01040040CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
20330 STEVENS CREEK BLVD
01040040
OWNER'S NAME:
APPLICATION SUB DA] 17
UPERTINO CITY CENTER ASSOCIAT
04/11/2001
(i PIIONE:
_
SANITARY NO. CON'T'ROL NO.
ARCHI'I'EC'I'IBNGINI?ER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u cl r_I fu
LICENSED COMrRAU 1OR'S IIECLARAI ION
Job Description
I hemh. alliml Thal I am Keened under pmvi,ioits of Chapter 9 (commencing
with Section ]W0)nfJ�ff ,ion 3 ofthe Rusineaond Profcnsiom Cr my license
' 'n 1.11 (orae and elDe I_
'i`,cne
t PERMIT.
Class far, u_-b
30 DAYS
TEMPORARY
[)'at, —/=5—f
�- �-/ -�Zi IT:FIITGm S DECL[ON
I understand my plan, ,hall Be used ns public records
OWNER—BUILDER DECIARATIOY
I beH,th, affirm bar 1 Ton e,aamtp, hour the C unison',I c n.c Law for the
h no y -. section 7031.3. B n J Profession, C Any - oypmTly
r
which 4 P inlli I 111 '. p' I"fi I trucmc
t
Poon t al- mH II ppl' Il 'hl 'n fl 'g t temem
I. IOo
y108I1On
that he licensed p II Ihe onset the C I to/,L W 2erY
70001 is t B.' 1
(commencing ithS I lDiv of the s and e)
tie I The tu,„ha, hr,ll,rd
.0
$0
rrThai s capnl«,fm a c.11i m "alarm
tf Seaman 9031.5 by any uPPlian I fora permit .hj,,,, the apPuemu n, 'il pcmlhy
Nu e
Occupancy Type
of not nurrt Than lire hundmJ dollars 155(101.
D 1. a, tw,teror he propady Cir iity etmlayee, with wage, a, nleir,ole cmupmsminit
Required
AM do The work, and the si ucme, is non Intended or offered far sale (tics. ]Ilio,
Janina and Pmfe„inn, Code: Do Contractor', License Law does not apply m an
❑speCilODS
inr or propeny Who build, or improves thereon, and wh9 does such work himmlf
mmug1, ms null ti,nrecaeo„ Wended
101 —
FOUNDATION
awn nnphyees. provided ouch me not or
offered for safe, II; hnwcvrr, the building or impmvnncut Is sold within one year of
,
impletion, he owncollaimer will have me hurden tf pra.;ng thin redid not build or
102 —
PIERS
ntprve fin'arfas—tr sme.l.
103 —
UFER
❑1.a—vne,ofIll epropcny, no eaelTl,ively e,rdoul'rug win, w,nsidronlounrs to
Prole—ore
1.04 —
REBAR
e pameel (S. BIW, Uu,iness and Cnlc:1'rhe Commuter's
maet thec
Lroicense Law does not apply to allow re, of Jump” who builds or Impmvas hereon.
