00080100 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILIRNO ADDItflSS: PERMIT NO.
93 1 1OLLANDERRY 121 _ 00080100
OWNER'S NAME: APPLICATION SUB DATE
' 08/1.4/2000
DONE: SANITARY NO. CONTROL NO.
❑m Y ARCHDECDENGINEER: - BUILDING PERMIT INFO
Poo BLDG ELECT PLUMB MLCH
LICENSED CONTRACTOR'S DECLARATION ,lob Description
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing p
eF vm�me with Section V000)of Division 3 ofine Bmineesant P•rofirdons Cola,andnty license
Liccneo Glasse and n, Lic.M_ / -
_ 520 SQ. FOOT ADDITION
�a5 O n Dare_ a Con rns t r
F LL Q .I—i Rif CHITECI"5 DECLARATION
y ((uA crslanJ my plans shall M used as public rcat s
Y
p O LlcmucA 1'ndessidnul
Pl (1\VNN}t-BUILDHIt DECLANA'1'ION ,
I+� I Wishy effort that I um emntpt Irons the Cantmemr's License Low for the
(=z a following reason.(Sieben 7031.5,Businc,s and Professions Code:Any city m county
F C which require,n Permit ,,comlmcL aline improve,demolish,or mpan say swemre ,
prior to its issuance,also requires the applicant Tao pvaritto file a signed statement
than he i,licensed Toussaint it)the pmvinmns of the Connector's License Law(Chapter 9 Sq. Ft. Floor Area Valu T
(to no,oring with Sectinu 70fHg of Division 3 of the Bunions,and Pntfcseio is Cale) - _
or thm he is exempt dwoAmm and Inc h.,i..far the alleged enemptinn.Any vinlmion 5 3
of Section]03 LS
or not more man five ohundred
dollars
dmlmrs a permit euM1jems the apPlicam m a civil pennhy
($500). APN NumberOccupancy Type
°I,as owner of the property,oT my entployeea with wages os their sole compensation, 9
062 0
m
will do the work,and the atruclare is not'imended or offered far enlc(Sec.7044. " ." Required Ins eChODS
Busing,and P..fu,in is Code.The Contractor's License Law does napply m ua - q p
w of property Who build,or impnwe,thereon,and who does wgh work himself
or through his own employee,provided that such improvements are not intended or 101 — FOUNDATION .
offered for sale.If,however,the Building or improvement is sold within one year of ,
iompletion.the oxmerhadder will have the burden of proving that he dalnot build or 1.02 — PIERS
mprove for putuo,c oI sale),
°1,o,—mr, fthe laormy,a xcluively mntraning with licensed conwnurs to 103 — UFER
nmmact the project(Sec.70W.Business and Professions Ctae:)The Cumarin,', 1.04 — REBA R
License Law does not apply tu an as,of property,as he Wilk or improve,thereon, 105 — ANCHOR BOLTS
Connector, ns
and who contracts for such projects with a cnmmaor(O licensed porsuam to the —
C000r,Licee Low.
°I am cannel ander Sec. ,B&PC Worms out 1,06 SEWER &- WATER
Owner Date 202 — UNDERFLOOR PLUMBING
WORKERS COMPBNSATIONDECLARATION 203 — UNDERFLOOR MECHANICAL
Ihereby affirmunder Pen.,hyofperjury one ofthe following declarations: 204 — UNDERFLOOR FRAME - ..
I hnvo. I will nw main a Cetlilicme of Consent to self-it"me for Worker's
ampe,,imsn. as provided far by Section 37(X1 of he Lahr awe. Ibr the 205 — UNDERFLOOR INSLILAI"TON
performance oldie work for which this permit is issued.
301 — ROUGH PLUMBING
°I haveiftheawdlrCode,nWorker'sfinmpamofte mkfasrequired
, ponalis 302 — TUB &� OR SH014ER
3]00 nl thew Labor Cndc,fm the perfnrmanuc nl the work for which tide Inrush is ,
issued.My Wader Compensal'an Isomnew carrier and policy ouatbef anct 303 — 'ROUGH MECHANICAL .
carters xv
A,wi oFEsetilvnoH TrmfwoR 304 — ROUGH ELECTRICAL
COMPENSATION INSURANCE 3055 — FRAME
crhiseectiottaocdnot beeompmlediJthepo,mhl.fanow mlmhddolmn
306 HOI_DQWNS
IslaO nr less)
1 veWiry mat in,he m
e perromnre nrme..ol,for which this penin,is issued.1 307 INSULATION
shall not employ any person in any manner m as to Incmnc subject to the Workers 308 — SHEETROCK
Compensation Laws or California.Dine
Apolunam 309 — EXTERIOR LATH
NOTICE TO AP0 the Wo k If,after Invoking this Provisions
of Labor
you sbould.
Became hwithcmply the Wuchprovnml¢matiwn provisionsof the Labor ncl.keoumu,l 310 — INTERIOR LATH
Q z forthwith comply with such provisions or this permit shall M Deemed rtvnked..
Z
CONSTRUCTION LENDING AGENCY 311 — SCRATCHCOAT
a IherchynfOrnu
hal there isacon,mationlent'mgagency for the performance 313 — ROOF NAIL ,
o1'the work for which mis permit Ls k,ard(Sec.309],Civ.C.)
i o
Leader's Name 501 — FINAL' ELECTRICAL ENERGY
D z Lender's Address 502 — FINAL PLUMBING ENERGY
U O I ecnify that 1 have read mis application o n i mme that me have information is
w F correct 1 agree to comply with all city Imd county ominana%and state laws relating 503 — FINAL MECHANICAL ENERGY
Q V m bonding cinstruction,i I hereby uullvrwere......nove,of(his clly at enter upou
rr meaMwe-mominaedproperty far inspemionparl 504' _ FINAL BUILDING ENERGYIL (We)agree m m
save,indemnify and keep handless me City of Cupenioo against /Atr
w liabilities.judgment,,rust,ams expenses which may in any way amme against said
505 FINAL ELECTRICAL
U Z City in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT - 506 — GAS TEST
SOURCE REGULATIONS. .. Issued by: ate' —/•�_��
Signature ntA,licawcormortir Dan Re-roots508 — FINAL MECHANICAL
HAZARDOUS MA'T'ERIALS DISCLOSURE
Will the applicant in fitture Wilding occupant store or handle noeardous material Type of Roof 509 — FINAL GRADE
as defined by the Cupertino Municipal Gide,Chapter 9.12,and the Health and Safety
Code,Section 255320)? _ . 510 FINAL PLANNING.
°Yen All roofs shall be Ss yyr��cted p�tgr,,q}, try x' �{pgg t�r� g g installed.
Will the applicant lir future building occupant use nptipmela or reviews which If a roof is installedrThou[ flrSY'cYKnifig .�tl`(ILpecTio, 1'gree to remove
until hazaNnas our mnmminams asd cd by the Bap'Area Air Quality Management
under? all new materials for inspection. Applicant understands and will comply with
°Ye, Na all non-point Source regulations.
I have read the hr7Jok us materials Membemcnls under Chapter 6,95 of the
California Health&Safety Cede,Sections 25505,25533 and 25534.1 undcrsmnd that
if the Building does not currently have air...L that a is ns,responsibility tu notify the
occupant of the requirements which as rte m prior m"wencce of a CeniGcme of
Occup:mcy. ,
Iry/_• tj Signature of Applicant Date
Owner or uumod -rrd - , Dole All roof coverings to be Class"B" or better
OFFICE