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02010048IiT Y OF C U P'IEII THNO R: -b - IDEMO CIU CUPS N® IP'IERM:T APP LIICCATI[GN FORM 0a o/oby� APN# Z-10- Building Address:�� l Sn Owner's Name: �'bc�� �.,�v � � cF�5� � V'''cS Phone #• . l 07n Contractor: ` � t License #: Contact: , Phone #:�, Applicant/Contractor: Building Permit Info: Bldg Elect Plumb Mech Job Description: E -s•�u,rK Residential: Commercial: 1-, �wA� Sq.Ft. Floor Area: $/Sq.Ft.: A Architect/Engineer: Valuation: rsv Gr o `.jj�} (�\Q � 16 Type of Construction: Occupancy Group: <157 1 Qty. if Applj a Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILIDNG BSEISMICRE Bldg Permit Fees BUILIDNG BPLANCHK Plan Check Fee BUILIDNG BUSLIC Business License BUILIDNG l� a00Z SUE Ozr'q Ua p � ppyy �3mlr oa a1 I Q ® z g0 0.� CITY OF CUPEI[ TIINO CONTRACTOR RA` TOR ffNFO UV ATION — BUILDING DIVISION PERMET, BUILDING ADDRESS: PERMIT NO. 20410 TOWN CTR # 150 SOUTHBAY CONSTRUCTION CO INC 02010048 OWNER'S NAME: APPLICATION SUB DATE TOWN CENTER ASSOCIATES 511 DIVISION STREET 01/14/2002 PHONE: SANITARY NO. CONTROL NO. (408)379-0400 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u u I__I LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license DEMO OF INTERIOR OFFICE is in full force and effect. License Class Lic. N Date Contractor ARCHITECT'S DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5• Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure $3500 prior to its issuance, also requires the applicant for such permit to file a signed statement - Sgg Ft. Floor Area , Valuation tl(at Pe istlicensed pursuant to the provisions of the Contractors License Law (Chapter 9 Section 7M6)'of 3 Business Pr9fessions Code) (commencing with Division of the and or that he is exempt therefrom and the basis for the allego exemption. Sny violation ' ^ ' ' '`3 6 J4 b 016.0 0' ' ' ' , of Section 7031.5 by any applica}tt for a permit subjects the applicant to a civil penalty of not -more that, five hundred dollars (3500). APN Number Occupancy Type NO ASSIGNED INSPECTIONS ❑ L as owner of the property. or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and'Profemions Code: The Contractor's License Law does not apply to an Required Inspections' owner of property Who builds or improves thereon, and who does such work himself or through his own employees. provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of , 'completion, the owner -builder will have the burden of proving that he did not build or improve for purpose of sale.). P I, a.5 owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's License taw does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contraclor(s) licensed pursuant to the - Contractor's License Law. ❑ I exempt under Set. ' , B & P C for this reason .. .. Date • 'WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have rind will maintain a Certificate of"Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the of the work for which this permit is issued.aveand �fforian,e will maintain Worker's Compenkation Ihsurahce, as required by Section of the tabor Code, for the performance of the work for which this permit is ishued. My Compehsation orkers InsLmnce carrier and Policy number Are: ' CERTIFICATION OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ' "� '(Thistswtfon need hot be completed if the permit is for one hundred dollars (311X)) or less.) I certify that -in the performance of the work for which this permit is issued, I ihall not employ any [arson 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 become subject to the Workees'Compensation provisions of the Labor Code, you'must ` forthwith comply with such provisions or this permit shall be deemed revoked. LENDING AGENCY " I hereby affirm that thbre is a Construction lending agency for the performance iCONSTRUCTION of Ole w6rk for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address' I certify that I have read this application and state that the above information is Cofrect. