01100070 (3)CId� o� DPERTONNO
CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS:
PERMIT NO.
20300 STEVENS CREEK BLVD
CONSTRUCTIVE BUILDING SVT,INC
01100070
OWNER'S NAME:
APPLICATION SUB DATE
DAY CASEBEER
3937 39TH AVE
10/10/2001
HONE:
SANITARY NO. CONTROL NO.
(510)531-1175
Z ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
0
BLDG ELECT PLUMB MECH
Z LICENSED CONTRACTOR'S DECLARATION
Job Description
I hemby aRrm that 1 am licensed under Provisions of Chapter 9 (commencing
w with Satian7000) of Division3cfth,Businessand Pr i yl cans,
is in full tome node
N'F.IW\METAL'�RAILINGS. FON, LEpp
ll �lln
-'ill
icro
6 license Class 'tin
Date _/�_IO._�/CLA
,5 DEC
g 1mulcromd—myplnvnR,mail Ebeused asPublic rmords
MAY 0 8 2002 MAY 0 8 2002
OLicensed Professional
OWNER -BUILDER DECLARATION
CiummON
1 hMaso M. that I am exempt from the a License for the
N
V Vl BUILDING
BUILDING B�Jll..[3ING
l roes Cade: city o
< following rtawn. (Sudan 7031.5. Professions Cede: Any city or counts,
Business shadimprove, demolish,
$5000
construct. m repair any strvmurt
O which requims a permit to conswct, vlrer, improve.
� prionovisa rtquires,the_-
- dvi hcis'license4 yur'suantmthe provlslom of the Contmcton's License Law(Chapter 9
Section ]BW) Division 3 the Businass Profepsions Code)
_ Ft A6aat s k,j, v Valuation
6. �) • f 1 ,
(commencing with of of and
h< is -end basis for rite ezemgibn. Any violation
��1'pF�� tQ pJ / 115 t..4 •
or Nei exempt therefrom the alleged
'of Secdan 7BJLs by any vpplicant for v permit sobiects Ne epp6cam m v civil pevhy
or not come tlua five hundred dollars ($500).
1.I��mI,��
101APN - F5ftATI ON Occupancy Type
❑ 1, as owner of Ne property, or my employees with wages as their sole compensation,
will da the work, and the structure is not amended or olkred for sale (Sec. 7044,
Required Inspections,'
Business end Professions Cade: The Contractor's License Law d«s ant apply w an
103 - UFER
orr of property Whit builds or improves theman, and who does such work himself
through his own employees. provided that such improvements are not intended or
104 — REBAR
' orfewd for xle. If, howeverdie building of impravnntcm is sold within arse year of
10 5 ANCHOR BOLTS ' <
completion, the owneoWilder will have the burden arpwving Nat he did not Wad or
—
mprovafarparposeafwle.f
106 - SEWER & WATER
01. as owner othe propcity. amexclusively contracting with licensed canromortto
202 - UNDERFLOOR PLUMBING
construct the project (Sec. 70W, Business and Protestants Cade:) The Contractor'.
License Law does not apply to an owner of property who Wilda or improsm Merton,
2 03 - UNDERFLOOR MECHANICAL
end who coavacta far such Amiens with a mmremmr s) licensed pursuant w the
-- .. ... ... . . .. ..
204 - UNDERFLOOR. FRAME
CommnarsLicamseLaw.
' ❑IemeaemaunderSec. "B& PCforrhisMason
205 - UNDERFLOOR INSULATION
Owner Data
301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
Ihereb affirm f
hereby rya perjury
303 - ROUGH MECHANICAL
�l I have ad win maintain it Camficnc'of cyrioml td self -insure for Worka.•a
304 - ROUGH ELECTRICAL
ompcnearioo, as provided for by Section 37W of he Labor Cock, for the
performance of rhe work rot which this pcnnir is imted. ,,
305 _ FRAME
aye and will maintain worker's Compensation Insurance, as required 4y smtion
306 — HOLDOWNS
37 f the LaWf Cod f tit perforrttmu f the work for which this gamut .'
issued daersc r Ino, c< P. ynmm�er ere. _..'
s- _307 , . INSULATION.,__
policy N,0..
Q,g•t`j308•OitSHBETROCKi"f
CERTIFICATION OF EXEMPTION FROM (
3O9 EXTERIOR LATH
.. - COMPENSATION INSURANCE'
cm^
-__..__...._—._..._.
310.?= 'INTERIOR LATH �,.',;•;.'
'fThis'senion need not W mmpinetl if the pcm,it is for acts hundred dollars
'
311 - SCRATCH COAT
(s1oomrkm.) ,,,
,
1 edniry that in the performance of the work far which this Worth is named, 1
313 - ROOF NAIL." .... �, !. t - .; .. -; '.. ..
