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02100062CITY OF CUPER'I'INO DIVISION PERMIT CONTRACTOR NI FORMATION:. BUILDING H. � BUILDING ADDRrSS: PA GREATER BAY CONSTRUCTION PERMrr NO. p2i ER'S NAMI:: SUITE 200 APPLICATION SUB DATIi PITO .: (408)248-6600 SANITARY 1.01. NO. ARCHITECT/ENGINI;HR: BUILDING PERMIT INFO BLDG ELECT PLUMB mri 0 0 0 0 LICHNSEDCONIRACTOR'S DECLARATION I )Ob Description I hereby elfirm Nal 1 am licensed Inde, provisions of Chapter 9 (commencing P with Section 7080) of Division 3 of the Business and Professions C,de, and my license is in full ("..ad effect. /� FIRIALE® I.iecns Class Lic.N Time Comm oo TENANT IMPROVEMENT ARCHITECTS DECLARATION I undcrsmod no, plans shall w taxed as p.hire records FEB '0 3 2003 I.iccnsed Pndcssional OWNER -BUILDER DECLARATION I hereby affirm that I amlicmpr from lw Coniston"nLictnsm law for lw BUILDING following reason. (Section 7(31.5. Business and Professions Code: Any city or county which requires a permit in construct, o1wr, improve, demolish, or repair any structure prior to its is ounce, also requires the applicant Inn such permit o file a signed statement Sq. Ft. Floor Area Valuation that he is licensed pursuant o the provisions of the Contractors License l aw(Chapta,9 (commencing with Section 7(110) of Division 3 of the Business and Professions Coda) or Nat M is exempt thcmfdtm and the basis for Be alleged emniption. Any violation of APN Numbern yType Section 7031.5 by any applicant for a permit subjects Nc applicant o a civil penalty of not more then five hundred dollars (SM. I, as owner of Ne property, or my employees with wage as Neu sole compensation. Required Ins CC1100$ will do the work, and Ure sductum is not intended or offered for safe (Sec. 70,14. Business and Professions Code: The Contractor's Liccnm law does not apply to an owner of q P property who builds or improves rwrcon, and who doessuch work himself orthmough his own employees, provided that such improvemenu arc nota eluded oroRemd for sale. If, 101 — FOUNDATION however, one building or improvement is sold within one year of completion, the owner- pose, or improve for paose, of will have the burden of proving that ha did not wapar 102 — PIERS /builder .1 103 — UFER I, as —.1 of the, property, am emlmively conducting with licensed conrrxmrs to consumer the project (See. 7040, Business and Professions COM:) The Contractors Li 1 04 — REBAR . cense law does not apply to an owner of property who wads or improve& themon. and who contracts for such projects with a contmcmr(s)Hamad pursuant to the Condacmr's 105 — ANCHOR BOLTS License Law' ❑ 1 am Lacm�.u. J�cr Scc. . B K P�C�for this rcaz'nn 106 - SEWER & WATER \�} % /7 Dater4/2U 29 202 — UNDERFLOOR PLUMBING I RKR . 1PENSAI 10 203 — UNDERFLOOR MECHANICAL I hereby afnor under penalty of perjuryoneof Ne fol gMclloatiou: 204 - UNDERFLOOR FRAME El 1 have end will maintain a Cenificaw of Conscnl msdf-insure for Workcr'sCumNn- .sation, res proviMJ for by Section 3700 of the Iawr Code, for the TCRmmanna of the 205 — UNDERFLOOR INSULATION workfmwhichNispemitoosted. 301 — ROUGH PLUMBING ❑ 1 have and will maintain Workers Compeastnion Insurance. as acquired by Section 3700ofthe Tatham Code. for the performance of the work for which this permit is issued. 302 — TUB & OR SHOWER My Workers Compensation Insurance canner and Policy number am: 303 — ROUGH MECHANICAL Camra: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 304 — ROUGH ELECTRICAL COMPENSATION INSURANCE 305 — FRAME (This section need not becompleted if the permit is for one hundred dollars ($100) 306 — HOEDOWNS m leas) ' certify llm in thc mnanec of the work for which this permit is iss J. I shall not r 3 07 — INSULATION employ any pe s ymann seas nbceflmcyubjen mtw Wo en Compensation laws "fcalifn .D :JJ JJ 308 — 309 — SHEETROCK EXTERIOR LATH App""'�0� should mETO APPLICANT: If. afro making This Cc ifinte Of Exemption, you laver Code must e subject in the Workcr's Climpcnsaton provixiens of the you 310 — INTERIOR LATH forthwith comply with such provisions or this ticrmlt shall IN, deemed revolted. 311 - SCRATCH COAT CONSTRUCTION LENDING AGENCY hereby Cagency tarthe pertormanceof roe Nat Ncrc issed 313 — ROOF NAIL see—UN7. the work for which this permit is issued (Sec. AN7. Co.iv. C.) which � t<ndcr's Name 501 - 502 — FINAL ELECTRICAL ENERGY FINAL PLUMBING ENERGY Lcndcr'S Address 1 certify Nat I have read this applicmiort and state rhm the abuse information is correct. I agree w comply with all city and county ordinances andsmm laws relating or 503 — FINAL MECHANICAL ENERGY Ioildingeonsrruethm, and hereby authnrne representatives of ouscily m enter upon the 0 FIN BUILDWG ENERGY ' above-mentioned properly for inspection purposes. t (We) agree It, save, indemnify and keep harmless the City of Cupertino against 5 F I eeswhichmay inany way aucoxagainst said City gmen,cosulandcaptn j hahilities.judu ov in cmiseytresice of ranting of is rmit. ' APPLI,A NDE 'TA AN .L COMPLY WITH AL1. ON POINT lk Issued by: 5 Date SO C EGULATI NS. - 2 Ng e -roofs 508 Typeof RV69 - INAL MECHANICAL FINAL GRADE Signature of ApplicanUConduaor Dam IAZARDOUS MATr:R1ALS DISCLOSURI3 Will Ne applicant (it future building occupant store or handle harsNuus matenal s Jefitred by on, Cartoon Municipal Code. Chapter 9.13. and the Health and Safety 510 — FINAL PLANNING Ne. Section 35532M)? All roofs sbalkbeinsrTtgMiopq]gTUlpofial W)kS'ial being installed. �J ❑Yes Who. