02020095 (4) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATIO :
BUILDWGADDRESS: PERMIT NO.
20425 STEVENS CREEK BLVD CALIFORNIA SIGN 02020095
OWNER'S NAME: APPLICATION SUB DATE
CAP GEMINI ERNST YOUNG 17805 COMCONEX 02/25/2002
PHONE: 2092393339 SANITARY NO. CONTROL NO.
m m Oz ARCHITECT/ENGINEER: BUILDING PERMIT INFO
kL" FF BLDG ELECT PLUMB MECH
�Z6 IL-J L_J L )
=seZ LICENSED CONTRACTOR'S DECLARATION IOU Descriptionzvi_o I hereby alBrm,hat I am licensed under provisions of Chapter 9(commencing
with Section 7008 ofccDciivvit^ision 3 ofthe Bull 117d Code.and my fired. INSTALL (2) SIGNS
izw Liccnsll flss a—v y Lich V 7o yS
S yI -'a nner
A CHRCo
ECI-S DELL AT
rnsg I undersand my plans shall be era a
0 s public rt Ns
i d o O ional
Licensed P.Itn
o OWNER BUILDER DECLARATION
t�+ = I hereby affirm that I am exempt from the C°nt=wr's License Law for the '
following reason.(Section 7 W 1.3,Business and Professions Code:Any city or county 5(]0 0
8 F o which requires a Permit m construct. or ct,alter,improve,demolish, repair any structure
63C� ..prim to lit issuance.also requires the appliam for such permit w file a signed suxmem -
dlathgislicensedPursupnttolhppovisions of deCommittees License Law(Chapter 9r a. Valuation
.(commencing with Section 7")of Division 3 of the Business..I Professions code) I s�, ;'i,3 if
"r')�)"
or that he is exempt therefrom and,he basis for the alleged emon list.Any violation t '
of Section 7031.5 by any applic'p for a Permit ubjmu the applicant o a civil Penalty
of not mom than Eve hundred dollars($500). 101APN ATI ON Occupancy Type
°I,as owner of the property,or my employees with wages as their sole compensation.
will do,he work,and the structure is not intended or offered for sale(Sec.70x4,
Business and Professions Code:The Contractor's License Law does not apply to an 104 - REBAR Required Inspections
owner of property Who builds or improves demon,and who does such work himself
or mmugh his own employees.provided Nat such improvements are not intended or 105 ANCHOR BOLTS
-offered for sale.If.however.Ute building or improvement is sold within no year of
completion,she owmer-wimerwill haw d.wreenofprovingthat hedid not Wild or 304 - ROUGH ELECTRICAL
improve fm Pmpnx°f sale.)' 505 - FINAL ELECTRICAL
°1,as owner of the property,stn exclusively contracting with m
licced contractors a 514 - FINAL PUBLIC WORKS
consumer the project(Sec.7044.Business and Professions Code:)The Contncmr's , -
License Law does not apply to an owner of property who Wilds or improves thereon,
.and who contracts for such projects with a conuecor(s)Ecrnxd pursuant,o the
Commctor's Used.Law.
°1 am exempt under Sec. - .B&P C far his reason
. Owner Date
WORKER'S COMPENSATION DECLARATION FINALE1'
I hereby oRrm under penalty of perjury one of the following declarations: r (�
_ I ° 1 have and will maintain a Certificate of Consent to self.insu , for Worker's DEC 2 6 2DOZ
Compensation. as provided for by Section 3700 of,he Labor Cade, for the
performmrce of the work for which this permit is issued.
°1 have and will maintain Workcr'a Compensation Insurance,u required by Section 1'1In�'��
37M of the Labor Code,fm me performance of tthatBUILDING work for which this permit is U
issued.My Worker's
ssCompensation
.Insurance carrier and Policy number are:
CERTIFlCAOF EXEMPIFROM W
COMPENSATION.INSURANCE
(This section need not br completed if the Permit is for one hundred dollars
($100)ar less.)
I certify that in the performance of the work for which this permit is issued,T
shall not employ any person in any manner so as to become subject to the Workers
Compensation Laws of California.Date
Applicant -
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
z become subject to the Worker's Compensation provisions of the labor Cade,you mus,
p O forthwith comply with such provisions or this permit shall be dermed revoked.
FCn CONSTRUCTION LENDING AGENCY
ar I hereby affirm that there is o cons n etion lending agency for the performance
0..Q of the work for which this permit is issued(Sec.3097,Civ.C.)
Lenders Name
.a z Leader'a Address
V 1 certify thin I have seed this application and suite that the above information is
kr correct.1 agree to comply with all city cad county ordinance and sum laws rrining
p
to Wilding construction.and hereby au0iodzi representatives of this city to enter upon
the above•memioned property for inspection purposes.
► L (We)agree to save,indemnify and keep harmless the City of Cupertino against
W' liabilities,judgmrms,costs and expenses which may,in any way occrue aspire,said
U Z City in consequence of the granting of this permit.
APPLICANT DERST SAND WILL COMPLY WITH ALL NON-POINT U(/
Rc LATI_15 - Issued by: Date
Sit, o Appl, r9Contuctor �_75mm Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
til the applicant in future building occupent store or handle haundous material Type of Roof - -
as defined by the Cup rtmo Municipal.Care.Chapter 9.12,and Ne Health and Safety
Code,Section 25532(x)' t
°Yef °No All roofs shall be inspected prior to,any roofing material being installed.
Will the applicant or f num Wilding occupant use equipm at or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
emit herardom ear contaminants as defined by the Bay Arta Air Quality Management
District? all new materials for inspection. Applicant understands and will comply with
0Y0s ON. all non-point source regulations.
I have read the hazardous materials requircmems under Chapter 6.95 of but
Cali(omia Health&Safety Code,Sections 25505.25533 and 25534.1 understood bar
if she Wilding does not currently have a tenant,that it is my responsial try to notify the
Ooeocupmi of, is wh most be me,prior to issuance of a C,mifiatir of
p - SQL Signature of Applicant Date
owner r,mhon .grin - Da. All roof coverings to be Class "B" or better
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Input Permit Number: s3261 �j"
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PERMIT#: ARCHITECT: VALUATION:
APN: 36901029 LICENSE 0: ISSOATE: 1/21/99
SITUS STREET: STEVENS CREEK SUBDATE: 1/20/8 PLCHKDONE:
SITUS NO#: 20450 TYPE: CGI LATE CODE:
AVE,CT,ST RD: BL BLDGDEPT:
N,S,E,W: DESCRIPTION: TENANT IMPV ENGDEPT:
NO#: PLANDEPT:
CITY: CU PLCHKREO: CMA:
ZIP: 95014 CATEGORY: 2 CTRARE:
LOT#: 0 DATEDUE: 2/3/99 SANDIST:
ID: SUN MI CRO Co.o.tcial HLTHDEPT:
STRCTENG,
OWNER: 2600 CAMPUS
TY CENTER. CAsppllp: TOTAL:
OWNER 2600 CAMPUS DR SUITE CE.sa#II#: INSPHOLD:
ADDRESS: 200 CNseppp:
CITY,STREETZIP. 1SAN MATED C4 94 Residential I�«
PHONE I RN-sR#N#:
CONTRACTOR: RE-sq#II#:
LOO: RUS-s##11#: I FS earch by Address
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