00120030It CITY OF
ININPERMIT CONTRACTOR INFORMATION:
Bua1142A sS DF_AN7-A BLVD WEBCOR BUILDERS PERMIT 0120030
(1WNER'S NAME: APPLICATION SUR DATF,
PORTAL SOFTWARE 2755 CAMPUS DR 12/05/2000
[ONE: SANITARY NO. CONTROL NO.
(415)349-2727
µ0i O I
ARCHITEC (ENGINEER: BUILDING PERMIT INTO
BLDO ELECT PLUMB MECH
yZI-1 I= f= 1=1
6 LICENSED CONTRACTOR'S DECLARATIONZ� Ihereby.Irrntm.t1.mheem,ed anderprovi,ns,ofcn:hphr e'o,nmeneing Job Description
p„ wensee]nm7aw)tmroi,ms3nfineD,wiseemilProm,durn,Code,amlmyhanse T. I REMODEL
I, b full ferec and effect.
j z 9 a Liecn,c class Lic. a
oe. Dine Convmm
LLG< ARCH) IT:CT's DECLARATIC�f s
O J l understand my pl n Shull III a, p bl' c ! < - 1loo -in
gg
OWNER-BUILDERrom theRA N fitt\\1
u7 ^ I hereby o(Sect that 1 1. exempt from the f rot ut a Lipen g�I oo for tl�
' <
following Hilo teas, a (Section ]tont 5, i, sinew and Profess ,Ate �NrMdy,E'ny ur� n
O whichrequiresi,liko tocnnsuuei.I.r, improve,demdish,m.pan any mmcwrc
� � pmnrmslicnsed Pursuant
Ihesisionnnt the Commodes Liews,I fllca slowed,Chap
lett heisit ,Sectio mule ofDivisin 3 o Commodes Busines Lind Professions Cern Sq. FL Floor Area Valuation
m,oMot
t he is
whin t therefrom
om suns he hasin 3 of me a alleged and i.A vi endo) $ 80000
or that he 7031.5
cxempt therefrom am the hums lits the alleges exemption. Any violation
of ne,.Tinn ]N I.5 by any applicant for a permit subjects the applicant m a civil penalty
'
or net it re man we nnndren dth.r, tssan. APN Number Occupancy Type
0I.Isownwof the property, nor.,,.,Joyce, with wages., theirsulecomprnsalmr, 36901035. 00
will do the work, and the structure is not intended or offered for sale (Sec. 7144, Re aired Inspections
Business and Profession, Code 'Me Comrecmr', Licence Law docs not apply tow p
owner of pmpcny Will) builds or improves thereon, and who does snrn work hilleelf 1.01 — FOUNDAT I N
or through his own employers. provided mut such improvements we not intended or
nBrrord for side If. hnwe,ic , the budding m improvement i, ,old within one year of 102 — PIERS
%,impletion, the owner-bui dei will have the harden of proving ]tat he did not build or
prove for purpoese of sale.), 103 — UFER
❑1.n, owner ofthepropenyamexclusivclycontending with uansedconhactmsm 104 — REBAR
eonswa the project (See 7BW, Business ow it Pimlesmm�s Cods.) The Cuu mctm's 105 — ANCHOR BOLTS
LwIrw Law dues tent apply In un,owner ofpmphny who hill,], or... proves thercam,
and who contmct, for such projects with a comracmrtsl licensed pursuant m the
CrommactnrsucenseLaw. 1.06 — SEWER & WATER
❑ I am exempt ander See. ,e&P c forthi, mason 202 — UNDERFLOOR PLUMBING
Owner WORKER'S COMPENSATION DECLARATION 203 — UNDERFLOOR MECHANICAL
Ihereby amort under penally of perjury one or the fallowing declarations: 204 — UNDERFLOOR FRAME
Cd re
I have and will ntnmmin a Conideme ofComenl losdf.in,me nor Workers 205 — UNDERFLOOR INSULATION
Can!,
so provided for by Section 37M of the Labor Come, ter the
performance of work for which this poi I, issued. 301 — ROUGH PLUMBING
01 him`unit will maintain W..lcr'r Compensation lnsuanso as eequirol by Section 302 — TUB & OR SHOWER
