00070014OFFICE
CITY OF CUPERTINO
CONTRACTOR INFORMATION:
BUILDING DIVISION PERMIT
BUILDING A DDRCSS:
PERNIN NO. (�
OWNER'S NAME:
U' { �
APPLICAl [ON SUB DAH:
20385 STEVENS CREEK BLVD"k`lvS
00070014
'IIONIi:
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SANITARY NO. CONTROL NO.
W D V PROPERTIES
07/05/2000
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ANCI11'IliC'1'/ENGINIiIiR:
BUILDING PF.RnI1T INFO
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No. j o8
dLUG ELIfCI' PLUMBMLCH
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anz
DECLARATION
LICENSED COYoned
Job Description
! m
anUR'S
I berehy affirm @w I um IiaoaM under smviGans.ansCChapter Y (cnnmenen,
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with ion,] ni NCllasincss unJ Pndcs>inm Cade. and my license
force
_
and effect,
in full lone unto eRca.
tell
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tun u
Lies rxe Clatis o tr -
to
Control
Dale S DEC A
ARORTECuse
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kv,,u tic ...0N
I mraersrat+m.ay 11 -- hall 1+y asyn :+, pnnhy rens„iils
SIGN .
irE
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Licensed Professional
o
OWNER -BUILDER
the IRAI
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1 hereby aRnn that 1 neap, mark ,he Common's License for the
/ ,
/
�y a
s and
city o
]03L5. allexs and Pmfcssinns Cabe: Any dry oreomny
re reason (Section 1. y%ins
xa
Much i tl ore no,
whichisisssupenph mdeamealterat
forsunopmanke
a sigtatement
for such Penninoicln signed statement
penont
pdmm%lickeaancc.aBo mqo the
FI00 Ceil
ValUa[IOII
—
pieepPlicam
ih:n be es,in, v000 smv M,i...3al the License l.aw (Ch Code)
lse wish Sceref ]m lic Business mmd
(emm� rl, Sella
vi Code)
basis 3 al the I
Anel' a
escalation. Any violation
or the he is escmbr Increfmm and Inc basis for the x ion( Any
he
co,thalleged
II unyapplicantIn, upermit sunjcet,hc npPliyunt nsacivil penally
APN Number
Occupancy Type
not onvic him five,
or mt,re,nunr nnanareddannrx (55(ro).
O [.ns le ncnd the pmpeny.o my engnayec with wages it,their sole co...prnxatiom.
Required Inspections
will do the work, and the structure is not intended or offered for sale (Sec. i614.-
Bminessand l'refestival Codc:'ThcConmutor'sLicense Law does nm apply In an
toviser II property Who Wilds ar improves (hereon. and who Joys such work himself
� 162E090. 00
nr through his own emplayeys. provided that .such improvemts enarc nm intended or
ntfercJ rot sale. If, hawmer, the building or improvement is cold within one year of
v
Odell, lo,nwn—hadder w tll have the hordenot' ......... that he didna, bill,] or
_
all forpursowatvalcy.
101 — FOUNDATION
01. as owner allhe properly. am exclusively ymarnyling whh hce''teII y+,mmymran
103 — IJFER
n'Pml'essioa Codermmrs ) The Cont
uatrvn the secure, (Sec. Y(Wl. Business ad
License Law dies no, apply Ins arroliolot pecpeny who builds cur imprmes there nn.
1.04 — REBAR
and who contract tor such projects with a sat asons) licensed pursuant to the
Commerce,u.
yenseLa
105 — ANCHOR BOLTS
01 con exempt under Sec. , B & P C tabes masnri
_
304 — ROUGH ELECTRICAL
Owner Dale
WORKER'S COMPENSATION DECLARATION
505 — FINAL ELECTRICAL
I herebyafirm under penalty of Perjury one of following declarations:
514 — FINAL PUBLIC WORKS
1 have and will i ainmin a Ceniticate of Conseil R+ self -insure lin Wader's
Coni'maim. as provided for by Section 37M of the "We CIA.. for ,he
Pudlmnancc of the walk fill which this econi, Its ixnassi
01 nave and will maintain Worker's Con,we ion Insurance, as required by Section"
00 Df the I,al Code. Gil the felt'onnunce nr the work for which this peons
sued. lily Worker's Compensation Insurance carrier and Policy number are:
'
Carrier: Policy Sir,
CERTIFICATION OI+B,XEMPrON FROM WORKERS'
.
COMPENSAHON INSURANCE
(This Semon need and be completed if rhe pmol is for one hundred dollars
($1(X)1 or less.)
