02070026 OF
CITBUILDIING DIVISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20300 STEVENS CREEK BLVD HOWARD WRIGHT CONSTRUCTION 00. 02070026
�bor W `EE CORPATION ORD FL. W) PIER 9, THE EMBARCADERO #1 _TLICAbQNyf6T/12002
I PHONE: SANITARY NO. / CONTROL NO.
(206) 447-7672
❑W C zo ARCHITECT/ENGINEER: BUILDING PERMIT INFO
be u p ❑LUG ELECT PLUMB MF,CIi
i�N_ LICENSED CONTRACTOR'S DECLARATION DD
=E IherebyaifrmJm,Ian.hem,duad,, ovi,i ,n]'Chavic-9(,a....mc1°g TENANT IMPROVEM eseription
to with Section 7")of Division 3 of the Busine. �/f''dP f ,'Cl. llla)liceme
is in lull force ante s+kp 4p6 S ) r�
z w U DteLicense CL+c 1j�pLie,a ,ye ��
:o e Dae�_p. _, __ Cnnmacmr_I`t-�k.•T-` Y e /A
i a O t., I CHITlCf' LARAl1 us r"il
gI undersmntl my plans shat toed as a .Ns
3 p
Licensed Prole+sinnal AUG O 9 2002
OWNER BUILDER DECLARATION L ll
I hereby affirm that 1 am exempt from the Contractor's License Law for the
F z a following reason.(Section 7031.5,Business and Professions code.Any city or county $23000
I to which requires a permit to construct,alter,improve,demolish,or repair any structure L SuI` D
a, mw
3 pnon its iaance.aim requires the applicant for such pamail apartment,
signed aae9r�a ra�t - - - - --- - -
'bat he is licensed pursuant to the provisions of the contractors License Law(Chapter 9 3�+IiA1V llfJaC�1®a. - Valuation
(commmacing,wirh Section7030)nr Division 3 or the Bminessand Professions Code) v.t
or that he is exempt thcrcfrnm and the basis for the alleged cmmjni,n.Any violation
of Section 703`5 by any applicant for a permit subjects the applicant to a civil penalty
of not rnnre man five hundred dollar,(55001. 10 3AP-N NOWDAT I ON Occupancy Type
E]1,as owner of propnP.or my employees with wage%as their sole compensation. 102 - PIERS
will do the work.and the structure is not intended or offered for sale(See.Toa, 10 3 - LIFER
'Business and I'mmssions Craft:The Contractors License Law does not apply to an Required Inspections
owoer or'eti'my Who build,or improves Britain.and who does such work hhnscif 104 - REBAR
r trough his own employees.provided that such improvements are not intended or
offered for sale,If,however,the building Lir improvement is sold within one Sear of 105 - ANCHOR BOLTS f -
iomplolma.far owne,larilder will have the burden III proving that he did am buil)or '
mprove for porpoaofaale.), 106 - SEWER & WATER
202 - UNDERFLOOR PLUMBING- - -.
I,as owner of the proper?,am earliness a d Proovsi with licensed i Contr cts ro .
Licenser to does
n (see, d a.Business o and pen,who Code:)The Cn,o,mims 2 03 - UNDERFLOOR MECHANICAL . „•
License Law doe.+not apply man owner,of propene who builds M improves thereon,
. and who comrects fau.simh projects with a coamanor(s7 licensed d puro the _ 2 04 -_ UNDERFLOOR FRAME
Contractors License Law.. -_. .. ... .. . .. .. . .... ..
01amexempt under See. ,8&PCfmfoisprison 205 - UNDERFLOOR -INSULATION
•
Ovine, Date 301 - ROUGH PLUMBING
R'WORKES COMPENSATION DECLARATION 302 - TUB & OR SHOWER
IherebyafimrunderPenaltyofperjur,,oneofthefollowingdedamtmns: 303 - ROUGH MECHANICAL
0 1 have and will maintain a Cerificatc of Comsenr to selt.insare for Workers 304 - ROUGH ELECTRICAL
J Compensation, as provided lot by section 3700 of to Labor Code, for the 3 05 - FRAME
performance of rhe work for whim tis permit is issued.
