02010046 (2) C1 BUILDINGfDPERO No PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20610 STEVENS CREEK BLVD 02010046
OWNER'S NAME: APPLICATION SUB DATE
APIER 1 IMPORTS 01/11/2002
.HONE: SANITARY NO. CONTROL NO.
f
O-oZ ARCHITECUENGINEER: BUILDING PERMIT INFO
u— BLDG ELECT PLUN114 MECH
y� LLD u u
LICENSED CONT'RACTOR'S D17CLARATION
z n I hereby affirm that 1 am liccnmd under provi.'ons al Chapter 9«nmmencing Job Description
?_C� with Section70W)ofDwision3oldieBusinessen rnInssmm ode.tied re,license RETAIL TENANT IMROVEMENTS
'zeais in mR Tome Berg �B��A
Licenu s Lie, ALED
1
or
O In ARCHITECT'S DECLA
,aj I understand my plana shall W used as public records
In 0 Licensed Professional SEP 17 2002
ce2! OWNER-BUILDER DECLARATION
I hereby air,.that 1 am exempt from the Contmaor's License Law for the
t z a rtalnwing reason,(Section 70313,Burioees and Proressdms code:Any city or coach" &47030
which requires a permit to conshuct,alter,improve,demolish,or repair any structure BUILDIiV
a3ce prior to its issuance.him requires the applicant for such permit o file a signed statement Cpp,,,,��[[,�try� p�,g
that tole is licensed pursuant no the provisions of the Contractor's License Law(Chapter 9 r•f ,., .' { ;•3.�"7US ULT",�,"V Va 1 t Valuation
Icnmmencing with Section i]")of Division 3 of the Business and Profusions Codd t., , U L'2', U r rZ%I,y�j:4
or that he is exempt then from arta the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
Of rut more than five hundred dollars($500). 101APN �f.)AT I ON - Occupancy Type
D 1,as he,of the Propcny,to,to,employees with wages a their vale cnmpoemnemn.
-will en the work,and the structure Isnotintended or offered for sale(Sec.70c14,
Baaineis and Professimms Code:The Convector's License law aces not apply to as 103 - UFER Required Inspections
owner or p,.,A,Who bards or itnpru.ca ntcrenn.and tubo due,such work himself 10 4 — REBAR
°r through his own employees.provided tbut such improvements arc of intended or
'.-offered for sale:IChowever,the Wilding or improvement is sold within ane year of _... ._ __
completion,the owner-builder will have the lumen of proving that he did not build or 105 - ANCHOR BOLTS
improve for puryosc ofmle.). 106 -_ SEWER & WATER
❑1 as owner of the porarty,.m�:eiusi:eiy�mtmurdns with licensed cbmmctnra�o _ ..202 =-UNDERFLOOR PLUMBING - _.
construct the project(Sec.7044.Bmaness and Pruressions Cade:)The Contractors 2 03 - UNDERFLOOR MECHANICAL
License Law does not apply to an owner of propcny who Wilds or improves thereon,
and who contracts for such projects with a.contmctogsl licensed pursuant to the _.._ . _... -2 04 - — UNDERFLOOR -FRAME
Convenors License law,
❑lamexempt under Sec. B&P C for this mason 205 - UNDERFLOOR"INSULATION
Gran Date301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER
Ihereby af.anderpeamtyofperjuryare ofthe following dealocalim , 303 _ ROUGH MECHANICAL
D I have and will maimuln a CmiOcme of Consent to self-imum for Worker's 304 ROUGH ELECTRICAL
Compensation, as provided for by Section 37W of the Labor Code, for the
perfotmxnce of the work for which this permit is issued 305 — FRAME
D I have and will maintain workers Compensation Insurance,as requires by Section 3 06 HOLDOWNS
_ - 3700 of the Labor Code for the performance f m work ror which this pcmmt ns 307 - INSULATION
issued My W rs Compcns hon I sure de ^Jera a Policy numWr vre
am Icyhb IO'"C�L , ,.. 30,8, o-e_ 'SHEF,�'TROCK ... .... . . . . -�.,...i•., -
'CERTIPICATIONOFFXEMP NFROMWORKERS'; -� 309 '- EXTERIOR- LATH !
