02010049UtTY OF CUPERTINO
DEMO
PERMIT APPLICATION FORIV-111
�zo�o6�i
APN #
3 GR q k A(z)
Date:
Building Address:
4P-Ock to
Owner's Name,.:
Phone
,,qoe
Contractor:
License #:
_ CrT 1;1�
Contact:
:a z Z�Ll
Phone #:
–7�>
Applicwit/Contractor:
C–v
Building Permit Info:
Bld Elect Plumb Mech
Job Description:
Residential: Commercial: )Q___v_"116111___N
Sq.Ft. Floor Area: 1` 177 SO
$/Sq.Ft.-,,$ Q —
Architect/Engineer:
Valuation: P,�
Type of Construction:
Occupancy Group-:
Qty. if
A e Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILIDNG
BSEISMICRE BldPermit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License j BUILIDNG
J CITYOIC CUPERIHNO
BUILDING DIVISION PERMIT CONTRACTOR INFORNINfION.
BUILDING ADDRESS: PERMIT NO.
20410 TOWN CTR # 190 SOUTHBAY CONSTRUCTIQ CO INC n201QLAq
OWNER'S NAME: APPLICATION SUB DATE
TOWN CENTER ASSOCIATES 511 DIVISION STREET 01/14/2002
PHONE: SANITARY NO. CONTROL NO.
a 0 04 ;_4 ARCHITECT/ENGINEER:
P3 0
LICENSED CONTRACTOR'S DECLARATION
z Section i
cn Ihereby affirm that I am licensed under provisions of Chapter 9 (cotimmencing
with S n 7000) of Division 3 of the Business and Professions Code, and my license
is in full force and effect.
License
.. Class Lie. #
Date Contractor
rEn ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records
Licensed Professional OWNER -BUILDER DECLARATION
1 1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
a which requires a permit to construct, alter, improve, demolish, or repair any structure
,o prior to its issuance, also requires the applicant forsuch permit to file a signed statement
tftaAtb 'isficfrise d
(com. pu2suanl t;,, t provisions of the Contractors License Law (Chapter 9
ening with Section 2) of Division 3 of the Business and Professions Code)
orthat0he is exempt thbreftorrand the basis for the 4ny violation
of Seetion 703 L5 by any applicapt for a permit subjects the applicant to a civil penalty
,of, pot,nime than ftye hundred dol ' lars ($500),
0 1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and, the structure is not intended or offered for sale (Sec. 7044,
Basioc!;s and Professions Code: The Contractor% License Law does not apply to an
owner of property Who builds or improves thereon, and who does such work himself
or through his own employees. provided that such improvements are not intended or
,off one at
offered for sale. If, however, the building or improvement is sold within n year of
donipletion, the owner -builder will have the burden of proving that he did not build or
improve for purpose of sale.).
01, as owner of the property, am exclusively contracting with licensed contractors to
c&istm6t the project (Sec. 7044, Business and Professions Code:) The Contractor's
Liceaise Law does not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.
0 1 am exempt UnItley see. 6"& P C,for this reason
Date.-
' WORKER'S COMPENSATION DECLARATION
I hereby affirm underRyof periurYme, of the following declarations:
penal
1 havi and will maintain i% C&tificaite of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
p6dbmnhne& of the work for which this, permit is issued.
'mainhiln Wtirkcr�s Compensation cin
0 1 havlo arid will nsurance, as required by Setti
3760.'of the LdborCode, for the perfmmmi6eW'the work for which this permit is
issued. 'MyWorker's Compensation Traniande carrier and Policy number are:
w
-7-
Careti>
PolicyN6. 62:ll �i2�
'�CERTIFICATION OF PXEMPTlON'FIOKWORKERS'
COMPENSATIONINSURANCE.
"'','(This section need not be completed if the permit is for one hundred dollars
($(00) or less.)
I 6ertify that in the performance bf the work for which this permit is issued, I
shall'not employ any person in any immiersoas to become subject to the Worker's
Cbinpen'satioh Laws of California. Date
Applicant
' ft
QTOAPPLICA'NT:lf, aft
If, thisCertificateof Exemption, you should
z become subject to'the'�'brkees Compensation'provisions of the Labor Code, you must
0 forthwith comply with such provisions or this permit shall be deemed revoked.
Sys w
CONSTRUCTION LENDING AGENCY'
fluireVy affirm that there is a'construction tending agency foi the performance
of the work for which this'perinit is issued (Sec. 3097, Clv, C.)
Leuder's'Nime
Z LImlcils Address
-
'icerti fy thitt I have read this application and state that at flue.'above infurimition is
'
coiled. I agree to comply with all city and county ordinances and state laws relating
I I
Uto b4ilding construction, and her6by'authmize representatives of this city to enter upon
>4 W the above-mentioned property for inspection purposes.