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. . ICAR NDERSTANDS D LL COMPLY WITH ALL NON -POINT Issued by: Date U' Re -roofs Sign ure A pntractor Date HAZARDOUSMATE IAL$ DISCLOSURE ' • ' Will the appli6nl or future build pccupant store or handle HazaH6us, material Type of Roof as defined by the Cupertino Municip Codc, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? •' ❑Yes No ' All roofs shall be inspected prior to any roofing material being installed. cupant use equipment or devices which Will the applicant or futulNo If a roof is installed without first obtaining an inspection, I agree to remove emit hazardous air contaminants the Bay'Aren Air Quality'Management Dktric17 all new materials for inspection. Applicant understands and will comply with °Yes all non -point source regulations. I It, "ve'rcad the hazardous materials requirements under Chapter 6.95 of the CAlifomia Health & Safety Code, Sections 25505.25533 and 25534. 1 understand that if the building docs not currently have a tenant, that it is my responsibility to notify the occupant of the requirements which must be mct prior to issuance of a Certificate of ?9,L'1 "'X72' &Idlo Signature of Applicant Date g PP &zed agent Date All roof coverings to be Class `B" or better OFFICE . CITY OUPERUNO CONTRACTOR INFORMATION: BUILDING PERMIT BUILDING ADDRESS, PHRMI"r NO, 20410 TOWN CTR # 150 SOUTHBAY CONSTRUCTION CO INC 02010048 1 WNCR'S NAME: APPLICATION SUB DAI L TOWN CENTER ASSOCIATES 511 DIVISION STREET 01/14/2002 PHONE. SANITARY NO. CONTROL NO. (408)379-0400 ARCIIITEC IENGINGER: BUILDING PERIB r INFO BLDG ELECT PLUMB MECH 1_I LICENSED CONT'RAM OR'S DECLARATION Job Description 1 hereby affirm that 1 nm Iterated under..l'..visions of Chnpmr 9 (commendo, with Seniors 7(10(0 of Division ]of tireon,ine„nnl Profession, Cadc, and my license DEMO OF INTERIOR OFFICE is in fun to. :mA elven. License Clan Lic.p Date Conmcmr ARCHITECT'S DECLARATION I node stand Iny for, shall he ... d as puhlic records Licensed 1'mfc,sional OWNER -BUILDER DECLARATION I hereby arrna he, I an, cacmpl rmm the C.ourr is License Law for the following maven. (Section 7031.5, Business and Professions Code: Any city or county which require%a permit in construct. cher. unprove, demolish, or repair any sleamure $3500 priors. its ounice. alsoq the ppl t for suchpermit l ble it signed.tatement Sqq Ft. Floor ATC�A Valuation 111v1h et Ip l Ihel III C t- ser License l (Chapter9 (nom acing IM1 Sect rMR))of D' t ftl Business Iprofession, Code) ft` (-, V IG 61 00""(;'! �: `� i''A, or that he Is exempt encrcfn,m nnJ Inc nus, far the allesM c'in ,ptibn. Any viola ,, of Section 7031.5 by any applicant for a permit subjects the applicam Ih n civil pcnnhy five hundred dollars - APN Number , .. Occupancy Type of a.. am than (3500). NO ASSIGNED INSPECTIONS ❑1, as owner orthe ar my employee,whowages x, fsoft - .. .. Required Inspections' ..