01070084 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0.
20425 STEVENS CREEK BLVDSO THBAY CONSTRUCTION 01070084
OWNER'S NAME:(1%� �� /� APPLICATION SUB DATE
J G/Jit? I�I ( /�� 511 DIVISION STREET 07/19/2001
PHONE: SANITARY NO. CONTROLNO,
\ 3 t5 _ 5- SO(, (408) 379-0400
BUILDING PERMIT INFO
O O ARCN/I/TE_CrIENGINEER: L BLDG ELECT PLUMB MECH
<� TK N✓ VtlM1/etA-��S G/06 CJ LJ I__7 Cl
y LICENSED CONTRACTOR'S DECLARATION
p z y I hereby )of not 1 am W licensed under provisions of Chapter 9(commencing Job Description
Fin f- wire SectioneOWI orect.,onlol the Business and fcssions encased my license TEMPORARY PERMIT.
retell force and rrcem. S36g9 y (EXPIRED ON AUG. /19/2001)
z z License sc Class �_ p
3 a ale 5DEC Contractor
ARCHITECT'S DECLARATION
l=a O I understand my plans shall b<med us public records '
sir
an d p Licensed Professional
OWNER-BUILDER DECLARATION
I naso affirm that 1 1. exempt from the Contractor's Code:Any
Law for the
? following croon.(Section 703 Business and Professions h.orAny city acme county
which requires a permit m ronsaua,alter,improve,demolish, fi tepid,any ewnum
i3—..-pdono is ancemso q movisioc rf hpemdLivemLaw(ahapter t. - -- - - ----- -
neom .c lipursuant)7M provisions rte Contractor's ina an seLawonsCcr9 s� y rSq. FI F',1006ACeaq.
feu me cine wnh Sxeref om a of obaDivision 3 er the leges e s reed Professions Coda ., '. y •'a-, 1 t'n P. 1'\_ <r_�_ -�• fin'\
or that ha is exempt thercfmm awl of noir roc the cts the ppliendno.Any I mmmn ,.e7
-of aiainn]O)to hY anydrP do dfmaPermifnipiects the npplicnm macivil panahy
of oat chary Ilion Era nnwrca aauara ascot. P umbar Occupancy Type
l
°1,as owner of the propenY•or my employees with wages o Rut rule comarmusi
- will do the work,-and the structure is not intended or offered for sale Sac:]OL$.
Bourn and'Pram,siana Code:The Commcmr's License Law does nut apply m an 102 — PIERS Required Inspections;,'
owner of property Who Wilds or improve,roman,and who does such work himself 10 3 — UFER +
or through his own employees.provided that such improvements are not intended or
offered ter kale.If;however,the nodal _ tis sola within one year of -.____ .. .. RE
gar impmvanc° r 104 — REBAR -"'--
completion,the owner-builder will have the burden of proving that he did not build or
improve sorpt,ryose 0fault,.). 105 — ANCHOR_ BOLTS _ _
ol.a:owneri�nn.cm,sd,,:mexcluivelycont�actingwith licensed cont;act�rsto _. . .- .106- SEWER & WATER . __ .__:,Info- — , ---------
_- construct the protect(Sec.70k14,Business and Professions Coder)The Convector's
License Law that,net apply to a a owne,o(proped,who Wild,or improees merenn. 202 — UNDERFLOOR PLUMBING
and who contracts.for such.projects.with a.commclmts) licensed.purnaam Incline _ .__ --203 'UNDERFLOOR- MECHANICAL`
Contrmmrs Liomac Low. ..
°l am somal Under See. :B&P C for this reason 204 - UNDERFLOOR'"FRAME"',
ones'
Date 205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING
I hereby affirm madee,pemltyI of perjury one of the fact lowing deductions: 302 — TUB & OR SHOWER
° 1 nave and will maintain a Cehificme or Cmiont to self Unit fee worker. 303 - ROUGH MECHANICAL
_ Compensation. a Provided for by Section 37M of Inc Labor Code, for the
permanence ofthe work for which this person isissued.,,, 304 — ROUGH ELECTRICAL
°1 have,and will-aimain worker's Compeovtion Insurance,as irqulrcil by Section —
305 FRAME
's]ao of the LaWi care,for the perfeemunae of the.ark for wmyn this .it as
306 — HOLDOWNS
issued.My.Worker s C-- 'p n Insurance er and Policy Y Wam:
. e
alyN - 3 -INSULATION-
_r C �k- :ORKERShW8SHEETROCKeCERTIFICATION OF EXEMPTION FRO
coMrENsnnovwsursnrvc30.9_ EXTERIOR_li
AisTrH_.s__�..-,�_. --
... _ . . •H
Chis se6idnimelinet be,completed ifthe permit isfor one hundred dollms 310 - INTERIOR LATH'
311 - SCRATCH :COAT - .
