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CITY OF CUPERTINO
BIIILDWCDMSION p IT
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,_'CONTRACTOR E"IFO 'ION!
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BUILDINGADDRESS
PERMIT NO.
18880 HOMESTEAD RD
SOUTH BAY
CONSTRUCTION CO INC
02060136 -
OWNER'S NAME:
APPLICATION SUB DATE
RATIONAL SOFTWARE
511 DIVISION
STREET
06/21/2002
PHONE:
SANITARY NO. CONTROL NO.
(408)379-0400
ZO ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
F
BLDG ELECT PLUMB MECH
i LICENSED CONTRACTOR'S DECLARATION
I hereby affirn that l am licensed under provisions of Chapter 9 (commencing
Job Description
p
with Section 7")of Division 3 of the Business and Professions Code, and my license
is infngforceandefect.
REVISION SUBMITTED , NO NEW PERMIT ISSUED.
uLice^:eel^aa uc.g
ORIGINAL
# 02050176.
Due
to
ARCHITECT'SSDECLARATION
DECLARATION
g I understand my plans shell be used as public rcmrds
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby aRrrn that I am exempt fmh the Contractor's License Law for the
following reams. (Section 7031.5, Business and Professions Code: Any city or county
D which requires a permit to construct. alar, improve, demolish, or repair any structure,
$ - prior an itsissuarrce. alsosequucs the applicant for such permit to rile a sigvedsutemem
— that hq it licensed pd'auml to the Psovisioa of the Contractors License law (Chapter 9„t
(cbhmepcing with S«tion 7000) of Division 3 of she Business and Professions Code)
.(`'q, Ft., FJoor Ares
S *•' nation
and she basis for Ne alleged exemption. Any violatione
or Nes he h exempt tang
applicant to
ofB«bona the. by anydredd ll ter opemrit subjects the applicantmacivil penalty'
l ty
of not mare Nan five hundred dollars (5500).
In e , Occupancy Type
Cl 1, as owner of the property, ser my employees wish wages ex their, stile compensation,
will do the work, and the gwmure is not intended or offered for sale (Sec. 7 ,
Basm«a and Profa.imr, Code: no Connector's License Law docs or apply to an
102 -
FE)T- - -
PIERS Required Inspections
owner of property Who Wilds or improves thereon, and who does such work himself
or throw{h his own employees. provided Nat such improvements are nm intended or
oReiW for We. however, the building or improvement is Bold within one year or
103 —
. UFER
completion, the owner -Wild « se will hethe bro
uNen of proving that he did not Wild or
104 —
REBAR
improve for purpose of uleJ
105 —
ANCHOR BOLTS
OL a owner of the property do exclusively contracting with licensed contractors to
106 —
_
SEWER & WATER .
consumer the pmj«( (S«. 7094. Business and Professions Cade:) The Contractor's
License Law does not apply to an owner of property who builds or improves thereon,
202 —
UNDERFLOOR PLUMBING
and who
o Contractor's License s for Law.
Co hcontracts such pmjens with a comrecmrts) licensee pursuant to the
• 2 0 3 -
UNDERFLOOR'MECHANICAL
C l am exempt order Sec. ,B&P C for this uewn
204 —
UNDERFLOOR FRAME
Owner Date
WORKER'S COMPENSATION DECLARATION
205 —
UNDERFLOOR INSULATION
Ihereby affirm under Faulty of enjury one ofthe following d«Iaradtrns:
301 —
ROUGH PLUMBING
302 —
TUB & OR SHOWER
❑ 1 have and will maintain • by Certificate of Conant the Liinsure for Worker'she
emnpern,tian, a pro.ieoe for by Section noB of the IaWr ende. for the
303 —
ROUGH MECHANICAL
perfomtanceoftheworkforwhichthisperritisiound.
304 —
ROUGH ELECTRICAL
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
305 —
FRAME
FRAME
3700 of the LaWr Code, for the performance or the work for which this permir is
lamed. My Workrs Compensation
e
' on Insurance carrier and Polity number am:
306 —
NS
"Policy Na'
.3,07 !—...INSULATION...,,..
TIONOOFMEMP IONMOMWOR�
308 -”
SHEETROCK '
is
(Tota s«rion Med our W completed it the permit is for one hundred dollen
309 —
EXTERIOR LATH .. _..
- �
(sloo)orlea.)
310 —
INTERIOR LATH
11 due in the pnfono a of the work for which this Partin is issued, )
311 —
SCRATCH COAT '
ilial) not employ any person In any manner so as to become subject to the Workers'
Compemotion Laws of C difom ss ta Da
313 —
ROOF NAIL
AppiCEIafter this Lesions of of Euhptiod ynuahmuld
n.