1 certify that in the performance of the work for which this permit is issued. I
shall tilt emplay any parson in any manner so as n+ become subject to the Workers'
Compensation Laws of Call ... me. Dam
Applicant
NOTICE TO APFLICAN'I''. II: after making this Ceniticare of Excn+ptinn, you should
Meona subject ,o the Worker's Compensation proy"m w of the labor Code, you oma
tie deemed
forthwith comply with .such provisions or this permit shall revoked.
V]
COt LENDING AGENCY
them is lending agency for the performance
hereby aRnn that them iss conal
(See,
III work far which ,his pvnnil is I,uuul (See, 3119], Civ. Cd
yC
LcmJe
Lcode,iNaim
,
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LcnJch Address
sky
1 clam y Iha, I have ream this application and stem Iha, the above information is
tr (~
et freer I agree ,o comply with all city ;uul county ordinances and state laws rclaing
fJ
, building crn,lina n. mod coebynuthorim reprcontmlvesolalis city os enter spm
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the adrve-mentioned property for inspection purposes.
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(We) agree a+save, indemnify and keep harmless the City of Cupertino against
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limbilidus, judgments, teas and espunses which may III any Wily aceIn, agmlust said
City in consequence of the granting of this permit.
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APPLICANT UNDERSTANDS AND WILL COMPLY Wrm ALL NON -POINT
�J
ItiSUCdb✓ Date
y'
SOURCE REGULATIONS,
-
Re -roofs
Sigmnmeof Appheam/Cantraaor nae
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant m future holding recusal store in handle hatcarded, material
Type of Roof
as defined by the Cupertino Municipal Cute. Chapter 9.12. and the Ife:Jlh late Safety
Code, Seaton 25532(.0
-
❑Yes 0 N
All roofs shall be inspected prior to any rooting material being installed.
Will the applicant orfame Wildingoyeapantuse equipmemmdmnyyxwhich
If a roof is installed without first obtaining an inspection, I agree to remove
mit her nodous air contaminants as defined by ,he Bay Area Air Quality Management
all new materials for inspection. Applicant understands and will comply with
Idea"?
O Yoe 0 N
all non -point source regulations.
1 nave rend the he ... I I, articles cNooanke under Chnpmr fi95 of the
1Ownamnutnotned.,car
C alifumie Rethink k Safay Carl, Sections 25505.25533 and 25534, l understand that
mHibilay m ratify 'he
on, cy have a caring Iha, it isy ¢msns
if the building dssd urrentl
ns which at Ise met nam m issntmee el' a Cenitic le of
occupant of the re,dremnm
Occupancy'
Signature of Applicant Date
All roof coverings to be Class `B” or better
Dae
OFFICE
CITY OF CUPF.RTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING A DURESS: PERMI'1'NO. (�
OWNER'S NAME: APPLICAItON SUB DAH:
l ' t
20385 STEVENS CREEK BLVD��1� fyv Aq/S U' { 00070014
'IIONE: SANITARY NO, CONTROL NO.
W D V PROPERTIES 94/4 cJoS�z C!d 9S/� 07/05/2000
O z ARCHI'I HCHIiNGINIHiR: BUILDING PERMIT INFO
O No . 44 g o8 BLDG ELEC1PLUMB MECH
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G<o
Z N= LICENSED I a CONI'cd Under
r DECLARATION Job Description
I tion 70 ttio(yOd i,i 1 am el B under pmvI' f of tons
9(cnnmenense
FwF s� ng
with Sectione and effect, ion]nrmcllasincss unJ Pndcs>inm Carle.and my license _
.] in full force and eRccr.
a d¢ Dole c Clens Lic.p
1�CC I.° Dam f.'omraLA
u1 a.0 ARCHITECuse II,,CLARA'r10N
t'=° I mnaers.a.,d.lay plata,,Hato I„•.oxen m.nue rea.adx SIGN .
�r
oo Lieen,e Proresaonw
a s p
OWNER-RUE-DER exempt m n the RATION /
=¢ 1 naso aRnn on 1 am exempt from the Cairns at License city
coronary for the
Y 'Inch ire rennin,(Section]o3 L5.Busincxs and Profcssinns Cec:Any city11meRa
oe x a which requires u pennh m wntswcl,ulmminryrovc,Jcmnlish,or nip T any xuvnurc
n3prime its issuance.also natuim.une applicant for such pvrtnino file a signed statement
— Ih:n he is laco,cd poreu:nmo the pmvi.ian,of the Connmcmr's License Low(Chapter 9 F100 rea Valuation
(cnntntene ing wish Selden]1100)al'IAM,ion 30ll the Business ood I'n,lesxinm Cute)
or thm he is exempt themfmm and the basis for the alleged exemption.Any violation
II See 1,70315 by any applicant for a permit subject the applicant m a civil penalty
or .m,re him fi a handmddanarx(s50f). APN Number Occupancy Type
O[..s owncnd the pom,.y.o my enq,layec with wages it,their sole co...penxaim.
