03090239 CITY OF CUPERTINO %1��' r
BUILDING DIVISION PERMIT wCOLVTRL�.I�iT`!IZ INFORMATIQN >i
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BUILDING ADDRESS: GYRO 3D FEAR FACTORY PERMIT N0.03090239
ER'S NAME: 10123 N WOLFE RD (BASEMENT PERMIT ISSUE DATE
NE: SANITARY NO. CONTROL NO,
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
�00 LICENSED CONTRACTOR'S DECLARATION
IU Iberebyaffirmthat Iamlicensed under previsions ofChapter 9(commencing
Job Description
,Z1 wi0 Socha.7001)ef Division Sof the Business and professium Code.and my license is
s< in full fame and effect.
License Class Lie.a TI--ELECT. FOR AMUSEMENT
Date Contractor
ARCHITECTS DECLARATION
I undersand my planss still he used in public rttnN
i555
'LL Licensed Pmfcssianal
Oat lam exIMERempt
DECLARATION
0 f I bertby.(Efm on I I.S.exempt from the Convenors :License Law co the
:00 fallowing renal&.(Sbedut 71131. Business and Improve.
de iva Code:Any city or county
$� which myulres a permit m cnnswca alter,improve,Jcmalish,or repair structure
•z'y' prior In its issuance,also requires the applicant for such perniuu file a signed statementNZ
t'•� Our he is licensed Punuaatbethe provislne,of Ne Canonicals License law(Charm,9 Sq.Ft. Floor Area Value
� $ (commencing with Soman 7000)of Division 3 M the Business and Professium Cash)or
that he Is exempt therefrom and the bob lar the aticged exemption.Any viaUuon of 31620037 . 00
Section 7031,5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more Nm five handled della.(5500).
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do On wank end the fVucam is not intended or offered for sale(so.7044,Business 101 — FOUNDA� Wd Inspections
and Professions Code:The Clinical Liam Law does not apply N an owner of
prepeny who builds or improves thereon,and who doessuch work himselforthrough his 102 - PIERS
own employees,provided that such improvement,are not intended oroffered forale.If, 103 — UFER
however.Ne building or improvement is sold within one yeu of completion.the owner.
builder will have Ne burden of proving that Is,did not build or improve for purpose of 104 — REBAR
safe). - 105 - ANCHOR BOLTS
❑I,ru owner of project
properly,,Business exclusively contracting with licensed convectors to
cons,La does not apply.?anowneand ni,who
ides d,or
?Tem ftmon.and 106 — SEWER & WATER
tear.lawdoesr Such Pytean ith. afpropcny whobeilmar improsthe Neuron.and, 202 — UNDERFLOOR PLUMBING
hon en�Wu for such projcN with a cantnnoHs)licensed purwant to the Conuamh
�`Elameaemvt ender cc. ,B�Pera this re on 203 - UNDERFLOOR MECHANICAL
204 - UNDERFLOOR FRAME
`r ORKE f ENSADONDEC AR11_4DaIN 205 - UNDERFLOOR INSULATION
I hereby affen under Penalty of perjury ane efthe following declarations: 301 — ROUGH PLUMBING
❑l haw and will maintain a CenificatcofConsenl to sell-inum forwork&r.Compen. 302 — TUB by OR SHOWER
satian,a provided for by Scene.3700 of the labor Cade.For On performance of the 3 03 - ROUGH MECHANICAL
work for which Nis permit Is issued.
❑1 have and will maintain Worker's Compensation Insure el,m required by Section 3 04 - ROUGH ELECTRICAL
377 of the labor Cade.sur Ne platform....[,be work far which Nis permit 1.issued. 305 — FRAME
My Wallace.Campenadon Insurance artier and Policy number art: 306 — HOLDOWNS
Cartier. Policy No.;
CERTIFICATE OF IDEMP170NMOM WORKERS' 307 — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK
or less.)Gels it. ed trot w completed if porrail fare.hundred do[).l$1001 309 — EXTERIOR LATH
I certify Out in he performance of the rk for which his permit is Issued.)shall not 310 - INTERIOR LATH
employ anypeon an mum
�omc aMtQuo lite orkeri Compensation 311 — SCRATCH COAT
Iawsor CaLfomi.,
Applicant313 - ROOF NAIL
NOTICE TO APPLICANT:IL after nuakid Nis certificate of Exemption.you should 501 - FINAL ELECTRICAL ENERGY
becomeb I to the Worker's Compensation provisions of the Lather Code,you must
�z AnOwit ply with men praviaima,a,this PermitahidiWdeemedmwlked. 502 - FINAL PLUMBING ENERGY
�5; CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hereby affirm that there is a construction lending agency for the perfurmanceaf 504 — FINAL BUILDING ENERGY
X> the walk fur which this permit is issued(Sec.UK Civ.C.)
p Lander,Name 505 — FINAL ELECTRICAL
Lenders Address
DZ 506 — GAS TEST
;)Q I certify Na 1 have read this application and sate Nat the allow information is
carted.1 agree to comply with all city and county ordinances and sate laws relating In 507 - FINAL . PLUMBING
�U buildingconswction,andherebyauthorizerepresentatiwsofNbcitytoenteruponthe "FINM2CeiiCAL
ahmcmcntiuned progeny foriaPemion purposes(We)agree to sew,indemnify and keep inters u Na City of Cupertino gaiat 0 9 rn Iiabili0cs,judgments,costs and expenses which may in any way&ccroe against aid City
in consequence of the graph ng ter this permR 5NG
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N0 Issued by:5 WORKS Date
SOURCE RE UL �NS.
&� -(��;7 / k
If Re-roofs
( eve of plicenU nt a
H ZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant slow or handle haardua material
as defiaed by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Side.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea XNu
Will the applicant or forum building by Or Bl sexes Air u of devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit havartlaus air contaminants a defined by the Bay Arta Air Quality Management all new materials for inspection.
District?
[:3Ycs 110
I have mad the haardoes materials requirement under Chapter 6.95 of the Califon ,
nb HodI"SefclyC Scetioa 25505.25533 and 25534.1 undersand Net if the building
docs re c�me by h tenana Nal' b my responsibility m nosily the upon of On
rcyui.mcmt hi. muilbcmel 1.issaa¢er.CeNficoiofau cy. Signature of Applicant Date
o as ariudag t y a All roof coverings to be Class "B"or better