—
ANCHOR BOLTS
and who rammer, lin such Project with :t Ommarmd,j rcen.m pursuant to he
105
Oium lin �opi`mmur So,. segs P C for dal, reason,
106 —
SEWER 8 WATER
202 —
UNDERFLOOR PLUMBING
0, nor Date
WORKERS COM PI?NS NJ [ON OECLARAI'[ON
203 —
UNDERFLOOR MECHANICAL_
I hereby aninn under penally of perjury one of the fontwing dcclamoosrs:
204 —
UNDERFLOOR FRAME
❑ 1 have sad will t in,ain a Certirrme of Corwin,, s il-iro re Iib Worker's
205 —
UNDERF.LOOR. INSULATION
Compensation, as provided for by Siren.... 39(x1 of the Lubar Cola for the
perf(lm,aucc(lithe work forty-0iuh this permit is voice,
301. —
ROUGH PLUMBING
O l have and will maintain W'orker's Compensation Insurance, as requited by Section
302 —
TUB & OR SHOWER
390x1 of Th, Labor Cade. Iia the pnforu.an,c at The work for wh"h this permil is
issacil9, I kcinCninfemnlionlnwanttcarr' and Parrymll,
303 —
ROUGH MECHANICAL
\ramie if0itzp Pnr.IN(l: O 06 Z 13
304 —
ROUGH ELECTRICAL
CERI IIICA'I'ION OFEXFMPuON FROM WORKERS'
COMPENSAI ION INSURANCE
305 —
FRAME -
(Thi, section need not W completed if the Permit is for one hundred dollar
306 —
HOLD06NS
(SHM) a Icc,J
307 —
INSULATION
I ttni ffl that in he person in n y ma n he sea if list wmeh this ct tlo t e issued, I
Chan nnt etttpl any in any manner ,t as u) become ,ab}ctrl m me Wtrkm:
308 —
SHEET ROCK
I. f G
A;,lx: T:nionl.aw,arearrarta Date
309 —
31.0 —
EXTERIOR LATH
INTERIOR LATH
NOI'ICGTOAPPLICAN7:11: after making this Cenilicatnafl?acmpdon. ynu,houlJ
become, rif u, the Worker, Compensation provisions of the IaWr Code. You mast
fon1wilM1 comply with such provision, or this peroulshul l be deemed revokad.
311
— SCRATCH COAT
CONS'1 RUCTION LENDING AGENCY
313 —
ROOF NAIL
1 hereby anino than here i, a conameljon lending agency for he performance
onhcwtn Ber whish min pvmdl i, issuedissued(s«. dB9rciv. c.)
It B
501
— FINAL. ELECTRICAL ENERGY
:male:
Lend •'Address
502 —
FINAL PLUMBING ENERGY
I cenay that l have mad misapplication and state that nNoc informdinn is
50'
— FINAL MECHANICAL ENERGY
nen. 1 agree to comply with all city and county ordinances and stale laws relating
v
ddingtatomcetn,Told hereby nafhari.erepm.em atives of IF city to enter wan
m—
504 —
FINAL BUILDING ENERGY .
he nMrvcmemicned prnfeny far inslxniou pugnno,
(We) agree tuwo matronly and keep hamdc„the City ofcupnmoill
505
— FINAL ELECTRICAL
Ii.luditics, judgmenn, teas trod expenses which may in any way acerae against said
•
°�
City ill eonscgten,cofthe gminingoflhis prrina.506
—
GAS TEST y
UN STS' S AND WILL COMPLY WIT If ALL NON-POINT
Issued by:
_ ate
SOURCANT
Re-roofs 508
— FINAL MECHANICAL t
SignatmeorAhplirm tlloinm Date
IIAYARDOUS MRI(?RIALS DISCLOSURE
Will JIW applicant or butum- Wilding occupant ome or handle buturnums material
Type of Roof 509
— FINAL GRADE
as defined by he Cotomno Municipal Cale. Chapter 9.12. sad the Health and Safe,
Code, ser,iot 2553260”
510 —
—I
FINAL NRI_ F'I_RNN I NG.
NN
El yrs 0N
FINAL
All roofs shall bei ti1�0�� tyr1. installed.
Will he apprrant or Tamm reading occupant use equipment maevi«•s which
If a roof is installed, tf•ithou[pfirsl'dblp3iniidtifecRhh3ree
to remove
emit haaunloa, all enma dr,ni s es dcrncd by he nay Area Air Quality Managcnent
Diodn9
all new materials for inspection. Applicant understands and will comply with
Ely" 0N
all non-point source regulations:
I have mad the hriandou.s material, mgnimmnas under Chapter 6,95 of he
Cxldonila I Icahn N Sul It, Code. Sectors 255115. 255,13 anal 25519. 1 nndemmnd Sha,
if he handl ing dre, nal cuncndy Stave .a Tenant, The( it is my re.vmsibili,y In not it, the
cuNnt of the requirements which must be met prior at issuance of Ceni rcate of
Oecupalcv
Signature of Applicant
Date
All roof
coverings to be Class "B" or better
),..ncroraalt ed agent Dam
OFFICE