'COMPENSATIONINSURANCE,';" _;
__. _ _ _.. 3'10,- INTERIOR—LATH
— --- --'- — ----- - -
„(Thi:xBidn ae�e nm xcumpldean he pemat is for ane Wnercaemmrs 311 — SCRATCH COAT
(3100)or IessJ
rsan in an manner so as m hecome sun object to the Wor
1. 313' -' ROOF NAIL:.. ,
r�' I ccnify thmIin me petfatmanca of the work for which this patten is issued;1
p r fix 501 - FINAL ELECTF2'IC11L`IENERGY
NAIL-
shall not cm to an' y j° Aeri
Compensation Lows of Callfomip,nate-
.Apphcant � - � - 502 -- FINAL .BLUMBING ENERGY . ..
NOTICE TO APPLICANT:ILafter making this Cenificatc of Esrntpnion,you should 503 - FINAL MECHANICAL ENERGY
z become subject to the Worker's Compensation provisions of the Lahr Code,you must
ZOO
forthwith comply with such provisions or this Parodi snarl be deemed revoked. - 504 , -. ..FINAL BUILDING ENERGY,,
Z . - . -
' a -CONSTRUCTION LENDING AGENCY ' - 505 — FINAL ELECTRICAL "
a"' " " 1 hereby hich that marc is a commend,.lenaidg agency for the perlormance -' -
af work for which his permit issued(se°.'3o9].CO.ca 506 — GAS TEST _
z -Leartio'sder a Name. _ ......,_. .-. - . ..
o'z L<wersAddress 507 - FINAL PLUMBING
U O I ttrtify that 1 have read this application and State that the above information is 508 - FINAL MECHANICAL
. G*:E.. coir<n.I agree a comply with all city and county ordinances and:mm laws relating 509 — FINAL GRADE
ru (/////�•/
OU to Wilding construct ion,and hereby authorize mmsetmives ofthis city to enter upon
>„ W, theaWve-mentioned property for inspection Reimposes, 510 - FINAL PLANNING
F., Gs IWe)agree to save,indemnify and keep hamdes;be City of Cupertino against
cn liabilities,judgmems.costs and expenses which may in any way accrue against said 514 FINAL PUB C WORKS
UZ City ince gvcor c of the gram in ,this permit. -
Ab`LI .TU ' ONS. ILL- 'TH AL:N N N' Issued by: Date
be ofApplicaM m r D e Re-roofs
H OUS MATERIALS DISCLOSURE
Will be appl cant or rebore Wilding Occupant store or handle himardous material . Type of Roof
Code.Sutton ae Cu ao .teed I Code,Chap¢r 9.12.and the Health and Safety , - It
as d, d by me Cuperi M
DYst ' ji � ` J l �_ All.roofs-shall be.inspectedd prior to any.roofing_ma[eria] being installed. .
w u m gppl p t -rp nt use 9 p t dei s wni
h If a roof is installed without first obtaining an inspection,I agree to remove
emit harmonicas commitments; ed by th Bay A A Quality Management
restrict? all new materials for inspection. Applicant understands and will comply with
lfir �,ti ❑Y< No
all non-point source regulations; t;,t,
`41 1 nine mad the harardous materials mcmimments under Chapter h 95 of the
California Health&Safety Code,Sections 25505,25533 and 25534.1 understand that
if the building does not currently have a tenant,that it is my responsibi lily to notify be
«cupam f there wl'eti must b uyirian a of n C nlEc to of
_ 16
°crap lure of A li Date
rau,nui;,w. , All roof coverings to be Class"B"or better
-c: - "OFFICE