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant orftauttturebuildingoccupantuaecquipmentordeviceswhich emit haaunlous air cnnmminams as dclined by the Bay Arca Air Qualify Management all new materials for inspection. Dislricp ❑Yea 9f" Ihavc read the hureNnu materials reyairtmcnm under Chapwrfi9SolNcCalifnr- nialMalNhSafelyC,de.Sections25585,25533am125534.1unM.m thmifwwilding Nes not currently hose a worn, that it is my resp,msibli ly to mor t cupmt of the rtcar bothmrunbe, f nmmisuaeceof.certificadar 'gamy. p Signature of Applicant Date a2 02 All roof coverings to be Class 'T or better wncr or awhmi¢d alma no, wDO m FZVi] rnaa F= OZyZ — °OU �3�t— dap0 CFO CITY OF CUP]ERTINO BUILDING DIVISION PEWIT �T (COCTOR][ ]F�: BUILDING ADDRESS: GREATER BAY CONSTRUCTION PERMITNO. OWNER'S NAME: SUITE 200 APPLICATION SUB DATE PHO : ( 0 8) 2 4 8— 6 6 0 0 SANITARY 0 CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing Job Description with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. # Date Contractor TENANT IMPROVEMENT ARCHITECTS DECLARATION 1 understand my plans shall be used as public records ' Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors 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 forsuch permit to file 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 that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number n Type not more than five hundred dollars (f500). y ❑ 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. Business and Professions Code: The Contractor's License Law does not apply to an owner of Required 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 sale. If, 101 — FOUNDATION 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 102 — PIERS sale. . I, as owner of the property, am exclusively contracting with licensed contractors to 103 — UFER construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- 104 — REBAR tense 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 Contractors 105 — ANCHOR BOLTS License Law. ❑ I am exem t "der Sec. , B*& PC for this reason 106 — SEWER & WATER ow Date 202 — 203 — UNDERFLOOR PLUMBING UNDERFLOOR MECHANICAL RKER 4PENSA 10 I hereby affirm under penalty of perjury one of the fol g declarations: 204 — UNDERFLOOR FRAME ❑ IhaveandwillmaintainaCertificateofConsenttoself-insureforWorkersCompen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the 205 — UNDERFLOOR INSULATION work for which this permit is issued. 301 — ROUGH PLUMBING ❑ I have and will maintain Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 302 — TUB & OR SHOWER My Workers Compensation Insurance canter and Policy number are: 303 — ROUGH MECHANICAL Carrier: Policy No.: CERTIFICATE OF EXEmi4ION FROM WORKERS' 304 — ROUGH ELECTRICAL COMPENSATION INSURANCE 305 — FRAME (Mis section need not be completed if the permit is for one hundred dollars (f 100) or less.) 306 — HOLDOWNS I certify that in the p6jormance of the work for which this permit is issued, I shall not 307 — INSULATION employ any pe y mann so as to bCr c subject to the Wor crs' Compensation J Laws ofCalifo . D APPI 308 — 309 — SHEETROCK EXTERIOR LATH E TO APPLICANT: If, after making this Ce ificate of Exemption, you should P. 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. 310 — INTERIOR LATH CONSTRUCTION LENDING AGENCY 311 — SCRATCH COAT I hereby affirm that there is a construction lending agency for the performance of 313 — ROOF NA I L the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name 501 — FINAL ELECTRICAL ENERGY Lender's Address I certify that I have read this application and state that the above information is 502 — FINAL PLUMBING ENERGY correct. I agree to comply with all city and county ordinances and state laws relating to 503 FINAL MECHANICAL ENERGY building construction, and hereby authorize representatives of this city to enter upon the ahove-mentioned property for inspection purposes. O FIN LL BUI LD G ENERGY (We) agree to save, indemnify and keep harmless the City of Cupertino against 5 F I E AL liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of ranting of this rmit. APPLICA NDE TA AN L COMPLY WITH ALL ON -POINT Issued by. V V Date SO C EGULATI NS. _ _ e-roofs 508 f INS, INAL MECHANICAL ? Signature of ApplicanVContraclor Dare HAZARDOUS MATERIALS DISCLOSURE Type of Rwi 9 _ FINAL GRADE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety 510 — FINAL PLANNING Code. Section 25532(a)? ❑Yes y�No All roofs s 4be s prlo �g,�y-,{'• f g�p� phial beinginstalled. ��Tt � ��1VL�L �LSLi1� �PJ1C�.7- 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? ❑ Yes [a'f" I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building dots not currently have a tenant, that it is my responsibility to notify the cupant of the requi hich must be met rior to issuance of a Cenifrcate of cu ancy. �• Signature of Applicant Date �hRS 1202All roof coverings to be Class "B" or better caner or authorized agent Datc