02040052 ctBUILDING DIVISION ND PERMIT CONTRACTOR INFORMATION:
BUILDING DDRESS: PERMITNO,
2029 STEVENS CREEK BLVD SOUTH BAY CONSTRUCTION CoINC 02040052
OWNER'S NAME: APPLICATION SUB DATE
D LORETTA R 511 DIVISION STREET 04/11/2002
/•HONE: SANITARY NO. CONTROL NO.
(408) 379-0400
w O OZ ARCHITECI'/ENGINEER: BUILDING PERMIT INFO
m BLDG ELECT PLUMB MECH
a i
H i LICENSED CONTRACTOR'S DECLARATION
I hereby affirm met 1 am hern,ed ander pm,kicas of Chapter 9 memmencing Job Description
iyl_8 tSection 7000)ofDivision 3ohneBe" andProfessi�asCode.aadmylicense PERMIT, EXPIRES ON 05/11/2002 .
mu tome a on'i"
J
iow� fsll h a .bm �{., INAL #02030084 .
u O�' ARCHITECTS D RATION 4
a g ]understand my plan,shallhe usee as punfie nemmta 1 N 1 0 200eL
3:5 0 o Licensed Professmn.I
OWNER-BUILDER DECLARATION
le-a, I hereby affirm that 1 am exempt from the Contractor's License Law for p1/'�
Cain following reason.(Section 7031.5,Busimmemid Professions Code:Any city oream VEL®',vG
ceF o which rtquirc,a permit to cnmwa,alter,improve,demolish,or repair any mm�ure
so .pro tot al, requires' th pplicant for such perm m File asgned nemment - - - ---- - -
a. mal he c licensed p'rsua f t the p(n';ions of the Obstructor,License Law(Chapter 9 S -ft Floor-Area,, -
mm mseci- 7100 foil•ision3onneBusinessandnbreseon,Core) Y';'?':7 q. t-T. •x. , a uation
g t „) v, •L 1 ,111 x.ti lei.
union he is exempi @bre fnnn and me basis for the nllegcd examptibn.Any violation
-of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of not mom than rive hundred dollars($5M).
umber r'"4.r Occupancy Type -
❑1,as owner of the property.Lir my employees with wages its their sole compensation,
will do the work,middle swaum'I,not intended or'dffcmd'for sale(sec.]W4,-
Bo.iness and Professions Calc:The Commcmr's License Inw,docs not apply to an 102 - PIERS Required Inspections ” "' '•
rthrough
owner of property Who builds or Improve,thercon,and who docs such work himself
or through his own employees.provided.that such impro,xmcnls are not intended or --_ 1 03 - UF$R
--oRerad for ade:IL however,the building or improvemcm is sold within one Scar of - ----" -
completion.the uvner-builder will have the burden of praying that he did net build or 104 - REBAR
mprove for purpme of arm). _ 105 - ANCHOR BOLTS _ _ _ _ ____ _
OLas owner of me property.am exclusively contracting with hansed cmnanms to ._. 106 - SEWER & WATER it a1., ., . �•Ci.i
consumer the present(Sec,'/Off,Business and professionsilds or The Contractor's
- LinenseLaw does net apprytoanowner btpropcnywho WBesorimprovamercon, 202 - UNDERFLOOR PLUMBING
and whe contracts.for such.pmicros.wim...contmctor(s).bcensed.parsuarn.m the __.. .. _. .._.203 --UNDERFLOOR' MECHANICAL-
Contract.,
'a License Law. ., -----'---- ---...---------
, .
❑1amaxemptanaecst<. . : .. .aePcfor mistiabn 204 - UNDERFLOOR FRAME.;:.:
ofvru? ' ^ "1 � 'oare '•"'' 205 — UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
301 — ROUGH PLUMBING
I hembynlfirmund,,mltybfperjurynneafm<followingdeclarnionr 302 - TUB & OR SHOWER
a ❑ 1 have and will maintain s C"'nificate or container to self-insum for Workers 303 — ROUGH MECHANICAL
Compensation. provided for by Section 3710 of he Labor Cale. for he
xrfarman<e'ennlwbrk.rorwmcnlmspeam,disisued. •„ 304 — ROUGH ELECTRICAL
❑1 hove and&ill rouran io Worker's C.th,61.1n.insurance,as required by section 305 - FRAME
3700 of to Labor Cm r to perfo3ma r thework r which this Permit 3 0 6 - HOEDOWNS
x's M Worker's C pc ion Insur nee d Poly beere. _
f '
`gip K1nlaynO3/ 2 220Y 307,<. ; ,INSULATION.
