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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CONTRACTnRfINFORMATIQN.'
BUILDING ADDRESS:
Ago 140MRgTRAn RD
HCBECK LTD
AKA THE BECK GR
tV"DO3080107
OWNER'S NAME:
1807 ROSS AVE
PERMIT ISSUE DA' IE
"Et
(214)303-6200
SANITARY N0. CONTROL NO.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
]Ob Description
p
I hereby affirm the, 1 am licensed under provisions of Chapter 9 (commencing
with Section 7(0X0 of Division 3 of the Busin «sgndpmfcssinns Cod,.md my license is
in mum deffect. c
TENANT IMPROVEMENT
��NALED
Licenses Lie.a
Da Convmwr
ARCHITECTS DEC 10
1 undcrslanJ my plans shall W used as pu is ccnNs
MAR 1 6 2004
Licensed Profov anal
OWNER -BUILDER DECLARATION
1 hereby affirm that( am exempt from the Contractor's License Law for the
following reoxon. (Schon 703 L5. Business and Pmfcssions Code: Any city or county
BUILD
which requires a penton to cnnamm, after. improve, demolish. m repair any structure
prior ser its issuance, also requires the applicant for such permit to rile a signed statement
that he is licensed pursuant the provisions of the Contractor's License law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7(XX)) of Division 3 or the Business and Professions Curie) or
3 16 0 9037.00
Nat he is exempt therefrom and the buts for Nc alleged Casuarina, Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of
not marc Nan five hundred dollars (5500).
❑ Lu owner of the pmpcny,mmy, CMPloym$ with wages as their sole compensation,
—
d Inspections
will do the work. and the smrnure is not intended or offered for ..to(Sec. 71)44, Business
and Professions Coal The Conmctoh Liceme law docs not apply w m owner or
102
— PIERS
propeny who Wilds or Initiatives Neman, and who doessuch work himselfor through his
own employees, provided that such improvements are not intended proffered for sale. If.
103
— UFER
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
104
- REBAR
ache 1.
105
— ANCHOR BOLTS
D 1, as owner of the pmpeny, am exclusively contracting with licensed contractors to
106
SEWER WATER
conswct the promt(See .7044. Busmen and Professions Coda:) no Convenor's Li.
— &
manelaw does not apply to an owner of progeny who Wilds or improves daemon. and
202
- UNDERFLOOR PLUMBING
who contracts for such projects with a convanorls) licensed pursuant the Contractor's
License law.
203
- UNDERFLOOR MECHANICAL
❑ l am exempt under Sec. . B& P C for this msson
204
- UNDERFLOOR FRAME
°r Data
205
- UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
301
- ROUGH PLUMBING
Ihereby arciren under lousily ofPerjury one ofthe following declmalons:
1 ,w oil will maintain.CenifemeofCamara tosd.m...for Worker'sCmnxm-
302
— TUB & OR SHOWER
nation, as provided far by Section 37W of the Labor Cods, Tor the performance of the
303
— ROUGH MECHANICAL
am mrwhichosupermitisissucd.
304
— ROUGH ELECTRICAL
0 1 have and will maintain Workers Compensation insurance, as required by Section
3700 of the Labor Coda, for Ne performance of the work for which Nis permit is issued
305
— FRAME
My Wortera pertvtlon lnsunmce prier a ad Policy mummer are:
306
— HOEDOWNS
Ca er.ZU�1CNCk�W�iQor /ta.:lA��-D?J
CERTIFICATEOFEXEMPpi@p1TtOM WORKERS'
307
- INSULATION
COMPENSATION INSURANCE
308
— SHEETROCK
(Thusectism need nothecomplesedifthe pennitisforonehundreddulma(SIM)
309
— EXTERIOR LATH
less.)
310
- INTERIOR LATH
I ecnify that in the punfomanto of the work for which this permit is issued, l shall not
employ any person many manna sn as w became subjectmtle Workers Compensation
311
— SCRATCH COAT
Laws ofcarromia.Date
313
— ROOF NAIL
Applicant
501
— FINAL ELECTRICAL ENERGY
NOTICE TO APPLICANT: IL after making this Ccniricate of Exemption, you should
Weome subject to the Worker a Compensation provisions of she labor Code, you must
ronhwith comply with such provisions orthis Permit shall hedeemed te.oked.
502
— FINAL PLUMBING ENERGY
503
— FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the Performance of
504
— FINAL BUILDING ENERGY
Newark fur which his pcmtit is issued (Sec. 1097. Civ. C.)
Lender's Name
505
506
— FINAL ELECTRICAL
— GAS TEST
Lcneer'I Address
and state Not Nc above ws misting is
I ecnify Nat I have read Misty
5 07
— FINAL PLUMBING
and County Wing to
l agree to comply with all city and county oNinsntts and auto laws
r
building hereby riaerposeaenudas or this City mcnmrupon the
FIN MEC CAL
ahow-mcamtra"tmn,and
.hovcmcnlionctl pmpcny for inspection purposes.
norecu
0 9
F I
(We) agree to save, indemnify and keep harmless the City or Cupertino against
liabilities, judgments. costs and expenses which may in any way acme against said City
5
NG
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: 5
U
C WORKS Date
S RCE REGU TIONS.
Re -roofs
Maine of Applin counselor Date
AZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building MCUPmt store or handle hm4Nuus pe tenal
u dcrned by the Cunmino Municipal Code. Chapter 9.13, and the Health and Safety
Code, Section 35533(.)7
All roofs shall be
inspected prior to any roofing material being installed.
0y. �a
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant of future building occupant use equipment or devices which
a Wa ardous air contaminants as dcri cd by the Bay Arca Air Quality Management
all new materials for inspection.
¢vice
0 Yes Own
I have mad Ne havardnus materials requirements under Chapter 6.95 of the Caliper -
his Health A Safely Cade. mecums 25NT5.35533 and 25534.1 understand Nat ifthe Wilding
does not currently hale a tenant, Nat it 4 my ocaga mihility w manly de occuPmt of the
mquiremcnts which most W mat Pon' to issuance epaemuheaw of 0.gopmcy'
Signature of Applicant
Date
All roof coverings to be Class "B" or better
.owner or authorie cot Daw