NOTICETO APPLICANT:theWorkers
501
FINAL ELECTRICAL ENERGY
Compensate
become subject the Workers Compensanon prtivtaioa of the Labor Code, you must
502 —
FINAL PLUMBING ENERGY
jt farnwithctimPlywimachprnairmnsorrmapem,itan.11xa«medreankoa.
503 —
FINAL MECHANICAL ENERGY
3 CONSTRUCTION LENDING AGENCY
I hereby which this a wm
there is eon lending agency for the pcAortnence
504 —
FINAL BUILDING ENERGY
Lathe work whim this Peron is issued (s«. 3897. ay. c.'
I Lender's Name
505 —
FINAL ELECTRICAL
Under,
506 —
GAS TEST
I certify that 1 have read this application and monitor the above information is
507 —
FINAL PLUMBING
correct. 1 ague to comply with all city and county ordinances and stere lows relating
to Wilding constmction. and hereby authonse representatives of Ibis city to enter also.
508 —
FINAL MECHANICAL
thenbruse.mamicnedpmpenymrmspechonparpa«.
(Wel agree m save, Indemnify and keep harmless the Cry, of Cupertino against
509 —
FINAL GRADE
Iiabilisiu, ji dgmems, costs andexpanms which may in any way same against said
510
FINAL NG
APPLICAVTUHDERSTA VpS`AgD WI LL=COMPLYN'ITHALLNON-POI\T
r—
l4
I$$ued
C WORKS Date
SOURCE REGULATIONS.
Signature of ApplicunVCmn.to, Data
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or mare Wilding «capant store or handle haalloua ormarsal
_ Type of Roof
-- -•
as defined by the Cupertino Municipal Cade, Chapter 9.12, and the Health and Safety
Cade. section 255324),
r'•
OYcs QNo i
All roofs shall be inspected prior.to.any.roofing material being installed.
Will the applicant or future building occupant use equipment or devices which
hazardous
If a roof is installed without first obtainingan inspection, I agree to remove
p g
=mit air contaminants a defined by the Bay Area Air Quality Management
District?
all new materials
for inspection., Applicant understands and will comply with
Na
all non -point source regulations.
I have read the haamdous materials requirements under Chapter 6.95 of the
California Health & Safety Code. Sectiom 25505, 25533 and 25534. 1 understmd that
if rhe building does not currently have 0(count. that it is my responsibility to notify the
occupant of the requirements which must he mer prior to issumen of a Cmiftmte of
0.�pon,
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or anthanaad agent Date
OFFICE
BUILDING DIVISION V PERMIT I CONTRACTOR
BUILDING ADDRESS:
OWNER'S NAME:
(RATIONAL SOFTWARE
O O ARCHITECT/ENGINEER:
u
Ha
z v=toi Z LICENSED CONTRACTOR'S DECLARATION
ZO Z I hereby aBirm that 1 am .3licensed under provisions of sCode9 and
(commencing
r<` MM' with fall section 7000) of Division 3ofthe Business end Profession CWe, and mylicense
l as I is in full forte and elTect.
N"
tt0 i U License Class Lic. x
Dam SDECLAl
LL LLO fn ARCHITECT'S DECLARATION
I understand my plans shall be used as public records
seO O Licensed Professional
&
6 o OWNER DECLARATION
1 hereby of0rm hat I ton exempt from she Contractor's License Law fm the
f-ZQ followingreumb.(Sectioni Business and Professions Code: Any city mcounty
tz- C which requires a permit m eonstmet. elect, improve, demolish, or «pair any structure,
i 3 m ., poor m us issmnce, also «quires dan apPlinm fw such permino hie a signed smmment.
that hgid Iicen6N ponuanf to the provisions nl the Contractor's License Law (Chapter 9
(commencing with Section 91XKq of Division J of she B.Imcvs and Professions Code)
or Chas he Is
exeme, Ifierelsom and the basis for the aIle%ed exemption. Any violation
--of Section ]031 5 by any applicant fora permit subjects the applicant to u civil penalty
of not mom than five hundred dollars (S50 )L
C I, a .owner of the p petty, or my employees with wages as theirsole eampen+udoo,
'-
will 'do'the work: und'the strucmrc'is'not intended or offered for 'sale '(See. T ,
Busibass'andProfessions Code: The Contractor's License Law does not apply to an
caner of property Who builds or improves thereon, and who does such work himself
inmpletion, the owner -builder will have the burden of proving that he did not build or
mprove for parpnce of vale.).
