02020095 (3) CI eau DFINC DIVIISIONVDPERMIT CONTRACTOR EWORMATION:
BUILDING ADDRESS: PERMIT NO.
20425 STEVENS CREEK BLVD CALIFORNIA SIGN 02020095
'NNER'S NAME: APPLICATION SUB DATE
'AP GEMINI ERNST YOUNG 17805 COMCONEX 02/25/2002
PHONE: SANITARY NO. CONTROL NO.
2092393339
p c ZO ARCHITFCT/ENGINEER: BUILDING PERMIT INFO
WO
E F BLDG ELECT PLUMB MECH
H I_I L-7 L2
GGG LICENSED CONTRACTOR'S DECLARATION
5„"a Job Description
5 Z— I hereby affirm that I am licensed i of C er ci
rot withSmt0"7"ofDivisinn3oftheBu a amy NST L '2) SIGNS
f x f is in full fore e-ecY- �' G !`
rc0 u.U L0ilcegns 1 [l L J
S 3 o r I A CHITECT'S AT
Be 1 understand my plans shall be use public re
i��M
i S p O Licensed Professional
� OWNER-BUILDS � � ON
v. 1 hereby affirm that I am exempt from the Convector's License Law for the
C Z< follo ag re..pit.(Sedan 7031.5,Busincss end Professions Code Any city lir county O Q
O wh cl qu es perml i trues alter mprove,demolish.or repair any st cmre
m ..pit no ds to ncgals regottes use applicant fmmen permit mfileesgtmdsmt ant - - - - -- 5
— thatbe,s_I'censedPurolator.theponi4onsofd,CiumchaesLicenseLaw(Chapter9 �Cso Csrc' pra,�s rE a-•. , Valuation
.
(commencing with Se tiont7000)of Division 3 of the Business aM Profeutons Code)
or that he is exempt therefrom and the basis for the Nlagerl esemddtioa.Any violation
-of Section'7W L5 by any applicem fora permit suhjttts the applicam to a civil penalty
of not mora than five hundred dollars(s5oo). 101AP_N�DATION Occupancy Type
❑Las net of the property,or my employees with wages as their sole compenaidon,-
win me work;and the oe:Tstructure a not intended lir offered Law for sale m(sec. 'a an 104 - REBAR Required Inspections
Business and Professions Code:The Contractor's License o de does not apply m an
owner of progeny Who builds or improves thereon,and who does m n work himself
°r through his awn employee Provided that roti improvements ere not immad d or 1.0 5-_.- ANCHOR BOLTS
-
completion,
omple for cele:IL however,then have
ovemcm is sola within one f ..cmnpletion,me owner,huilder will have ne hu,ern ofproving that nests not r;wid lir 304 - ROUGH ELECTRICAL '
improve for putpnse of cele.). 505 _- FINAL ELECTRICAL
DLmalthe of faro p(Seerty,om exclusBusiness and Professions licensedo Cotoict to 514 - FINAL PUBLIC WORKS
cemwa the project(Sec.YDf4.Business and Professions Code:)The Convector's
License Law does not apply men owner of progeny who builds lir purama tnercon,
mmasuchand who cos for such projects with.e commciorts)licensed pursuant.mo-the
Contractor's License Law.
0 exempt
1 em exempt under Scc. B&P C for this reason '
Date
WORKER'S COMPENSATION DECLARATION
a' l I thereby,aRnu under penalty of perjury one.(the following declarations:
❑ 1 have and will maintain a Cenificate of Consent to self-insure for Worker's
{tit/ Compensation, as provided for by Section 3700 of the IA60f Code, for the
Performance of the work for which this permit is issued.
D 1 have and will maintain Worker's Compensation Insurance,as requited by Section
3700 of the Labor Code,for the perfoimance of the work for which this permit is
.. issue) My Worker's Compensation Insurance eamerand Policy number an:
.,,
KICAJI UP"hMy NoX�
CERTIFlCACOMPEN COMPENSATION
ION INSURANCE:"0M WORKERS' - � ` • (I �` r l' I '.
'COMPENSATION INSURANCE;"
(This section need not be compleled if the permit is for one hundred dollars
($100)or less.)
I certify that in the performance rm the work for which this permit is iissued,shall not employ any persoin n any manner so es to become subject m me Workers'
Compensation laws of California.Dam
'
NOTICE comesubject
APPLICANT:If,after Corhmaking this Campeau,of ofExemption,Laborde,youhmu must z become subject y the such pr Compensation provisionsofthe deemed
Code,you must
Q Q forthwith comply with sato provisions or this permit shell be domed revoked. '
CONSTRUCTION LENDING AGENCY
1 heathy affirm that mere is a convection lending agency for she performance
�:r of the work for which this permit is issued(Sec.]K197,Civ.C.)
Z Lender's Address'„ -
V 0 I cenify that I have read this application end state that the above ieformmima is
correct.1 agree to comply with all city and county ordinances and state laws miming
Q V to Wilding construction:and hereby authonae rtpresentatives of this city to enter upon
Izl the above-mentioned property for inspection purposes._
p. (We)agrea rosave,indemnify and keep harmless the City of Cupertino against
Z) liabilities,judgments,coats and expenses whichmay in any way accrue against said
City in consequence of the gniof this'permit.,,
APPLI
[.ARST SAND WILL COMPLY WITH ALLNON-POHrr Issued by: Date f/
rV
S o Appl m2onuacmr ase Re-roofs
HA7ARDOUS MATERIALS DISCLOSURE "
tlllh,applicant or future building overprint n..or handle hazardous natenel Type of Roof.
as d .Soc by,the 32(.) nn Mun cipsl Cad Chapter 9.12,and the Health and Safety
Code.Sttbon 25532(a) . .'• `•.• -^ s ^ • !1 t'1' •.
°Ye °No n +f _ _ All.roofs_shall be,inspected-prior,to any-roofing material being installed.___, .
Will theappli anter fgwrtidddng oecupamuseeq.ipme.tordeviceswhich If a roof is installed without fust obtaining an inspection, I agree.to remove
error hazardous air cdmemmants a definW by the Bay Area Air Quality Management
District? all new materials for inspection. Applicant understands and will comply,with
Dyes - ElNo all nbn-point source regulations.
I have read the hazmdous'materials rogvirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533 and 25534.1 understand that
ifthe Wilding does not currently have a tenant,that it is my responsibility to notify the _ -
- ..'art o(Iis wh' must be met prior to Issuance of a Certificate of
Occup. . '..'
1. Z_ Signature of Applicant Date
owner rautnnn .gent . Date All roof coverings to be Class •'B"or better
1 . OFFICE .-
.. t