371() of line Labor Code, it,, the efoom are of the work for which thi, pentdt Is 303 — ROUGH MECHANICAL
isued. My Worker's Compensation Insurance carrier and Policy mmnher arc:
Coiner:_ p,oMPTIO; 304 — ROUGH ELECTRICAL
CERTIFICAT'IUNOP Isdi, No: FROM WORKERS'
C(IMPIiNSAT[ON INSURANCE 305 — FRAME
rink section need oro he completed if permit i, f ane hundred deltas, 306 — HOEDOWNS
($1(umice,) 307 — INSULATION
1 certify that m the perfomance of the work for which this permit i, issued. 1 308 — SHEET ROCK
,hull nm employ myIhersnn in any manner so as to Intron. subject m tine Workers'
ClimPenmtlon Lwsnf California. Date 309 — EXTERIOR LATH
Applicant
croo
NOTICE TU APPLICANT: It, after making this Certificate of Exemption. youshnuld 310 — INTERIOR LATH
O zbrtame subject b the Workers Compensation provisions of the Labor Cecil you most
0 forthwith comply with such ,nnvo,inn, or this permitshmlhedemnelree"k°m' 311 — SCRATCH COAT C�
Crr.4 to CONSTRUCTION LENDING AGENCY 313 — ROOF NAIL S/
a i Ihereby .Mimi thin there is .,destruction Icndin,agency for the peroureeme — Q
of the work forwhichthispmmitisIssued(Sec.3an.Civ.Cd 501 FINAL ELECTRICAL ENERGY
a� Lend"`Name
Lender's Address 502 — FINAL PLUMBING ENERGY
U Z
0 —
1codifythatIlimereadthisapplicationandstatethintheabuseinfor information 503 FINAL MECHANICAL ENERGY
Is, E. carted. [agree m comply with all city mal anunty ordinances and more lows retain,
O 1.hoildinge,m,trm,imm.ar1horehymath.....em,nowmaliwsufthiscityInrue,upon 504 — FINAL BUILDING ENERGY
w me.bove-menhoneapropny(or m,p don paryxa. 505 —FINAL ELECTRICAL
y Q, (WkWg"
ave. indes keep harmless the City of Cupeninn against 1�,
y Iiahilitie,, ern..nAwh.h n yin any way uccme against snitSlh6 —GAS •LEST
thegrans permit.STMVDLL CO P WIT ALLNDN.P I TIssued b RP17 — FINCH DII IMATNF Y•SignutumnfApplicautIto Re-roofs 50 — FINAL MECHANICRL
HA7ARDOUS MATERIALS DISCLOSURE .�rp�p — FINAL GRADE
will he npplicmn o
or lre building oo rdemn nom (itM
r handle hazamrws muted'.. Type of ODI-'
as defied by the Cupeninn u mctpal Code, Chapter 9.12, andthe Health unit Sandy 510 — FINAL PLANNING
Code. Section 25532..11?, No
All roofs ftitbe-inEptQogWriPU$WT(IocWtUMBerial being installed.
Wiillb,pphcantorhitutebnddmgaccupintu,requipimtn,trdevireswhieh If a roof is installed without first obtaining an inspection, I agree to remove
em it linewdou,.irton1 t, as d.]-red bythe Day Area Air Quality Management
Ihtncn °� all new materials for inspection, Applicant understands and will comply with
°Y" No alf non-point source regulations.
I have read the huzm'Jous ..menti, regalmmem, under Chapter 6.05 oldie
Califomia Health A, Solely Cscle, Sections 255(15, 255ll and 23534. 1 understand That
if the builJing dotes not curre a",. more that it is my m,p,msihihyymnR -
oc,dT the re,ircmen It must be nm rine m Ismune, �:1Cen
Dec. n I
Signature of Applicant Date
Ownw. ati o ted.,e,d 11 All roof coverings to be Class `B" or better
OFFICE
OFFICE
c
CITY OF CUPERTINO
CONTRACTOR INFORMATION:
FlUiLDINC DIVISION PERMIT
BUk.DINGA1OE�s60 S DEANZA BLVD
WEBCOR BUILDERS
PERMITND.00120030
OWNER'S NAME:
APPLICATION SUB DATE
PORTAL SOFTWARE
2755 CAMPUS DR
12/05/2000
JONb
SANITARY NO. CONTROL NO.