-
shelf not employ any. person in any manna, sdas rn become subject to the Workers
'
501 - FINAL ELETRI CAL ENERGY
Compensation Laws of California: Date,
Applicant502
- FINAL PLUMBING ENERGY
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
L becamesubject athcWorkdsCompensation ph isionsoftheLeon,Code.youmust
'
503 - FINAL MECHANICAL ENERGY
forthwith comply with such provisions or thusPermit shall he decor drtnok d.
504 - FINAL BUILDING ENERGY
3CONSTRUCTION LENDING AGENCY
505 - FINAL ELECTRICAL
l beach, IF. that there iso conetraction lending agency,for the performance
bane won for which this permit is issued (Sec. 307._ Cis. C.)
506 - GAS TEST .__. ..._.- ..
ane `r:n"uaRss
507 - FINAL PLUMBINGt •1,t,
Ianaymmlhave mad mis.ppliaahanand stamNamaaWveinformation is
508 - FINAL MECHANICAL
sorted. I agree to comply with ml city and county midhianees, and out. laws rthoin,
509 — FINAL GRADE
to building construction, and hereby' authorize representatives of this city to enxr upon
the above-mantionedproperty for lnspec0onpurposes,
510 - FINAL PLANNING
y (We) agree 1. save. indemnify andkecph.],.iheCityofCapeninoagthmst
which y in say way acewe against mid
A liabilities. judgments, costs andpxpenxs ma
514 - FINAL P C WORKS
City in convoi of the gaming of this permit.
APPLICANT UNDERSTANDSAND WILL COMPLY WRH'ALL NON-POINr
Issued by: Date
y'
SOURCE REGULATIONS. :.i
Signature of ApplicanUConnanor .. -Dae :.
'
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE .c
Will the applichen or fbwre Withis, ,.a, store or banNa haiiNws mmened
Type of Roof.: -1 •. ..-- '.'�:.,.". .
.. Cade. Chapter 9.1]. and the Health and Safety
m defined the Cupertino Municipal
-
tr, •... ., I i -,v .„ l
�iai"a..
Codc.Surian85J21e)7..,, (i""i, f;,;t..).vi ...
i.
El yes .."
aJ
shall be.inspected-prior..to.any.roofing material being installed._ ... _ .
Will the applicant or future Wilding occupant use equipment or devices which
..All.roofs
If a roof is installed without first obtaining an inspection, I agree to�remove
emit haraNnus air contaminants as defined by the Bay Area Air Quality Management
I Disoim
all new materials for inspection. Applicant understands and will comply with,
o Yes
_
all non -point source regulations:
aG re N da sus mmerhdx rcqui ms under Chvprm 6.95 of tit
Cali m a & fhy Cade. Sections 850 33 nd 25534.1 understand Net
,
if aIsh acs or ndYh .,a., t is my mponsibuity to notifythe
ups n pp Jo issu m'of a Canifcne of
/i///•a .
'
Signature of Applicant Date ._. .
w
'
All roof coverings to be Class "B" or better
is ��{� a Dare
OFFICE
CiTY OF CUPERTINO
CITY•F PERMIT APPLICATION FORM
CUPEkTINO
APN #
ate:
Fee Group
BAPPLOTHER
Bu.i,14ing'-Address:,,'-,-,�,-,-�
006 at��, 'SU rt: Z -f-00
Owner's Name:
Phone #:
VA' -Z
/16)6 -
Contractor:
License #:
obl4t4t
778 79
Contact:
Phone #:
,VTT__
13
Applicant/Contractor:
Boiler > im to 1,75 M Btu
Building Permit Info:
Bldg Elect Plumb Mech
Job Description: Wq 1-tv-rpt..-24t"mrf
Residential: ornmercial: U
Sq.Ft. Floor Area:
$ / S q.
r
BCONSTAX
Architect/Engineer:
Valuation-
T,-Aut-A
Con. Tax for BQ Zone
Type of Construction:
Occupancy Group:
� - Lvi
-,
Fee ID
Fee Group
BAPPLOTHER
- U
01,16H, oil
Boiler <= 100,000 Btu
MECHANICAL
Boiler> 1 OOK to 500K:Bi;b_11[&UX$j
Boiler > 500K to 1 M j4i_u___
13
BBOILER4
Boiler > im to 1,75 M Btu
0 WK It 0 IV -A
BBOILER5
Boiler > 1.75M Btu
I Mons z 0
Construction Tax
BCONSTAX
Ind/Off/Co!!�Quasi
I M4 no
Con. Tax for BQ Zone
Hotel and Motel
Constax — Resi/Mobilett
i Elec 600V <= I OOOA
ISMIL W 2
I Mmom
X
BELEC200
Elec Svcs 600V <-- 200A
I ELECTRICAL
BENERGYADD
gnSg*z Add Multi
I
BINVESTIGA
Invesdization fee
1 of 3
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