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02030039C' 0z z0 a� r� p Z)z U_0 OF t) h �z CITY O CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 20269 STEVENS CREEK BLVD SOUTHBAY CONSTRUCTION C INC 02030039 ,WNER'S NAME: ADVANCED HEALTH IMAGING 511 DIVISION STREET APPLICATION SUB DATE 03/11/2002 PHONE: (408)379-0400 SANITARY NO. CONTROL. NO. ARCIiITGCT/ENGINEER: BUILDING PERM11' INTO BLDG ELECT PLUMB MECH IJ LJ LJ I___7 LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with S<eion7(w0)ofomi,ran3anheBasn z, and Nof....i Colic, andmylicec i'n full forst delle yC '��r ri,y Lice sc s✓ _d -p b l D�- DEMO. ARCHITECT'S ,,puARATION I undcnivnd my plans shall be used as public records Q� l-icensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 vin exempt from the Contractor', License Law forme following reason (S,c,ian 7031.5, Business and Profession, CWe: Any city or county 1 O O O O which requires a permit to consimn. alter, improve, demolish, or repair any stmcturt print to its issuance. also requite the applicant for. such parent to file a signed smucmem �.g Valuation mat he is lkcmwd pugw4m m the p... i,imm of the Comractoe, Llseose Law (Chapter 9 (eimncpciag with Section 70M)of Division Sof he Baiincap and Profienaons Code) CO:y:T1;31 >; p.jE R,t or Ihvi he is exempt thercfmm'and the basis for the alliged exampion. Any violation . of Sceion 7031.5 by any applicant for a permit subjects the applicant m a civil penalty Iof aa, mare than live hundred dollars ($500). 101pN DAT I ON ' `t' Occupancy Type D 1, as owner of the property, or my employee with wages as their sole compensation, - -,111 do the work, and the sm¢nare is not intended or offered for sale (Sec. 7f W,' Bminess aad'rrorecsion, Cash: The Cantmcror's Lx,nm Law due, hat apply m an ------ 103 - - - - - -- - - --- - - UFER Required Inspections < - owner of pm,smy Who Wilda or in,pm, as menton, and who does such work himself 104 — REBAR or mmugM1 his own employees. proviticd that such improvements vrc not intended or " ufkrcd for side. If; however; the building- " '- - i is sold within one Icor of - _ . _.. ,__. _._ __ 105 _-.._ ._ ..__.. —__ .__--_ _.. — ANCHOR BOLTS eburdenvemen the owner -builder will have burden of proving that he aid not build or icompletion, mrrovc forpar,rossi,ale.). 106 — SEWER & WATER r D i:a: awn—Ithe-'.__-.. vlr-.. -y .a___..:.g w;._.. ---" orsm p(Secny,am Proem moe:)Th - __202-= UNDERFLOOR PLUMBING.._ -, Conor omwntheoes n(see.7to 7044.Businessand Prtywheaenter)Theves tremor's Business Lid Law docs not apply man anther err pro who builds or improves menton, 203 - UNDERFLOOR MECHANICAL'' who imm -and was conmcla for sa<n.nraiau with a.<ommaar(,) fi«eed.wnaam m.me.._. ... .--.2.04 - __. UNDERFLOOR' FRAME—- RAME-.__ ._ .__-.._.... _ .. ._ . -_. _...... _.. Comracnr's i.iccnu Law. moo D l am eacntpt under Sec.' " ,B& P C fonhis reason 205 - UNDERFLOOR' INSULATION Owner " Date . 301 - ROUGH PLUMBING WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER hereby arm,n ander penalty of jury dne of me fallowing declarations: 3 03 - ROUGH MECHANICAL D d have and will maintain a Cenificme of consent to self-msum for worker', 3 04 — ROUGH ELECTRICAL Compensation. as provided for by Section 3700 of the Labor Cade, for the performance of the work for which this Permit is issued. 305 - FRAME D 1 have and will maima4i worker', Cinummotion Iniumnce, as rcquimd by Section 3 06 — HOLDOWNS 37W f to Labor Cod f theperformance f in k farMuch this perm i is 307 - INSULATION M W korsCo p . t I AVd licy x 308' SHEETROCK JS``� ?'' Par<rN 1dCo5C So�54Sa -, CL'RTIFICATIONOFFXEM O hROMNORKERs .,, '309x`'—``EXTER'I'OR'-LATH' COMPENSATION INSURANCE "(This secima need' not ere completed if the pi i, for one hundred dollar, 311 - SCRATCH COAT ' 001 or less.) - " '.l knirr tnofi� rodlKefan!,:;�e<ar mg wariTdr wnien Pia p«mh i, [„�ca. l -31.3- - ROOF -NAIL „ ilial) not employ any person in any manner son to become subject to the Workers 501 — FINAL ELECTRI CAL ENERGY Camcmut ,n Laws prcdiramu..Dat` Aprheant _ _ _..502. -..-FINAL PLUMBING -ENERGY.