will do the work,and the structure is not intended or offend fur sale(See.7044,-
Business and Ii fission,Cadc:'n.Cmumea r',License Low does nm apply In am Required Inspections
larr II lrroperty Wh,hoods lar improves mere.....and what does xneh wark himselr
through his awn employees.provide the such impowemen..,are ma intended or 3162E090. 17,10
nRered ror sale If,hnwmer.the Wilding or improvement is cold n'ithin one year of
mplerion,IW—nobullderw Jl have the hunlenot'pming that he diJnot build or _
improve for parpowf.. yalcy. 101 — FOUNDATION
O 1.as owner It pmperry.am exclusively eaalraelo g whh hecnted"'nlraemm m 103 — IJFE R
Lunstruct the project(Sat.Y(Wl.Business tnd'P'ul'essiom CNc:)The Conmallo
icense Law does not apply In anolirclot pmpedy who build,,,,impra,es thereon. 1.04 — REBAR
and who contracts filar such projects with a et nu'actorlx) licensed pursuant m the
Commctoe,License Law. 105 — ANCHOR BOLTS
O l con caampl under Sec. ,B&P C fo,hi,¢asnn _
Owner Ilam 304 — ROUGH ELECTRICAL
WORKER'S COMPENSATION DECLARATION 505 — FINAL ELECTRICAL
I herebyaffim,ander penalty of Perjury one of the following declarations: 514 — FINAL PUBLIC WORKS
1 have and will nainmin a Ccndicate of Concept ”'sell-insure lin W..ky s ,
Compensation. a, Provided for by Section 3](0 of the "We CIA.. for the
Perlimua acc of the work for which Ihi,permit Is issued,
01 have and will maintain Worker's Compensation Insurance,n,requited by Section
"00'1the I,al Code.En donnun
the pccc ofrbe work for which this pennu
sued,lily Worker's Compensation Insurance carrier and Policy number are:
Carrier: Polivy No.:
CERTIFICATION aP P,XEMPOON FROM WORKERS'
COMPENSAHON INSURANCE
!This section need not be completed if the Permit is to,one hundred dollars
($110)or les.) '
1 certify that in the performance of the work for which this permit is issued.1
shall nal employ any panne in any manner so as to become subject to the Workers'
Co ntairsation Laws of Cold...ma.Dam
Applicant
NOTICE TO APFLICAN'I''.II:afar nwking Ihis Ceniticare nt Excnnpninn,you should
Meanie subject to the Worker's Compensation provisimts lar the labor Coale,you mull
z
2 forthwith comply with.such provisions or this permit shall he decncd revoked.
f" Cat them is a oR 1.ENDl NC,AGENCY
' hereby that Irio ixs cannramvon lendingagency for the performance
Lente work lotme which this pvnnil is I,uuul(Sats)119],Civ.C.)
0. C Lender,Naim ,
� Z LcnJch Address
U I eanify that I have read this application and sem that the above informminn is
U+ Fy
correct 1 agree to comply with all city and county ordinances land slide laws relating
f, m building crnsmuetian,and coebynmhorim reprcommlvcsol'Ihis city w enter also
} L51 the adwe-mentioned py,l for inspection porpous.
(We)agree to save,indemnity and keep harmless the City of Cupeninn against
r Z Ilabilillos,judgments,ants and wlwnses which may III my Way over to agulnst said - ^
U Z City in consequence of the granting of this permit. � J Q )
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: ✓ Date y'
lilgnunne of AppliamVGmmacmr Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSIJRB
Will the applicant or future Wilding occupant store or handle Weardu rs nwtedal Type of Roof
as defined by the Cupertino Municipal Cute.Chapter 9.12.and for Ilydm and Safety
Code,Saline 255)3(.)" -
❑Yes 0 N All roofs shall be inspected prior to any roofing material being installed.
Will the appli,an.or Jump,building occupant use aquipmentotdeshms which If a roof is installed without first obtaining an inspection, I agree to remove
mit haeardous air contaminants as defined by the Bay Area Air Quality Management
.suer, all new materials for inspection. Applicant understands and will comply with
OYes Oho all non-point source regulations.
1 null read the hwusdh I, ama,,als re lmocmcnu under Chapter 6 9 of the
Califumia Health k Safay Code,Sections 25505.25533 and 25534,l understand that
if the building des not currcnl ly have a rennin,(hut it is my mHmnsibilay or ratify the
occupant of the retrylrements which must Iry met nam....ssntmee of a Cenitic le of
Occupancy' Signature of Applicant Date
ownamnuthorne.,car Date All roof coverings to be Class `B" or better
OFFICE