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CITY OF CUPERTINO
PERMIT APPLICATION
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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
S I LVER I E
III INC DANIEL
PERMIT NO.',
20488 STEVENS CREEK BLVD
OWNER'S NAME:
2320 DEL
MONTE AVE STE Al
APPLICATION SUB DATE
CUPERTINO CITY CENTER ASSOC
02/06/2003
PHONE: -
( 8 3 1) 3 75 -
012 O
SANITARY NO, CONTROL NO.
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ARCHITECTtENGINEER:
BUILDING PERMIT INFO
BLDG EL® PLUMB M®
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Jot} Description
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effect.
REVISION --IN
HOUSE USE ONLY
License Class Lic. #
Date contractor
NO NEW PERMIT ISSUED, ORIG. 02040076
ARCHITECT'S DECLARATION
I understand my plans shall he used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I 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
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to rile a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
Sq, Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$1000
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
ApN Number
umber
Occupancy
Y Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
36901029.00
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 oroffered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
10
- FOUNDA d Inspections
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 We. If,
102
— PIERS
however, the building or improvement is sold within one year of completion, the owner -
103
builder will have the burden of proving that he did not build or improve for purpose of
- UFER
sale,)'
104
— REBAR
O I, as owner of the property, am exclusively contracting with licensed contractors to
105
- ANCHOR BOLTS
construct the project (Sea 7044, Business and Professions Code:) The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon, and,
106
- SEWER & WATER
who contracts for such projects with acontraetor(s) licensed pursuant nothe Contractor's
License Law.
202
- UNDERFLOOR PLUMBING
O I am exempt under Sec. B & P C for this reason
203
— UNDERFLOOR MECHANICAL
Owner _ Date
204
— UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
205
- UNDERFLOOR INSULATION
I hereby affirm under penalty of perjury one of the following declarations:
O I have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
302
- TUB & OR SHOWER
work for which this permit is issued.
303
— ROUGH MECHANICAL
O I have and will maintain Worker's Compensation Insurance, as required by Section
304
ROUGH ELECTRICAL
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
305
'- FRAME
Carrier: Policy No.:
306
— HOLDOWNS
CERTIFTC MPENSATONINS RTE OF EXEMPTION Q ORKERS'
CE
307
- INSULATION
(This section need not be completed ifthe permit is forone hundred dollars ($ 100)
308
- SHEETROCK
or less.)
309
- EXTERIOR LATH
I certify that in the performance of the work for which this permit is issued, I shall not
310
'^ INTERIOR LATH
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date —
311
313
— SCRATCH COAT
- ROOT'' NAIL
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
501
F I NAL ELECTRICAL
502
_ F I NAL PLUMBING ENERG 1.
ENERGY
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction tending agency for the performance of
503
- FINAL ME+`CHAN I CAL ENERGY
the work for which this permit is issued (Sec. 3097, Civ. CJ
Lender's Name
S 0 4
505
— F I NAL BUILDING ENERGY
— FINAL ELECTRICAL
Lender's Address
Icertify that I have read this application and state that the above information is
506
_ GAS TEST
correct, 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
PLUMB I G
above-mentioned property for inspection purposes.
FIN ry L
(We) agree to save, indemnify and keep harmless the City of Cupertino againstliabilities,
judgments, costs and expenses which may in any way accrue againstsaid City
%FINAL
A-27in
consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by:
NG Date;
SOURCE REGULATIONS.
Re -roofs 602
— OF PLYWOOD NAIL
Signature ofApplicaHAZARDO Date
HAZARDOUS MATERIALS DISCLOSURE
Type Of R �3
— ROOF BATTENS
Will the applicant orfuture building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
604
- ROOF IN -PROGRESS
Code. section 25532(a)?
All roofs shall be inspected to any roofing material being installed.
[j Yes [] No
prior
If a roof Is Installed without first obtaining an Inspection, i agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for Inspection.
District?
EJ- Yes ONo
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Heaith & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building
does not currently have a tenant, that it is my responsibility to notify the occupant of the
requirements which must be met prior to issuance of a Certificate of Occupancy.
Signature of Applicant
Date
.All roof Coverings to be Class "l3" Or better
Owner or authorized agent Date