-_.._..... ._. NGTICETOAPPLICANr:v.anermakingmj.eenifieatearexen,pdan.raaahaalo bc2ome subject to me Worket's Compensation provisions of the Labor Code, you must 503 - FINAL MECHANICAL ENERGY forthwith comply with such provisions or this permit shall be deemed revoked. _ -.5.04 .,- FINAL. BUILDING. ENERGY_._. ..... 'CONSTRUCTION LENDING ACENCY " ' I hereby atrmn that them is a consuuaion lending agency for the performdnce- 505 - FINAL ELECTRICAL ofthe work for 'hichthi,perm,tisissued (s<3097Civ. C.) ` s 506 -_GAS TEST _Lend N me ' - ._ - •, .'r._ .., - _y Ilpders Address _ 507 _ - FINAL PLUMBING 1 certify mat 1 have read this application and state That ober above information is 508 - FINAL MECHANI CAL cbiicct. I agmc n comply with all city and county ordinances and sine laws relining 509 — FINAL GRADE m building construction. and hereby authorize representatives of this city to enter upon me abave-ninraned property for inspection parpmez., 510 — FINAL PLANNING (We) agree to save: indemnify and kap harmless the City of Cupcnino against liabilities, ji dgrnems. cos¢ and expenue which may is any way aecrae .,.in,, said Cit in conseyuence of the gaming of Chia permit "' "' .. n 514 — F INA PU IC WORKS A In, ERSTANDS'AND CL COMPLY WITH AICN -POINT .... V%T( Issued by: Dat I a :q3-tl-O Re -roofs s�ana, rnrrl.<anvcan�menr, ...'.,'. .-,Dam HAZARDOUS M LS DISCLOSURE - 4 ; Will the appl jam future W len,accapa t tree handle hazardous material Type of.Roof .. .. .. .- .. - - sdefred by theC pc m Municipal -ewe Chapter 9.12and the Health dSafety Code S a 255321a1 . t - ,. .d, ',) f All roofs shall be_Inspected prior to any.roofing material being installed _ W IIIM1 applicant f t b Id g up mumcyuip t a Hien If a roof is installed without first obtaining an inspection, I agree to remove Pith do air contaminants is defined by the Bay Ana Air Quality Management District, all new materials for inspection. Applicant understands and will comply with ❑Yee ,. ON. , ; �-; _ all non -point s6urce regulations.,: ,. I niced�the'hniadous materials-«gotremenai under Chiint, 695 of the California fledtp & Safny Code, Sections 25505,25533 end 25534. 1 understand that f mchild'g des not currentlyh v tent that 't' my mspo,bltyt notify the'-- oecupam the i mm n 'moa. be met pd m isomer o C Bcnc of ` - ' Signature of Applicant Date 3 _ All roof coverings to be Class "B" or better Owner or authorized agent, Doc r .:. _a.: - - - OFFICE - - - -- - 11 OZO U I�..zw n z z N O C O U U i3LLF- Ixt ] LL _, F• z > E2C LLI — a 3 = CITY OF CUPERTINO /� /y/� it �� ✓ ON BUMDING DIVISION PERMIT F► i - BUILDING ADDRESS: PERMIT NO. 20269 STEVENS CREEK BLVD SOUTHBAY CONSTRUCTION CC INC 02030039 OWNER'S NAME: APPLICATION SUB DATE ADVANCED HEALTH IMAGING 511 DIVISION STREET 03/11/2002 PHONE: SANITARY NO. CONTROL NO. (408) 379-0400 ARCH ITECT/ENG LNEER: BUILDING PERMIT fN.FO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busi9�ss and Professions Code, and my license DEMO. is in full fore d eff Lice se a tc. p J J D Contra♦ r 1�---' ARCHITECT'S D RATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License law for the following reason. (Section 7031.5• Business and Professions Code: Any city or county $10000 which requires a permit to construct• alter• improves demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement Qpp.-. ��7�.q, �A7p'@3 Valuation that he is licensed purIsu'ant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Pr9fessions Code) 3N. 4 V V tr V V •. or that he is exempt therefrom and the basis for the alleged exemption. Any violation . of Section 7031.5 by any applicantlfor a permit subjects the applicant to a civil penalty of not more than five hundred dollar (5500). �,,�,F 10 IkPL' ' N'CiC71V DATION Occupancy Type 0 1, as owner of the property, or my employees with wages as their sole compensation. - 103 - - UFER Required Inspections will do the work, and the stntidwre is not intended or offered for sale (Sce. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property Who builds or improves thereon• and who does such work himself 10.4 - REBAR or through his own employees, provided that such improvements are not intended or _ 'offered for sale. If, however, the building or improvement is sold within one year of 10 5 — ANCHOR BOLTS completion, the owner -builder will have the burden of proving that he did not build or improve for purpose of sale.). 