I 01 aeowner of the peopenyam exclusively contracting nt
with licensed comcmm
onrs
cnruct the project (Sec. 7B . Business and Professions Curie:) The Contractor's
c _ License Law des not apply Io an owntt of DroPcrtY who Wilds or improves .hereon,
- and who contracts foLsuch TMjccls with a commnw(s) licensed pumtant.m the
_
Contractor's License Law,
Q 1 am exempt under fire ; B k P C for this reason
Owner' Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following dedamtirm:-
It- ❑ 1 have and mill maintain a Cenificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 37M of the Labor Code, for the
'perfommnce of the wufk for which this permit is issued.,,
C 1 have and will meinmin Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the peifomunce of the work for which this permit is
i"dcd. My Workers Compensation Insurance earier and Policy number arc:
-Ca tort 9t : }r{j s. f!ipaliby Nod u
rr,'I L CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE,'„°! •
(This section ted tot be a .ateled it Ilan permit is to, ne hundred dollars
IS 100) or less.)
I,:.I' n ry Ih i in the Performance' fth k h htl permit is .sued -1
hell nI employ any Anon in any manner sn as to become subject I. the Workers
fonhsvith comply with such provisions or this permit shall be deemed revoked
”ie ""-�" °'CONSTRUCT,ION LENDING AGENCY
' " 1 hereby a(Erm that .here is m construction lending agency for the performance
bf dwork for which this permit is issued (Sec. 3097. Civ. C.)
L, der's Name :. -_:,.. ... .. _
Lender's Address,
sl ccnify that I have read this application and state that the above information is
correct. 1 agree In comply with all city and rosary ordinances and smu, laws relating
to building conswetion, and hereby authorize representatives of this city m enter upon
the above-memi... d mpF,ty for inspection purpows.
IN's) agree m save„indemnify and keep harmless the City of Cupertino against
liabilities, juJgmenm, costs and expenses which mey.ln any way sceme against stud
City in consequence of the gtmning'af this panni):
APPLICANT UNDER WANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIQNS:
Sigwmreof Apph ano,"ato tou Duret ;.
,`t -HAZARDOUS MATERIALS DISCLOSURE
' � I IcuPptinnt or form, building aecupant at.rcu, handle huzardousnmecdat
se defined bysdic Cupenim!Mmudlat Code. Chapter 9.12, and the Health and Safety
11,61v
r,A Sea on 553_( )
❑Y .
Wdl the applicant or furore building occupant use ectiti,nner, or devices which
emit hazardous air conmminams as defined by the Buy.AL,!&iir Quality Management
District'
r' 1 have read the mor1us.matertuls recian,mems order Chance 6.95 of the
California Health & Safety Code; Sections 25505:25537 and 25574. I understand that
if the building does not currently have a tenant; that it is my responsibility to notify the
.,.,an, of the requlremems which must be at, rW m issuance of u Cc,t 1,mr of
Occupancy.. -'
Ow r or authorized agent _ Dmc
511 DIVISION STREET
(408)379-0400
kTION SUB DATE
06/21/2002
BLDG ELECT PLUMB MECH
Job Description
REVISION W-BMITT'ED.,-_,NO NEW PERMIT ISSUED.
ORIGINA ( 02050176. [/^C
102 - PIERS Required Inspections ” PI'1 y
...............103 _-..LIFER------'-----_..._...--= ------ ___._.....-------.-.._.._... ----
104 - REBAR
105 - ANCHOR BOLTS
-. .. __... —. __.
106 - SEWER & WATER - "'" •'"
202
UNDERFLOOR
BING
203- UNDERFLOOR'MECMHANICAL
' ._..._._L_....__.__
204 - UNDERFLOOR .FRAMEII;I•
205 - UNDERFLOOR INSULATION
301 - ROUGH PLUMBING
302 - TUB & OR SHOWER
303 - ROUGH MECHANICAL
304 - ROUGH ELECTRICAL
305 - FRAME
306 - HOLDOWNS _
"307.,_�
. INSULATION;nr :
309' -' EXTERIOR LATH
310 - INTERIOR LATH
_ -3I1 - SCRATCH 'COAT.. NI s : , - -
313 - ROOF NAIL'
501--- FINAL -ELECTRICAL rENERGY-- -;;-,.,;,;:-
502 - FINAL PLUMBING ENERGY
503--- F,INAL MECHANICAL-ENERGYr; ';::--:-.', . „1.„
504 - FINAL BUILDING ENERGY'. -
__ .. _505...-.. FINAL ELECTRICAL.. _..... __ ......._ _ _..._- . __..
506 - GAS TESTr).:..:- ,,;t,;
507 - FINAL PLUMBING
508 - FINAL MECHANICAL
509 - FINAL GRADE
510 - FINAL NG /
Issued%�.4 C WORKS Date C/v
Re -roofs
...Type.of.Roof... ...._.. .-w...... ,. ,...._,...
_.. All roofs -shall be,inspected prior to any roofing. material. being, installed,,",- ,_
If a roof is installed without first obtaining an inspection; I agree to remove
all new materials for inspection. Applicant_ understands and will comply with
all hon -point source .regulations:, ..,,
,._.Signature of Applicant -.. Date
All roof coverings to be Class "B” or'better
OFFICE ... .. . .... .. .. ...