(415)349-2727
ANCHITF.CI'/ENGINNIiN:
BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
�d
l_'7 �7 C— v
.t'i S
3
LICENSEDCONI'RAC'IUR'S DECLARATION -
lob Description
2 _
I hereby affirm 0mt I am licensed under provisions of Chapter 9 (commencing
=C
x f
with Section 7000) of Div room 3ofineBusiness and PrufessionsCod, and mylicense
al
is in full forte xnJ e(fe �D
T. I REMODEL
O a
3 °• y
• Class l.ic, p
Duo " Com
O g
HITF.Cr'S DF.CLARA
CLA
1 undersl nd plans shall be used as public remrds
1121
121
OO
Littnsed Prmfcsos mal
Piaa.
OWNER-BUILDER D1iCLARATION
'
t1i
1 herchy affirm that 1 am exempt from the Contractor's Licemb hw for the
Z,u a
following =son. (Section 7031.5, Business and 1'mfessions Code: Any city or county
.
A ❑
which requires a permit in construct, alcor, improve, dem"IUh, or repair any structure
Cprior
to its issuance, also requires the applicant for such pemril to file a signed statement
su
Sq. Ft. Floor Area
Valuation
am
that he is licensed pursuant to the previsions ofthe Continuities License Law (Chapter 9
(commencing with Section 7") of Division 3 of the Business and Pmfcssion. CoJU
$ 80000
or that he is exempt therefrom and the basis for the alleged exemption. Any violation
of Section 7031.5 by any applicom ter or pennll subjects the upplicanun a civil penalty
of not ntam than five hundred danam(55110),
APN Number
Occupancy e
P y�p
3691.11035. 00
❑L mowneror)bc norm Mees with wages as their sole compensation,
nope r r s a
Required Inspections
p
are is
will ne ,he work. and 0r, Simeone is mol emended to se Law for snot apply to an
and Professions The Cummcmr's mall.m Law docs not apply m an
'Hu.a,
of its or and who does such wink himself
owner of progeny Who builds of improveat ,
101 -, FOUNDATION
such, not intendednyear or
of through his soon employees. budded or such improvements within
offircal for sale. If, however, improvement sold within one geld or
ge
� ], I]I2 - PIF_ P,S
ide willI proving
improve for po awnor-hulWer will have the bunlen of proving that he did not build or
improve raf wtWse acme.).
103 - UFER
❑Laerafthe propcmy,amexclusively ctinocdngwith licensed contractors to
104 - REDAR '
Lnood ma project (Sec. 7044, Businev, and I'ndesslons Cmdaq) fhe Commemr's
nxicen.eLawdoe.notapplytoanowneratPnrpemywbobuiwaorimprovesthereon.
105 — ANCHOR BOLTS
and who contracts far pmjens with a contracmgs) licensed puoaant to the •
1 0E - SEWER R WATER
Lasuch
Conlmemrs license w.
El l nm exempt under See. .B& P C for this Denson
202 - UNDERFLOOR PLUMBING
Owner
WORKER'S COMPENSATION (1N DECLANATION
ENS
2- .
v 03 UNDERFLOOR MECHANICAL
I hereby affirm order glomi, of perjury are or the ranowhtg dcelaralwo':
204 — UNDERFLOOR FRAME
0 1 have and ,vin maintain a Certificate of Consent to .elr.insum for Worker.
205 - UNDERFLOOR INSULATION
Comlpensation, as provided for by Section 370x1 of the Labor Code, for, the
301 — ROUGH PLUMB I NG
performance of the work for which this permil Is issued.'
302 - TUB R. OR SHOWER
❑I have and will maintain Worker's Compensation Insurance, as acquired by Section
3700 of the InMr Code, for the performance of the work for which this permit is
303 - ROUGH MECHANICAL
issued. My Wo mpensmimn Insurance career and 'olicy number e
Cartier: E_�
304 - ROUGH EL ECl'RICAI.