106 - SEWER & WATER 0 1, as owner of the property, am exclusively contracting with licensed contractors to 202 - UNDERFLOOR PLUMBING - - construct the project (See. 7044, Business and Professions Code:) The Contractors 203 - UNDERFLOOR MECHANICAL License Law does not apply to an owner of property who builds or improves thereon, -and who contracts for such projects with a coniactor(s) licensed pursuant to. the 2 04 - UNDERFLOOR FRAME Contractors License Law. 0 1 am exempt under Seca . B & P C for this reason2 0 5 - UNDERFLOOR INSULATION Owner Date 301 - ROUGH PLUMBING WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER 1 hereby affirm under penalty of perjury one of the following declarations: 303 - ROUGH MECHANICAL 0 1 have and will maintain a Certificate of Consent to self -insure for Worker's 304 - ROUGH ELECTRICAL Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 3 05 — FRAME 0I have and will maintain Worker's Compensation Insurance, as required by Section 306 — HOLDOWNS 3700 of the Labor Code, for the performance of the work for which this permit is 3 0 7 - INSULATION tss d. M Workers Compensation Insurance c rand Policy number are: Cf ^a-�5 308 —, SHEETROCK :iU , er. Policy N "FROM CERTIFICATION OF EXEM O FROMO�RKERS'' 309 - EXTERIOR LATH' COMPENSATION INSURANCE 310 =.INTERIOR LATH - (This section need not be completed if the permit is for one hundred dollars 311 — SCRATCH COAT (S 100) or less.) 313 - ROOF NAIL I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' 501 - FINAL ELECTRICAL ENERGY Compensation laws of Califomia. Date Applicant 502 - 503 - F I NAL PLUMBING ENERGY . FINAL MECHANICAL ENERGY NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code• you must forthwith comply with such provisions or this permit shall be deemed revoked. 504 — F I NAL BUILDING ENERGY CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL I hereby affirm that there is a consiruction lending agency for the performance - of the work for which this permit is issued (Sec. 7097. Civ. C.) 506 — GAS TEST Lender's Name Lender's Address 507 — - FINAL PLUMBING,_ I certify that I have read this application and state that the above information is 508 - - FINAL MECHANICAL cbrrect. f agree to comply with all city and county ordinances and state laws relating 509 — F I NAL GRADE to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. 510 - F I NAL PLANNING (We) agree to save, indemnify and keep harmless the City of Cupertino against • liabilities, judgments, costs and expenses which may in any way accrue against said 514 - F I NA PU IC WORKS L/ L City in consequence of the granting of this permit. APP C ' TRSSTANDS AND LL COMPLY WITH .ALL N '.POINT Issued by: Dat E SignatureofApplicam/Contracror Date Re -roofs I HAZARDOUS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material Type of Roof as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section. 25532(a)? _ El Yes '.. ONo All roofs shall be inspected prior to any roofing material being. installed. ,. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? all new materials for inspection. Applicant understands and will comply with °Yes °N° all non -point source regulations. 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code. Sections 25505, 25533 and 25534. 1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupa t, the e uirements-+vki must be met prior to issuance a Ce ificate of C, arc l Signature of Applicant Date L All roof coverings to be Class "B" or better Owner or authorized agent Date. OFFICE S1111y,(z1v CITY OF CUPEI�JINO ITY OF CUPERTINO DEMO PERMIT APPLICATION FORM az °3 c, 03 % APN # Date: ' I Building Address: t � C) � . Ip 7Srt c -J Q Owner's Name: Phone #: Contractor: License #: Plan Check Fee 3 3 L,C�l Contact: Phone #: U\C3 Applicant/Cogtractor:�� CS.6 0.1n Building Permit Info: Bldg Elect Plumb Mech Job Description: Residential: Commercial: Z) C-- rn (--D Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engineer: Valuation: U Type of Construction: Occupancy Group: Qty. if Applic4e� Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILIDNG BSEISMICRE Bldg Permit Fees BUILIDNG BPLANCHK Plan Check Fee BUILIDNG BUSLIC Business LicenseBUILIDNG 5 6S S