Ey 4%, (We) agree to save, indemnify and keep hitrunle'ss the City of Cupertino against
Cn liabilities, judgments, costs and expenses which may in any way accrue against said
City in
consequence of the granunbpf this permit.
,dAP (CANT UNDElNDERST
D N ILL'COMPLY, wrrH ALL NON -POINT
�0 R
-----------
Will the applicant or future buildh occupant ktiure or handle hahrdous material
d fined by the Cupertino 4unicip Code, Chapter.9.12, and the Health and Safety
qdc,'Section 25532(a)? '
oyi, :% 0
Will the applicant or futurebui mg occupant use equipment or devices which
emit hazardous sit contaminants as med by the,Bay Area Air Quality Management
Distiiet?
t CI Yes No
I have read the hazardous 'materials, requirpriumts under Chapter 6,95 of the
t,aliforma Heafth'& Safety'Codc, Sections 25505,25533 and 25534. 1 understand that
10 the building does not currently have a tenant. that it is my responsibility to notify the
occupant of the!,equire,ments �eli�mtst be met prior to issuance of a , Ceftificate of
0 y
Date
BLDG
Job Description
W OF INTERIOR OFFICE
BUILDINU FbKMII INFU
ELECT PLUMB MECH
tr 'm r1opr Area_., vaivation
APN Number Occupancy Type
NO ASSIGNED INSPECT ONS
Required Inspections �
Re -roofs '
Type of Roof
All roofs shall be inspected prior to any roofinginaterial being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection. Applicant understands and will comply with
all non -point source regulations.
Signature of Applicant Date
All roof coverings to be Class "B" or better
M
CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT s
BUILDING ADDRESS:
YERMI'r NO.
20410 TOWN CTR # 190
SOUTHBAY CONSTRTJCTTQN CO
INC 02010049
NAME:
APPLICATION SUB DA'Z'E
WNER'S
OWN CENTER ASSOCIATES
511 DIVISION STREET
01/14/2002
` PHONE:
SANITARY NO. CONTROL No,
(408)379-0400
Z ARCBITLCTIENGINEIIR:
BUILDING PERMIT INFO
BLDG ELECT PI.IIMII MECII
I_I CI 1_I f.l
soLICENSED CONTRACTOR'S DECLARATION
Job Description
hereby xlRrnuhnl I nun licensed un de, provisions of Cbpte, 9 (amunerring!
With Section(s) of Division 3 or Business and Pmmsmona Goac. and my Bcenxe'
DEMO OF INTERIOR OFFICE
ha in
in full ante and eRacl.
License Claea Lic.a
Date Contractor i
F ARCHITECT'S DECLARATION
1 understand my plans shall her used ax p.hire remNx
rLicensee Prefexsinnal
OatNLm exempt from CounnON �
I hnnbY nffnn Ism 1 nm exempt from ,he Cmmacmr's License Law fur Ihefollow'
mama ]onstru Buxlte,and Calc:Any tiny stcoonry
when rc9uircx n pem,d re construct, flit msec Improve. dmuonit t or repair our xwment
which permit vet demolish,
poo t issuance,all requires ,1 pp1' f 1 h pe- in Ile , l
$3500
_
Sq Floor Area .Th
Valuation
Led hatter
— .s mdformer,wlh<wu fth'. L'
'.
1 mms Code)
homanc. rri f D , i c d P fe .Cale)
ons n = th teat ]ft;
r s t 71 h ".1"; r1
;rt 0
or thatan the l
nm lie funs tall the apermi thjecWthAcxcmpd
"'3694'00'16°'OOY
{
t acyvinl
031.
of Section tan 5 by any drrucanl fur are t ,bjwu ,he oppl cans i evil Penalty.
ion 7031.5
APN Number
I �,x1.1'Ix„ -Occupancy Type
.gaol,mgrctban live hu,drcddannrs(SSIxn
NO ASSIGNED INSPECT
ONS
❑Ens owmranhe pmp=ny ormyemployee. with wage, as meirsom i,npenmion.
- "— .
,he work. and ,he sla¢Ime is no, intended n, offered far sale (secs 714,1.
Zdo
.Business and Professions Cale: The Contracecl License Law does no, apply m an
Required II15pfCt100$un `.' II ;.",
owner of property Who builds OF improves Iharcnn, and who does such work himself
Or through his own employees. provide l that such improvements am not intended or
Offered for sale. YC however. the building or improvement N sold within one year of
'completion the owmer.IwJAer will have (lie burden orp evimg that he did not build or
1
improve for purpase oriole.).
