03060045CITY OF CUPERTINO
BUILDING DIVISIONPERMIT
CONTRACTOR INF RMATION
BUILDING A DDRESS:
-740 VALLEY 2-RERN DR
SOUTH BAY
CONSTRUCTION CO
f D "'03060045
NER'S NAME:
511 DIVISION STREET
PERMITISSUBOATE
✓NE:
(408)379-0400
SANITARY NO. 'Ll OLNO.
ARCHMI C IENGINBER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I Wham by effathat I am licensed under provisions of Chapter 9 (commencing
P
with Section 7tggB of Division 3 of the Business and Profassiov Code, and my license is
mumteaanaerr«t.
m
POty
manse Class Q Llua 53 9 4
TENANT IMPROVEMENT ALSO
Data Cuntrmmr
ARCHITECTS DECLARATION
1 understand my plans shall W used as Public records
—
3 2003
Licensed Profession.(
OWNER-BUILDER DECLARATION
1 hereby .('firm that 1 ore exempt from the Camns License Lew fur the
BUILDING
Cnde: Any city or county
hamnn. (cobtian ID3 L5, Business and Code:
flfollowing
cnnstmm, step io fora, der oli repair any
which requires n permit improve.
h peril t file
prior to its issuance,also ntto the the isionanf Ln HuchpamiuOfireseLaw statement
re statement
mmneaeucansedpaeevoomtheprovivinns3ofthentndwrsnmenselaon&Coc¢r9
Sq. Ft.
Floor Area
Valuation
(commencingwith Section of Divisions oftheegedexeand Profession"Cale)or
32610047.00
Net he is exempt therefrom and dte buys for the alleged exemption. Any violation of
and
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit "objects the applicmt m a civil penalty of
Bat more Nen five hundred dallare($5003.
.
❑ I, as owner of the property, or my employees with wages a their mle compensation,
i U i
—
d Inspections
will do By, work, end the structure is not intended or offered for sale 7061, Business
Profession. Code: The Conuacmrs Limns" does
md Law nut apply man owner of
10 2
- PIERS
property who builds orimpmses thereon, and who doe"auch work himself orHmugh his
ownemployees, provided thamch ioprovemcnts art not intended oroRerad forsaln If.
103
— UFER
however, the building or improvement is mid within a¢ yea oreompletion, the owner.
builder will have the human of proving that he did not build or Improve fur purpose or
104
- REBAR
al`')'
105
- ANCHOR BOLTS
❑has owner of Ne property, , B k... and contracting with licensed C uschm. to
cauwcnhe project (Sec. 7INd, Business and Pro2uions CW.:) no Conmaaor'"u-
106
— SEWER & WATER
cense Law does not apply to an owner of property who Honda or improves thereon.and
202
— UNDERFLOOR PLUMBING '
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
Lmat.L.,
203
- UNDERFLOOR MECHANICAL
❑ Toro exempt under Sec. ,B& P C for this reason
204
- UNDERFLOOR FRAME
"Date
205
- UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the fallowing declarations:
301
— ROUGH PLUMBING
(bare and will maintain aCenirnm of Covera mselhivurt for warteei Compcn.
302
— TUB be OR SHOWER
"anon, at provided for by S«tion Baa of He Labs code. for the performance or the
303
— ROUGH MECHANICAL
work for which Ni" permit is issued.
304
- ROUGH ELECTRICAL
p I have and will maintain Worker's Compensation Insurance, ss required by Section
3700 or the Labor CaM,for Ne performance of He work for which this payout is issued.
305
— FRAME
My Workers Compusaion Insurance carrier and Policy number am:
306
— HOLDOWNS
Cortin: YAMME ME CO . POI Icy No.: 011 LL? —01
307
— INSULATION
CERTIFICATE OF E%EMMON FROM WORK ERS'
COMPENSATION INSURANCE
308
- SHEETROCK
(TMss«tion mol notbcbomplead Rine permit Is roroac hundred dulars(5Rn)
309
- EXTERIOR LATH
Irate,.)
310
- INTERIOR LATH
employ certify Net er Thu p any maned of the woh for which Nis Permit is In«a. l eha11 not
personinanymmwrmuwbecome "ubj«til @e wortrn'Compenation
311
— SCRATCH COAT
Lawof a
Laws of California. Data
Applicant313
501
- ROOF NAIL
- FINAL ELECTRICAL ENERGY -
NOTICE TO APPLICANT; If. efmr making Has Ccnifibalt of Exemption, you should
bemme whj«t m the Workers Compensation provisions of the 1eWr Code. you must
forthwith comply with such provisions or this Permit Hall bt deemed hawked.
502
— FINAL PLUMBING ENERGY
CONSTRUCT] ON LENDING AGENCY
503
- FINAL MECHANICAL ENERGY
I hereby alarm that Here is a conauactinn lending agency for the Performance of
504
- FINAL BUILDING ENERGY
the work fess which this permit is issued (Sec. 30G, ON. C.)
the w
Under's Nemc
505
506
- FINAL ELECTRICAL
- GAS TEST
Lender's Address
I etnlry that I have read this application and state that the above informuiun is
507
- FINAL PLUMBING
I agree m comply with all city and county ordinances and rule laws relating to
buildingconstruction, and hereby amhori¢rcpreunutiw of Nu m t
construction, city upupnn the
CL
FIN MECjWNG'
ehovc vd property, for Inspection
an purposes.
emnify
(We) agree ra ase, indemnify and keep harmlev He City of Cupertino ageinv
(We)
O 9
FI
liabilities, judgments. costs and expenses which may in any way see= against aid City
5
in coveyuence of He granting of this Permit.APPL
ERSTAND D WILL COMPLY WITH ALL NONPOINT
Issued by:5
WORKS Date i
�0 CE REGU TIONS.
Re-roofs
Type of Roof
/ �'1S1e 3
Si wee of ApidayleVContrmmr Data
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building Occupant store or handle havamous material
a defined by the Cupeni Municipal Cade, Chapter 9.@, and He Health end Safety
coad.Setnonzs53z(an
All roofs shall be
inspected to any roofing material being installed.
C Y., Nu
prior
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
R haeamnus air b aymyro ma as darned by the Bay Arca Air Quality Management
all new materials
for inspection.
our
❑Yes Nu
1 have read Hehvamaus mamrials rapartan tsunderChaptar6,95ofdmCalifor-
nu Health & SafetyCadd, Sections ]5505,25533 md25534.I undersand Na ifthe Wilding
d u hose a mnank th is my possibility m Wary He acupmt of the
mq.immcnot minm wissuanccar. CcnificamofGccup dy.
a3�03
Signature of Applicant
Date
All roof coverings to be Class "B" or better
Owner
Or authorircJ egcm Data
I