,,,, 1 n fy that in the pemom,ance of the xoIX for we,ch;his penmt is issued.I'.
shall not employ any pe. many man 313 - ROOF NAIL '
Coon
NOTICE TO APPLICANT:[1,IL after Date
this Certificate of Exemption.you should
a to become ire ea na s e o ers
_:Advrcant- " - - 501 - FINAL ELECTRICAL ENERGY - -- - ; -- -
502 - FINAL PLUMBING ENERGY
a
Z Qbecome t comp m Inc Worker,Compcmmroh pfandi ons of the Inner Code,you man
fonhxith comply with such provisions or this panni shall he JeemcJ revoked 503 - FINAL .MECHANICAL ENERGY ..
4 CONSTRUC`nONLENDING AGENCY 504 — FINAL BUILDING ENERGY
1 hereby am.in,,[there i a cohstmcton lending spicy for the performance
'� ? arnewerkmrwmynmlp t isaaral •scv»raa.cl 505 - FINAL ELECTRICAL _.
-d.Q —Le lie's Wme_ ... __ a. . _. _ _ ._ _ _
Lcndc's Address - " ..- 506 - GAS TEST It
o:z 507 - FINAL PLUMBING
t.7 1 ccnify marl nave read this application and set¢that Inc above i law,'Is is'
mast,l agree re,central,n, I hi nu ptysim ynanty nrdmaggm and slaty laws ranting' 508 - FINAL MECHANICAL
.O.0 m aWsegncrui ed in,inmmnyaomodrPmpent5uscsnnnis city l°tenor upon
y,m my nbaveamp fee,.prnpeay lin ian keep
Purpose',. 509 - FINAL GRADE
(N'e)amarti,ave,indemnifyaonndk hi heam,inaeCity yaCupcnino against —
lip Caa inies.judgments,casts and<apenses which may in any way accmc neatest said 510 FINAL PLANNING
U-Z Cay,n conse,ryc PWALAN amingol this perma. �C+
iAPPLICAN'r EN 4NL .N'aWILL'CO YWITN ALLNON-Pf)INT Issued p1.4 — NA C WORKS Date
SOURCE L. VS ' •��' Y
5i8nit IAPPIicnnVCmtt cI 1 : -'Dam--,r t Re roofs
HAZARDOUS MATERIALS DISCLOSURE
' ' warn "licarm or finum Wilding compeon,s or handle partial imparnal Type of Roof �� _ _ - ('1' — - �`` "'•••.
- as defined by the Copemind Municipal Code.Chapter 9 I_,and the Health add Safeety
Coda,Scrflyd25J1;al,.p !•: I .I ,,,.,, '. rvy. b�
❑Yes' •••<• ,..;, ❑ye, I.• !. - All roofs shall einspected prior to any roofing material being installed.
01 •AVill the applicant or future building Occupant use equipment ordevices which If a roof is installed without first obtaining an inspection; I agree to remove
emir hazardous air rionaminans as defined by the Bay Arra An Quality Management
Daimler? all new materials for inspection..Applicant understands.and will comply with
IF 1 °Ye , 4"° all non-point source re ulations..
1 have read the h saJ . medals q rte e'and Carper 11.95 of thepy\J�r,,�
California Health s Safety Cwl Section.,23505 t it
d 355b1 I duuand //(,(/(fir ✓ _ w /
if theb 11dng Jas�nJ(I�c tly a( vt ems I i Y are b'lly Y the
mot
t h mu I rte I pr or ton>suane cml cmc of ,
- " Occupancy -
. ., -- Signature of Applicant Date
caner ar aalnanurl agent .. �7 Date All roof coverings to be Class`B" or better,
OFFICE .. .