02040057CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS: -
PERMIT NO.
20705 VALLEY GREEN DR
SOUTH BAY CONSTRUCTION CO
NC 02040057
OWNER'S NAME:
APPLICATION SUB DATE
W LE COMPUTER
511 DIVISION STREET
04/12/2002
1-E
SANITARY NO. CONTROL NO.
(408)379-0400
ARCHITECDENGINEER:
BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
i
r-7
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7")of Division 3 of the Business and Professions Code, and my license
TI (57 855 SQ. FT.)
,s m full force and effect.
License Class Lisa
+
TEMP PERMIT ISSUED ON 05/10/2002
Dale Ca`
ARCHITECT'SSDECLARATION
ARATION
� 1 understand my plain shall be used as public rtrnNs
(#0205 '0,6 f1
0,
a r
Licensed Professional
OWNER -BUILDER DECLARATION_
I
1 hereby a1Ems that 1 am exempt from the Contractors License Law for the
following 7031.5, Business Professions
mason. (Section and Code: Any City or county
which requires a permit to construct. alter, improve, demolish, or repair any structure.
F'
.. prior to its issuance, also requires the applicant for such permit to file asignedsuutrat
(hal hi? is l'ced¢d puesidiu slhp provisions of the Conouctnr:L Lw(Chapter9
(Cn mC idkvsihSCI 17060j fDvidin 3 of the R.,moi pad lirfeWnns(_'OdE)'.
Sq
y ,S Ft Foor`A y
2'1 >,'�*-�' q, 9. �F.9 A �j rlly t�r'n
X!•�7��uation
I 657oVV
or thin he ad exempt therefrom and the basis for the alleged a empty 8. Any violation
.' .4 ..
,
-of Section 703P.5 by any applicant for u permit subjects the applicant to a civil penalty
of nor more that, Eve hundred dollars(5500).
32 AP�Nt�mb�5
'
t:'; �.r.-.: Occupancy Type
01. as owner of the property, Lir my employees with wages as their sole compensation,
61 4
—twill'deu tai Prof Professions
the Coade: Th IS .t mended'en a Lredaw for Sale apply 1. an
Business aril Cod c: The Contractor's Lew Jas not apply to an
and
101 - FOUNDAT1�fCLlred Inspections'
stry Who w
owner ofh his ow em builds or improves thereon, and who arcs such work himself
.
m through his own employees. provided thin such improvements ora not intended or
`icRereS
t
_ _.1 Q 2..._ -__.PI ERS_.._
isms
fox sthe wer however, the buiavetheng r rd vi IJ he
notb of
completion,the owner ba (der w It have the burden of proving thin he did not build or
103 - UFER '�" '•
1 - '
raprpurpose of sale.)
104 REBAR
0-1:us neoofthe property ;c To si vey jontroil g wrlhl i c W.sitl coureters to
105 - ANCHOR BDLT.rI' -p ',. .
construct the pmjcct (Sec 7044, Business and Professions Castle:) The Contractor
..� .r I
License Law does not apply to an owner of property who builds or improver merecn,
106 - SEWER & WATER
_.ndwho. contrects.forsuch projects with.. comomlm(n),Iiceascd.pursuam. to.Ne.-
Contmcmr's License Law.,
.:-.—__.
20'2---'UNDERFLOOR,;PLUMBING-
❑IemexempundlrSa:" ;A;&PC far this rearon
203 - UNDERFLOOR'�MECHANICAL
Ownar .'WORKER'S COMPENSATION DECLARATION
204 - UNDERFLOOR FRAME
205 - UNDERFLOOR INSULATION
I hereby affirm nw.r pepalty of perjyry,dnenf the following declarations:--
❑ 1 have and will maiot�in'i Certific,tc'-of Consent'io self -insure for Worker's
301 - ROUGH PLUMBING
Compensation; as; provided for by Sections 3704 of the Labor Cine, forthe302
- TUB & OR SHOWER
xrrnranance'nrlbewarkrur,.nicntmrpEamiai.�rraed.,.,
303 - ROUGH MECHANICAL
0l have "aria will maimor, Wader, Cnmperisation lnsumnc ". as re,doeii b; Section
304 - ROUGH ELECTRICAL
3700 of the Labor Cmc; for the performance of the work for which this Permit is
isiuml MY Wodeli Compensation Insurance carrier and Policy number am: `.
