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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
40ONTRMTOR IN 04MATION _,
BUILDING ADDRESS:
PERMIT NO.
20705 VALLEY GREEN DR
SOUTH BAY
CONSTRUCTION CO
INC 03040046
OWNER' ME:
PERMIT ISSUE DATE
�IVPLE COMPUTER
511 DIVISION STREET
04/08/2003
SANITARY NO. CONTROL NO,
(408)379-0400
ARCHITEC MNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that [am licensed under prgvNone of Chapter 9 (commencing
wlNSoedon i0fal fDiviron7of the Burircu Jd Profuuom Code, end myliccneck
In full forte e m ✓
3 6Q�
cies can nc
TENANT IMPROVEMENT
DDa�nu
As Rr
FINALE®
n shallL'CPSDE
1 upa�agy /nr plane wn he used u pumte records
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1
NOV 1 0 2003
Licensed PnTasional
OWNER -BUILDER DECLARATION CLARATION
1 ncrchy amrm that I Lew for Inc
eacmpl from Ne Comas;
Y V L
Co :Ansa
703 13. Business and Pmrrsemfl Code: Any city st manly
reason. 1
permit or construct, fur. nt fie any anuctum
which ennit t
wnkh ants nnit
h pedco
isu n
t a sig
the retouch Permitm file Law etsumcnl
theapplicantoff
prion to isoissuance,ruant Contractor', Uanu Law 9
Sq. PI, FI00( Area
that In cCon
of thehe Busl
pursuant m the of Division inneCNe) of
Seceion 7W0) o 3 m Coda)
Profeon,
$450000
with
(commencing with
(commencing tof he al eged axe t An
ebut,
Nee he k exempt therefrom and the bole for doe alleged exemption, Any violation of
—/'kjl1l �I�r�b�r.00
Occupancy Type
Section 7031.5 by eery spplmma for a permit subjects Ne applicant to a civil penally of
not more Nm five hundred dollen ISM,
, jam(
�
❑ 1, u owner of Bae property, m my employees with wages u their sale compensation,
Inspections
will do the work and the ettucturt k not Intended m offered for eek (See.70M. Bwilaess
and Profusions Cade: The Conuactoes License law does not apply m an owner of
101
- FOUNDAW)iYffl
property who buildsorimprama Baemon. and whodoeaaueh work himselfor tlwugh his
102
- PIERS
ownemployees, provided that such impravemenu Pmnot intended aroffeea l for sole. IL
however. the building or Improvement is told within one year ofcompiedon, Neowner-
103
— UFER
builder will hove Bu burden of proving Thor he did not build or Improw for purpose of
104
- REBAR
sale).
❑I.mownnraf,hepropeny.smexcluiwlyconuaclingwidolimnudeontnnonm
105
- ANCHOR BOLTS
construct the pmject(Sec.7044, Business and Professions Code:) no Convector's U.
lO6
— SEWER & WATER
come Lew docs not m in owner of property who builds or Improves Nemon, and,
who contracts Bettors projects with a conutexorD) licensed punuam in the Contnnofs
202
- UNDERFLOOR PLUMBING
License U.
❑ I am exempt under San. , B k P C for this reason
203
- UNDERFLOOR MECHANICAL
Owner Dole
204
205
- UNDERFLOOR FRAME
- UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
I hereby Prima under penalty of perjury arc of the following dulan0otae
301
- ROUGH PLUMBING
.intend will meinwlo&Certifrnmof CouentioulM1luum forWmteM1Compcn.
302
— TUB & OR SHOWER
an,u provided for by Section 7700 of the Labor Code, for the perfO mace of the
work for which this pooh is kned.
303
- ROUGH MECHANICAL
❑ 1 ban and will msinlrn WorkcYs Compensation Insunna, u acquired by Sardine
304
— ROUGH ELECTRICAL
3700 of the labor Code, for the pedoamance of the work for which Nle pemait is bound.
305
— FRAME
My Worker's Cnmpensetlon innunue canipr red Policy numher art:
ca
306
- HOLDOWNS
CERTIFICATEOF EXFMPI7D Faomw KERS•
307
— INSULATION
COMPENSATION INSURANCB
308
- SHEETROCK
(This section need not he completed ifthe permit Is for one hundred dollen($ m10
nr leas)
309
- EXTERIOR LATH'
I certify that in Be, perfnmaamt of the work for which this Permit is cooed. I sbrl nor
310
— INTERIOR LATH
employ any pattern In any manner an u m become subject n BU Workeri Compewdon
311
Laws of Celifnmk. Dau
313
- SCRATCH COAT
- ROOF NAIL
Applicant
NOTICE TO APPUCANP, IL efur making this Certificate of Exemption, you thoum
became subject n the Worker's Campensadon provblons of the lalnr Cede. you muse
501
— FINAL ELECTRICAL ENERGY
comply with Such pmvlBnumthis permilshall bcdamned Unukcd.
502
— FINAL PLUMBING ENERGY
LENDING AGENCY
503
- FINAL MECHANICAL ENER
I hereby aRime the, them les construction lending agency for the performance of
d(Son.3. Cb. C)
the work for which this permitklow(197
504
— FINAL BUILDING ENERGY
Lender'eName
505
506
- FINAL ELECTRICAL
- GAS TEST
Lendcr'. Address
1 certify that I haw read this application and sou door the ebow inforroumn Is
cones.IagreeIncomplywithallcityandcountyordinamtaendstaulewm1mingm
5 7
- FINAL PLUMBING
building construction, and hereby authodu rtprtunuvrts of this city On enter upon doe
FI L MECt
ALIWO)
agree In saw, Indemnify and keep harmless the City of Cupertino against
%0-.shove-mcn0onedpropenyforiupenirnpurpaus
F Iliabilities,judgments,con,
and expenses which may In any way accrue agamil said Cityin
co unec afthegningoftbbepermil.APP NTUNDERSTANDS N WILL COMP Y WITH ALL ON -POINT
Issued by:
Date
SO CE EGULATIONS.
A
Re -roofs
les ppIiCNVCR
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
WIII Ne or future building ram orhandle al
e, cup Health a d Safety
u dcMcd by the Cupertino Municipal Cade, Chspur 9.17, sM the Hcaldo end Safety
a Cupertino the
Cade, Bordon 75537(.)7
All roofs shall be
inspected prior to any roofing material being installed.
_ ❑res0
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or (mea building oaupenl esu equipment m Jevla4 which
hanrdnm Pit conuminents u dcOncd by the Bay Arca Air Quality Management
all new materials
for inspection.
uicti
❑Yes O
1 how mwf the hanor msmaurialsrcquiumenes under Chopur6.95 olthe Califon
'
nix HcoW Srcey Cud'Sauans25N)5,25533 and2S53J. I undersand flstifNc ilding
does n u sly how a linen th 11 h my mepo hlliry to notify Iles roto t M c
mri.i en "job must p rmivaonce acnavraasm O
Signature of Applicant
Date '�• ;I
%(
roof coverings to be Class "B" or better `'
er mharbed ag m'Dole!All