/2001
PHONE:
SANITARY NO. CONTROL NO.
(408)379-0400
Z ARCHITECT/ENGINEER :
O
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I.J
i LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby a1am, that 1 am licensed under provisions of Chapmr9 (commencing
to with Senior7000).!Division 3 of the Business and weln m3-?"
TENANT IMPROVEMENT.
Is In full force and 7 C
aLicarec Class` Lic.N
Ddlf _8,/
// ARCHITECPS DECLA
S DECA
,< 1 understand my pia ..holt be used as public records
aLicensed Professional
ne OWNER -BUILDER DECLARATION
ot 1 hereby affirm that I am exempt form the Contracmr'x License Law for the
�!
milowing maser. (Seclian 7051.5, Business and Pmfeesions Coke: Any city or county,
1 0 5 0 6 0 0
p which requires a permit to construct, alma improve, demolish, or repair any .nrucmre
.prion. its issuance. also rcgore, theapPlicamforsuch pfmduo fits, "gnedslalemem.
— that he is licensed pmsuannoth,prorisiowofcomContractors License Law (Chapter 9
(commcnciag with Scmion7000)of Division 3 of the Business and Professions Coder
Fj jppr Tact
1 1 •3192jj �`J-a}
Valuation
or Thai he is exempr themr,, m and the h ous for the alleged exemption, Any viclminn
y.' „6rs
'
—of Section 7031:5 by any applicant for a permit subjects the applicant m a civil penally
,oro°t more than Five hundred donate(S50B).
,,r:,6�
101A'N �tr t7ATION
'''jy '-' Occupancy Type
01. as owner of the property. or my employees w an wages as their sole compensdron,
_
:. _..... -
103 - UFER Required Inspections- t:
will do the work. and the structure is not intended or offeree for sae (Sec. 7034,'
Buxinei and Professions Cone: The Commucwr's License Law does not apply or an
own r of property Who builds or improves thereon, and who does such work himself
intendedor
104 — REBAR
ofthrough u mpmyeet pbuildin bar ipowdimmisimprovement,Out
"'core lei 1'-Ifhowever,thell buildingorofu-la 'm nae year or
---. .._
- 105 - ANCHOR BOLTS '
icompletion. me owm«.wdeer war have me burden or proving that he did not band or
mprove forpurposeofsme.).
106 — SEWER & WATER
r m the my, exclusively contracting with licensed commcwrs m
01. P x _u "S w'
202 – UNDERFLOOR PLUMBING r ---
Professions ilei, or The ve, meC.mmu..
ronswn the does
n (Sm.,Dead Business property
License Law a«a not apply m an owner my won voce or improve:
203 – UNDERFLOOR MECHANICAL''''
t W the
r ...ana_whn.aontcrin or.�am projects with a.ean�m,etnma).Been.ea pursuant ro me.
with a co
"'
._ . - 20.4.. -..UNDERFLOOR. FRAME.-..-
Commcmrs Liccnsc Low. ,
.s-�.B&PCfnrthisreason
❑IamcscmptundcrSo<.'
205 – UNDERFLOORI'INSUliATION
Osn=r Datc" `"
301 – ROUGH PLUMBING
"' WORKER' S COMPENSATION DECLARATION
302 – TUB & OR SHOWER
Inerebrarrmnunder pewhyorperjpryone ofinernnowmgaeelatarona:
303 ROUGH MECHANICAL
I'.
o I bav6 anddal mmnmin a cenmctim of Consent In seir-mare for Worker's
_
304 ROUGH ELECTRICAL
Comlxnmtion: as Provided for by Second 371%1 of the Labor Code. for the
performaoce of he work for which this permit isioofd..,
305 — FRAME
IM1 a 'II ,il. Worker', C ,r ( I: q dbys r
306 — HOLDOWNS
`f70U f in Lab Cod 1 the psi f the k f which this ' I cook i
klsc pe f Insurance and Poly x
307 INSULATION
CsuaM
im� 3,a ;o
_—
308 ;- iSHEEROCK..