3 0 5 FRAME
em' "ne 07 i'1'.+fs F;::`J<policy No.: " I"306-�
--_-_-_��,^y`- ...... _.,-x_.,TA` --'_r _.�.. .^•,•-,•,-,R�`
13t
@r sla
' s CPRTIPICATIONOF EXEMPTION FROM WORKERS -'
i'fal�'S a
3
COMPENSATION INSURANCE t°
U T r
i Il (Th reel itd thecompleied ifah permit is f std 1
($IW) less)
1
ORATH
_
rs, 1 cert Fy that nth pert ,mance .7the " d for whi< t s is I
- - TER OR IyATHr -- - - -
r .
shall not ply any person n any manners t hecnme bili la the m
y d
C AT
Compensation Laws of Calfp Dim
- 7"C
-Applicant-. '. .. - '
— . __. _ _
---�� �+".-+"`a
13-- ROOF NAIL-
!NOTICETO APPLICANT If, af¢r mak $Ih-Ceniticatcof should
hemme subject 16 the Worker's Compenmimn provisions of the bit, Cme,'you must
501 - FINAL ELECTRICAL ENERGY
forth nh comply with such pro tuns or this permu shall he deemed a kcd.
_
--'CONSTRUCTION
502 -- "FINAL--PLUMBING-ENERGY- -- -- --
s'')' LENDINGAGENCY
I nereny,rfm, that here mi,mmi.olending agency for the performance
503 - FINAL MECHANICAL,,ENERGY'I' -e
of Lm workme vrn'dh thisperm, '-r :qe Se 1! 7. civ. ; "'
Lenders Name• '•..-.v_ .�. .._._ __.. �. -,� a•._
.. .._._ ._.,.5.04 ....- -. F I NAL_.BUI LD I NG... ENERGY_..
unae.�Aas: `
505 - FINAL ELECTRICAL'::`
oo
. icenif,doulhave readthis application and state thattheabove information ii
506 - GAS TEST
coireciA agree to complY,with ail cisY arta eopntY ordinun<es and state laws mlati°g
io building mnswnion; and hereby'nmbonse reprtsemativa of this city to enter upon
507 - FINAL PLUMBING
he idanve-owitngneg property far_ir,cnon parpnser.-,the
(W)agreetos a dmnfy yak
rerm,aginst std
508 - FINAL MECHANICAL
ihnyinanCry
liabilities ) dgments. 1 d pc sn may in any y cane gemd mid
509 - FINAL G
City neyu nee of th g t g Ilhl peons -
permit
ANILICANrUNDSRSTANDS AND Ii'ILLCOMPLY�WYTHIAI) NONFOINf'r
(-
(] !' N I G
SOURCE REGULATIONS
Issued Date
Swint rApphrant/Commctor if - ":,'" " '-,Date -',(•'
RC-fOOES
r HAZARDOUS hfATER1ALS DISCLOSURE
wll theppl_t futurebum'ng ..,a. to. or handle h amou mat Tial
Type of Roof.. - '� "•-` �'�' `
.. .>..... ..-.•1t
as dein d by Ih C penin Municipal Core Chaps 9 I and the Health and Safety
r ,
Cenci.
ine SeecYon 25531a)rt ❑N xaM1. ti+yj i..F p.
t�•� I\d..-s �t�rly.,-+,.xJ`..
All roofs,shall be inspected,prior io-any roofing being Installed_.
wBto "- ' e - - ' --
applicant building p t use devices
-material .. remove
If a roof is installed'wi[hout first obtaining an inspection', I agree .to remove
g p
&i,Cmo
�mth d a cram il.n df cd by the Bav A-`e_v�rQ Ily Management t
me,
all new materials for inspection. Applicant understands will comply with
❑vex , -❑Nn,,- r r -.;'
" :r.
"and
"-all'non-point sourceYegulauons::' -" I -- - -
1,
' 1 h ve'reud the hazy dolls-matgrial iequarermat under Chapter 6.95, of the
'
Callfdmm Health & Safety Code. Sections 25505, 25533 and 25534. 1 understand that
notify the
if the building does not anal,
have a mndeL that d is my moed.
w
baupam of the requirtmenn which musTbe met poor m ismanc<nf a Certificate of
of. a
Signature_of Applicant Date
All roof coverings to be Class "B" or better '
owner pr enmonaea .gem-; :.. Date
'OFFICE --
"