,
' lista pmpe. 7 press
LinxWd
acommaingwithde:) is
the project lace ]1144, .mJ 1'ry
the project
or The Contractors
1 • u
tranccxs
who dds ,hereon,
License law does our o man n hn there
apply pmt= r w prove.
m ens ).lice seion
and wha comma.a for such p) with a mmmnorts),IicenseJ purs,mm Iu the
cisw with,
C abettor's license Law.
o serapt code, Sec. • ;B'& P C for this reason
t' l' • ' - d I'
Own ,. Dad" " , •-
WORKER'S COMPENSATION DECLARATION
I hemehy alRm, under pcnahy of pc fury' due nr the following declarations:
I love'undwill' dminbin a'CcoiOcum or Convent',; self-imure for Worker's'
J❑
Compensation, as provided for by Section 3700 of the labor Calc, for the
i pe,firm dof die wink for which dr, perunljx ixsucd. .
Ell M1ave nail w II ,in W A C p ii I' c s g rc 1 hY Sermon
37M of the Labs Codc, fm ,he perfbmmnce of ,he work for which this front,
issued My WkerxC mpen i I tufa - and Policy -mart arc
��'/
SI R_TII9GATIONOL F.X WQRKE i
"•: i.l') { /ha'! t .. F`e5.v ,••_ 1 -.,
.• 1 .i. C, r' •..! .I, '� k •`
IONTO URANCE''t V
"- I 'COMPLN1A31QN INSURANCE' S i T?
I:•'' .,(9'M1,dseeta„ed ndtbcc Inplaed if they an'I is for .,at h,ndmil donara
.
1$100)or less.)
,l
fictionany eco a
chit m employ a c n, become b e n t ,he Workers'
employ any l
Cha C l atc''f
n n
Applicant, ... stns o,. .. ... ...
of Exemption should
Ifafternanking ix Caines
NOTItesTOct
' ”
a the Workrs f you nisei
hesuch its permit onsof theLabor
revoke.
� fonnwith comply with such nix a this permit shall be Jea,ted invoked.
finhwuxubeery provisi`nsno
I
r4j Imml.d :.�' CONSTRUCnONLENDING AGENCY'•
'Ihcrclry nBhm tial lharc lnncensmmtlan'lending agcncy'fdn the perfnminnu
"' '• '
e orthcwoakfar whicA,nis permit ix ixsueJ(Scc. 309]; Civ. C.)" "'
I -
a LendeLf Namc .•....�
- ... -
Lender4Addms, -,
,
so
1 ,fy0 ilei rc dth''iPplix n d i, ,Am ,h<nM f Mahon s
-.i
copped I grc t comply Ih II city nail d n,y J' a I t ,c I mining
mhuilAing mnmmciion. and he,chY nmhnnre reprcsematives of Mxcny mentor upon
a Ibgnbwc-,ncminneJ punpn,y for Inspcciinn Pu,pnc.,
(We) ;gree m save, indemnify eau kdep hmnJcss' ,he City of Cup6Aina against
7 liahilitics, judgn,ems, enslF unJ expenmx which may in any way necme again.a said
yCity nconxe9itence ofth g niing Ih pc I "' "' " """'
•I' ILAMI'UNDiRs NT
r
Issued ISSUedby• Date
'b Lliro1 Ise"i".l^l`(^
Re -roofs
A2AItIH)U$'MATI RIALS DISCLOSURE
w11 Inc. pN e: t r , m Iv m a< p rvt d n ale n t lana ,namnal
Type of Roof
9pJaf Jiy,l Clea M p GJ CI I, 91 ,d I,1 H'IIM1 ml':.
f
r1a'
L��:'
CtM Sect 255\21x1
❑ve-+ ' .' I ` Int xl;a ;t" I ° a
y.tRm {:�..
!.a f' r
All roofs_shall ebe inspected prior }o any roofing material being installed
W,B the ppl m .,are na s r t mega p t m c s w•n,m
,
If a roof i$ installed without first obtaining ao'inspectloit; Iagree to remove
antiFrOardorWro, I,tsonnam,to, rednyll ❑ y maAFrQuadilyh1traocuout
Dia ct -
all new materials for inspection. Applicant understands and -will comply with
oY',
all non -point source regulations.
P I \'1 have rreeJ'te I Nous 4umenm. mry rdimmx audit, Chaper,15.95b(,he
Califomlu Hcnlih'& Safety Cudc: Scctinuix 25505, 25533 nod 25574. 1 ,mderabnal Ilse,
(Ihe lad IBJ of Jyh ¢ nth,, yrepo b'Ity,nmTy the
'
Occup of the e I it m n, ch is be 1 P J o issuance f Cell u0catc of
`y
oww
Signature of Applicant Date
All roof coverings to be Class "B" or better
r o1 t DIC
r see ;
I .
• ,. nrl " .. .. •.
I OFFICE _ ..