01 have and will maintain Workers Compcm.mtion Insurance,as required by Section 306 - HOLDOWNS
37W of the Labor Code,for the perfommnce of the work for which this permit is 3 07 - INSULATION
issued.MyrWorker's Compensation Insurance carrier and Policy number arc: 308 - SHEETROCK
.. Carrier Policy No,:LJ C2 DY1IJIe If ._.
1 NOFEXEMPTION FROM WORKERS'•" - • .309 +=i'EXTER`'IOR,'LATH,,.
COMPF.NSATION-INSURANCE' _ '.',- 310 -- - INTERIOR.--LATH .--
red
_ INTERIOR,-_LATH ,--eed nor be cranpleted it he far it is future hundred dollars 311 - SCRATCH COAT
a1Wl or less% 313 - ROOF NAIL _
I ttmify dam fi rhe perfmmance of the work for which this permit is issued.1 501 - FINAL EliECTRI CAL 'ENERGY
shall not employ any person in any manner so,as to become subject to the Workers'
compenwtion Laws of California.Do,, - 502 - FINAL PLUMBING ENERGY
NOTICE
s - - p 503 - FINAL MECHANICAL ENERGY
NOTICE TO APPLICANT:If.after making this Cenifca¢ofEmm cion,you should `
Z become subject n the Worker's Compnsation PI starts of the Labor Code.you mor
C forthwtimcomply with such provislnmorthis petminchllhedeemed mvoked. 504 - FINAL BUILDING ENERGY
CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
1 herehy affirm that there iv a ren traction lending agency for the pirforanum.
onbc wodi rwhich this 506 - GAS TEST
Permit is issued(Sec.3091,Cis.c.)
y p <nneraName' 507 FINAL PLUMBING
D Z LcmelIsAddress' 508 - FINAL MECHANICAL
V O I unify that 1 have read this application and state wt the strove information is 509 - FINAL GRADE
W correct.1 agree to comply with all dry and county ordinances and state laws minting
,O `j to building coadructmn:and hereby authorize meneamaeves<,ftis city,,anter apron 510 - FINAL PLANNING
} W the awm
ve- entioned pm,am,sur inspection ammues.
I y (We)slime iosave,indemnify and keep harMcssthe City ofCupetin,against 514 - FINAL PUBLIC WORKS
VA liabilities,judgments,coos and espen• his may in any way icenre ngaimt said r�
Q 7z. City Inconsequence of ton gran i tis, ti r'. {/�f
SOURICER UNDERS • LIMPLY WITH ALL NONFOINT Issued by: Date
It
Signature of Appfirane(Im .. DamRe-roofs '
HAZARDOUS MATERIALS DISCLOSURE
N911 the applicant in furore wilding occupant dome or handle hoodusaus material Type of Roof - -as deired by the Cupertino Municipal Cndc.Chapter 9.12,and the Health and Safety
Cside.Section 25532(0)'!
r .. . ,. •� All roofs shall.be.inspected.prior to any.roofing materia] being installed.
.i
Will meapplicantorfuture building occupant use cgaipmentordeviceswhich If a roof is installed'without first obtaining an inspection, I agree to remove
Omit hazardous air cmnraminanrt m defined by the Say Area Air Quality Management
District? all new materials for inspection. Applicant understands and will comply with
0Ye, all non-point source regulations..
`--� I have read to harsrdous mimnsls regviremems ander Chapter 695 of fore
California Health&Safety Code.Sections 25505,25533 and 25534.I understand that
iI he building docs nu c}Yaan ly have a mnm6 that it is my responsibility m notify the
°apart of the rc `�<nt x•hich most t poor to issuance of a Ccr lGca¢of
"°peon`?' Signature of Applicant Date
Owner°r amhoriaed agent All roof coverings to be Class"B"or better
OFFICE