� le(Se. 704,. ,adltproperty, ..will no the work. sod ne c C not intended or n rl torn Tor ..rel Law ode: T Unrest Law ap l Cmle: The apply In an :Baur, fWh. a . asunm builds or improves 0cram, and who Maes r of h ns. the o .adw owns ofp,,,Na y work n edo m n r his o em provided mut such eruntenems art not intended or or through his awn n she building p e e .. IJ m year of coned for le however. ve complet n the hIJ will have the b Ic provingfd theJJ nor build or i an'rest,f 'tar,stes, of'ole.). C] 1. s cravior'rthe P' p ty.exclusiveIY conlractong'is ll Icontractrma, not it } 1 t(S 71W Business dl . r.Cd )Th C I r , LiveLa J e apply a f l I u L oy h Ap , thereon, and who conlrnas for such p)jWis with a conlm bed) licensed Pursuant to the .. Contractor's License Law. ❑I xnnpt B& P C for this reason Dam • . "W� ORKEWS COMPENSATION DECLARATION I hereby of inn under penally of pe jury onepf she following declaration. <1/ v ❑ 1 nave'and'will maintain a Certificate, or Consent to self -insure for Worker', /O Compenwllnn, as providnl lea by Section 97(X1 of the Labor Coda for the ec 1, esti.., brain, of the work far which his namrn have mud will Innintrin Wnrkcr'.v Cdn,pa,.k,lion Insumnh, m cipArred by Section J7 of the Laler Code, I'oi the performance of the work for which mi, permit is ,sued My Waker',C pen. t I sum utrcr and Policy �number art ote:gN it.litcVw-l7r" I 7 •. yN. ,f�I_—QQ-D "CI RTII9(.A71(1N Up EST ION 1' ROM WORKERS t�S:I Il.. t' w 11, t'1,1: '1�s P, iCOMPENSATION INSURANCE' / I .` Y • _ '1' (Thidseclion seed not he nimplacd if the permit is for one hundred dollars t 1 ^ t ($1 00) or It ' 'I certify thal'in the'peirmmance of the work for which this scraut'i. ka.&L I shall and employ any punsua is any mmnirl',o a, to hecnnu ,object a the Workers' Compcn.,nllon laws of Calfornit. Dine Applicant. NOTICE TO APPLICANT, It. arm, making lhi, CeriOcule of Hxemption. you he.),] ' I becomesubjecnn the Workeri Compensation pmvi on, brim laMu Code; you mui. forthwith comply with such previsions or this permit shall be deaned revoked. - ns Nd'I" s". CONSTRUCTIONLENDING AGENCY 1.111 hereby uBrin Oim lherc is ac cl laednn lending agency foe the perronnnnca " of the work for which oris peraii, is issued (Scat. 3097, Civ. C.) Lender's Nante lender's Address'. _ ,i1 that lhave rend this andstate that the atone infoemainn is county ....bases and nmrc law's relating cityand ,,I corma.4,r m cnmply wish 611 cily'u agree ri Inbuildingsenfinne i,i,,,city noi,liou rap.a,entmive, of da, citymsecs.clam f i pa quses. ILe nb,i(We) pn,pcdY rnr if, and keep or (W,) agree m save, a nnnify and keep harndcss she ii,me nn aid way antic against liabilities, ecquennea roses and cxpen,hi which any in any way acrna against seed City in consequence the gmming of the., permit: " -" I. /'s lICANT R Gft5bV_; D 1.1. COMPLY WITII AL1. NON-POIt•If'f Issued by: ! Date RIX ✓\. Re -roofs Sig ITU } 11Date �n 1 HArMDOUS MATE IAL S DISCLOSURE 1 Will the..plica 1 fabric bu IJ achitchat were r handle Kilmartin, earecrial Type of Roof _ ai dcf ed by m Coloration M p Cod Ch pl 9 12, a J eh 11 hM1J S f ty Cdsk S fo SSt2l )71 t I , U sj• ;'+# ; T t S 1 ❑re. N j S 5 , , All roofs shall be inspected to any roofing material being installed. sprior , I. w ll n 1l'I t eq n d , 1 ',nlh If a roof is installed without first obtaining an inspection; I agree to,remove It.nrc tnlaas nsJ dlyI Bry Ann Air 0'11yMnLg cot n DI I all new materials for inspection. Applicant understands and will comply with ,., ., oY "^ all non -point source regulations. I. "L have id the lama k Internal, rup,imalitu, under Ciaptvc 6.9]'uf the Celdernin Hcnllh & Safety Cod,; Section, 25.505, 2.5533 and 25534. 1 undersand that . if the looking fires not ciamally base ;I "nana. Ihat it is toy lxeponsibidily ,I'unil'y the ocl:,ip;'iniI of the myulrem I, shah niva 1w nue prior to Issunncc of 6 Cee?IR,nm of - e'• Signature of Applicant Date "Q" All roof coverings to be Class or better ' Tessa agent Do!'