WORKERS
CRTIFICATIONOFEI[ONI
,
- 309 '– EXTERIOR `LATH -
INSURANCE
_COMPENSATION INSURANCE_ "'" "
-310--',.- INTERIOR" "LATH ' _ "`
not be completed if the permit is for one hundred dollars
311 SCRATCH COAT
(EIWI oThL`u;Ai°nnW
–
rtiy to tmm_p t m kr h M1m a mie,s ee,]
313' – ROOF''NAIIi"
shall taeIms�pr�loyanyP '^ to b msubjectt .hWorkers'
501 – FINAL ELECTRICAL�'ENERGY
ry+ �y
Co.-die
t- - -
kpPico^sT0'
" 502- -' FI'NAL PLUMBING -'ENERGY -- --- '
503 - FINAL MECHANICAL ENERGY �
Y I mf t IE pnon.yooumulst
AP AN a term ationprevisions
tN orm, subject Compsnsm on pmvvt a mon
be bjcn w the Work
dosid, erred nooked
Idnhwim comply with such provisions or this permit shall be Jccmcd revoked.
pr shall lie
__.. -.. _.. ... ..
504...-.- FINAL_.BUILDING ENERGY_. ......._ _..._____ _.
s,t
` CONSTRUCTION LENDING AGENCY '.
505 - FINAL ELECTRICAL
I hemby arfmr Thar them is a construction lending agency for the, perfummrce
of he work for 'Ich his .at, issued (Sid. 3w7..Civ.e)
506. — GAS, TEST.
,,
Lender. Nd _
1<a sAadm,, ".
.... — - ... . .__-- . .... .. .... . ..... _ ..
507 FINAL PLUMBING,•,
r 1 certify that 1 have read this application and smm that the above information is
508 – FINAL MECHANICAL
cored. 1 agrcc to comply,wiih all city and county ordinances and nae laws relating
509 – FINAL GRADE
to building construction, and hereby unionize repre.sentarives of this city to enter upon .
m d ve-m pdnwd propeny lbr insp Ginn Purpoas, .
510 – FINAL PLANNING
y (We) agrcc 10loss. indfmnify and keep harmless the City of Cupem ear, against
A liabilities, judgmelns, cons and expenses, which may in any say i«me agent said
514 – FINAL PUBLIC WORKS
�. cit i^ coney uencc rt ini granting ot'this 'permit. .
APPLICANT UNDERSTANDS AND WILL COMPLY" WITH ALL NGH.POINT
Issued by: Date
Y'
SOURCE. REGULATIONS: i 1'
Siemt r.nf APPI e:mVC m .n - , '. Dale -
r HAZARDOUS' MATERIALS DISCLOSURE
Or
Re -roofs �7
W,11m applicantor fur Wldn,ga pant t lmralle hasvdous ma¢rial
ase fined by the Cupen Municipal Gyle, Chapter 9,12, and the Health and Safely
SCM
TypeofRoof, ,
"'.. t
1 ', -, ..
4, , I �.
❑Vc,235)2f l7
L3 No 1'h i'•,,
All roofs shall be. inspected. prior to any. roofing.material-being installed._,-
Will theo Room bolding pat use equipment devices which
el,
If a roof is installed without first obtaining an inspecuon;'I'are to remove
lh lair cot , rams as defined by he B -y Arco Air Quoin, Management
nlstriaT: „
all new materials for. inspection. Applicant understands and will comply with
0Y" ONO .
all non -point source regulations.:,
.( I have read iit h d m tar I requirement, u e Chapte 695 of the
.Calf H slih & S f ly Ciel S I'm 255115 35533 and 25534 1.understand chat
Blind building docs rimcurrently have am tthtiti myrcpo b'Igt md"Im
'
ace pant of the requirement xhidi must be tan poor to is. oared of a Cemfcac of
y '
Signature of Applicant Date
All roof coverings to be Class "B" or better'
ownet or ant .nada agen1� Date
,
- ., -L.... .. ,.. OFFICE ..