CERTIFICATIONOFEKEMPfION FROM WORKERS'
res
305 — FRAME
COMPENSATION INSURANCE
306 - HOI-DOWNS
(This section need nigh caoplmud if the permit is nor one hundred dollars
(sHlBlm Icre)
307 - INSULATION
I certify mat in the performance of the work for which this permit is is.acd. I
3013 — SHEET ROCK
'baot employ any penial in airy manner so n.. to beo"me subject to the Workers
n n
Compensation Laws of California. Date
309 - EXTERIOR LATH
Applicant I
NOTICE TO APPLICANThold
alter ranking This erficate of Exemption, yon s
L Cti
?10 - INTERIOR I ATH
ss
4WG
her not suh<clothe WorkeraCnmpensfin.toontoo nonboLabor Code ,youmuot
forthwith comply with such prodeemed revoked. or this pennon shall he deerevoked.
X11 - SCRATCH COAT
v
F
CONSIRUCI'IONLENDING AGENCY
:313 — ROOF NAII.
Foa
I herchy orf n net there is a conperform
lending agency for the perfoancm
an.
ofthework bar wmch]is mut i,koamd(See 3097,Ci, C.)
�.
5—
01 FINAL ELECTRICAL ENERGY
mo
Undcr'sName
502 - FINAL PLIIMBING ENERGY
Lender's Address
C1eerilythmlhavereadthisapplicationamistatethattheaboveautomationis
W
503 .- FINAL MECHANICAL ENERGY
r.
O U
correct, i agree to comply with all city and enmity ordinances and state laws relining
to building corroboration, and hereby amhrrim mprese natives of this city in enter upon
c y - F I i IAT. BUILDING ENERGY
Cks
dmalm.-oanimned pmpeny for insppcdon pam"s`s'
(We)agmc mauve, adenmi fynnd keep hornless the Chy of Cu,noino aga'.st
51 - FINAL ELECTRICAL
rn
liabilities, judgrnems. costs and expenses which may in any way sector, against sold
1151 E. — GflS TEST
U Z
City'. conss•Ruence or the gran' anis perm'
,
^
APPI NTUNDEI N )WILL .IPVWITH LNONPOINT
507 -FINAL. PLLIMBIIUG Date
fi01 < .1 L
Re-roofs -. _
ssnamneo- goon wuae - nob —
HAZARDOUS MATERIALS DISCLOSURE
909 - FINAL GRADE
Will the applicant or future building accuptm store or handle h"mrdous mmeri"Ie
P of Roof
rs defined by the Cupertino Municipal Code, Cbaptcr 9.12, and (lie Health and Safety
51 0 - F I hlAl. PLANNING
Code, Section 25532(x)'!
O Yee ONo
All roofs shall 5d. i''nspectRTdrif&to Rjlgboi-irdg hifilffifibbeing installed.
Wlndm applicas, or future hmnding"ceapanl use c,ui,nrarr,dc,ias which
If a roof is installed without first obtaining an inspection, I agree to remove
• cart humrdnux air conm..nam , ns defined by the Bay Are" Air Quality Management
District:'
all new materials for inspection. Applicant understands and will comply with
0YeF ON"
all non-point source regulations.
1 have natal the hamnlon' thowd.ls myuimotion under Chapter 645 of the
California Health & Safely Cal Sections 25 15, 25573 and 25574, l understand that
if lIt adding AtKs nob, corm yl veamnx dlmitis my te'punsibilinyt notify the
sK p rf the rcquiemcnl wh' Ilrtsl lel Arlo Is'a:mce'of a mifica of
G i n y'
Signature of Applicant Date _
-
All roof coverings to be Class "B" or better
Ovine, or nathonsed agent ,ate L—I
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APPROVE®
IN ACCORDANCE WITH THE CITY 06
CUPERTINO CODES AND ORDINANCES
DATE_ I LS"'OD
SIGNED �-
This set of plans an specifications MUST
be kept on the job at all times and it is on
lawful to make er„ changes or alterations
on same without written permission from
the building Dept., '.,y of Cupertino.
The stamping of this plan and specifications
SHALL NOT be held to permit or to be an
3pf.-oeal of the violation of any provision?
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