RTIFICATION O
FEXEMPT NFROMWOR s t - ' -308 I 1 SHEETROCK''
COMPENSATION INSURANCE:3r(J'e _
(Tru:seOiod�eedno,becomplemd'tnhepermnisfor one hundred dollars 30.9,.:,.,:. EXTERIOR—liATH-
(S]W).rless.) 310 — INTERIOR LATH
_ 31 T., _.:SCRATCH COAT _...... .
` I eemfy that in th pe f m m of thek'for Zell Ib pc it I.. d,1 ' t. "l
shalt I employ may perm y an to become subject I me Workers 313 — ROOF NAIL` ! '
Cnmpc Y LawsofC f Dam
— 50-1 - - FINAL'-ELECTRICAL -ENERGY
NOTICE TO APPLICANT If after king tins Cennfcate br Exemv6om you ammo 502 — FINAL PLUMBING ENERGY r,
Z 1 pYwt Wdikcra Cnmphnsaibn pravisionsorde Labor Crile,you must
become s b int t m
Q forth m comply
1 m M1 p Irons ort...permn shall W deemed a ked.
ZR 503- . FINAL.-MECHANICAL. ENERGY. .
E.4 'is f It 2ONSTRUCTIONLENDING AGENCY, 504 - FINAL BUILDING ENERGY
1 nemby aft red mm(here ,dconsirvu on Ilnd ng age y fen the perfamaanee
w->. nrmewmmkrmwhitntnisp alrsissueprs<e.3o9zCiv.c . 505 — FINAL ELECTRICAL --_. _ .. ._.....
— —
Q L Lie nad2,. 506 - GAS TEST
o.
U'O ,Ieertif,denlievet<aamisapgReanm�nnaaial�mmm<amvel;,rbm,aem�is 507 - FINAL PLUMBING '
Wo cbrmat.I agree to comply with all city and emunty,ordi ances and slate laws minting 508 — FINAL MECHANICAL
O V lobaturveg emikered profanity
for inspection sothbrimreposesmtivei of this city to enter upon
w me boom t J.p e.nyrfyandkephalm 509 — FINAL GRADE
CW IWc) g to a de ify and keep harmlev theCty of Cupertino agmen
.E7 n liabilities.judgments. t and expenses may in any y gamsIsad 510 - FINAL PL ING
U,Z City' consequence of thegranting df th perm r" - /'
APPLICA NDERSTALD 'Ah'D WILL CO�IPLYW*HALLNON-POINT n_. 14 I N C WORKS
_ u .'uLnrloNs 'it Issued�y: Date
signpry ppficanUCommactor •'..+ ate....'. Re-roofs
t HAZARDOUS MATERIALS DISCLOSURE'
Il the
applicin par future building occuphm some or handle haxadous malanal .Type Of ROOF .
.;defined by the Cupenno Mumap.(Cod Chpt 912.andthe Headand S.fny t (,l , •- 11
Code 5 a on 25532( )
_All roofs shall be inspected prior to any_roofing_material.being.installed.,
Will menpptic.ntormtua building oaeapant,use eq.iPmestmdcviceiwhich If a roof is installed without first obtaining an inspection; I agree.to remove
'mit has dousatma .....imme,asdefinedby'me Bay Art.Air Quality Management
i trot t _ all new materials for inspection. Applicant understands and will comply with _
ov ', ' all an source regulations.,
havetrtad'me hazardous marcnW qurrcmenu funder Ch<pler 6.95 of the
California Health h Safety Code;Sections 25505:25533 and 25534.1 understand that
ifine buildin IaeannlcuncnO M1eve tenam.thm itism M1ilit -tit the
Y Yssumerr, Ymno y
occupem of Or'e requirements xhic pro aIN'c'bf a Cmifca¢of
occupancy. ., ...
List ce nam ono ism Signature of Applicant Date
o '
o e 'ariaed gem, Date„,,. All roof coverings to be Class"B'a or better _
.,
OFFICE _ .. .. .. .. .. .. .. .