03090221 CITY OF CUPERTINO ,
BUILDING DIVISION PERMIT CONTRACTOR WF RMATION -
BUILDING ADDRESS: SYL—MAR CONSTRUCTION PERMIT NOO 3090221
ERS NAME: 1310 TULLY RD. # 114 PERMIT ISSUE DATE
EQUITY OFFICE PROPERTIES 09/26/2 003
PHONE: (408) 293-7969 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i00 LICENSED CONTRACT'OR'S DECLARATION
u I hereby affirm that l am licensed under provisions of Chapter 9(commencing lob Description
with Section 7000)of Division 3 of t e Business and Professions Code,and my license is
+'fid in fall force a aderreet. REVISION--IN HOUSE USE ONLY
;q= License Class Lat.0
'pFpp
Data AR {ITECTStDECLARATION NO NEW PERMIT ISSUED/ORIG. #03070215
IWu un ,. plan bear aspuhlic rccnrN
a
dPrnfcs'
OWNER exempt fr m CLARATIO /\ '
1 here art ore that 1 ore exempt from the Contractors License Law far the
p 0 toile J. (Section 7031.5,Business and PrAcssions Code:Any city or county
<m� which requires a remit m construct.shoe improve,demolish,or repair any structure
prior to its issuance,auomquires theoplicamtarsuch permit to file a signed smmment
a that he is licensed puvuanuo the provisions of the Contractor'sLarse hwlCharmr9 Sq.Ft. Floor Area Valuation $O
iFG (commencing with Section 7000)of Division]or the E usiness and Profession,Gale)or
$ hot he is exempt tbercfmm and Ne basis for the alleged exemption.Any violation of
Section 70]1.5 by any applicant for a Permit ubjects the applicant 10•civil pcnshy Of 3 A9N8Qa]5er 0 0,.. ncy'I�'pe
th
not mom an fin hundred dollars($50)). --- --—
1.as owner of the refinery,or my employees with wages at their sale compensation,
will do the work,and 0eswnu,e is not intended or offered far sale(Sec.7044,Business Ugte�,�. (e
and Professions Code:The Conuumr,License Low docs nut apply to an owner of 101 — FOUNDA'I'PU-jtJ d Inspections
property who builds or improves thereon,and whodoessuch work himself or through his 1 1�l
awn employees,provided Nauuch imprawni are not intended oraUered for sale.If. 102 — PIERS
however,the building or improvement is said within ane year o(complction,the owner.
Wilder will hive the burden or proving that be did not wild ar Improve for purpose of 103 — UFER
"I`')' 104 - REBAR
I.s owner of the property,am exclusively contracting with licensed comncmrs to - -
consumer the pefject(Sec.70d4,Business and Professions Code:)The Contractor's Li. 105 — ANCHOR BOLTS
cense Law docs not apply to an owner of property who builds or improves thereon,sed, 106 - SEWER & WATER
who contracts for such projects with o contractor($)hunpursuant sed pursuano the Cnntnnor'`
,ZO2 — UNDERFLOOR PLUMBING
Licenec Law.
I ore exempt under Sec, ,B&PC far this reason 203' - UNDERFLOOR MECHANICAL
r Data 204 - UNDERFLOOR FRAME
WORKER'S COMPENSATION DECLARATION
I hereby afntm underpeneltyof perjury ore of the fa0owing dedaraiotts: 205 — UNDERFLOOR INSULATION_ .
❑Iheveend will mainuine Cenificsm olConsenuO selrinsure for Wohoh Compete 301 — ROUGH PLUMBING
"tion,as provided for by Section 37110 of the Lou,Code,far the rertaran asea of the 3 02 - TUB & OR SHOWER .
work for which this permit is irsucd.
303 - ROUGH MECHANICAL
❑I have and will maintain Worker's Compenonceo the w rkfoax r which
as ratihis Peod by Sssued,
]7IXlar thchwr Code.for the pertarmance of the work for which Nis permit is issued. 304 — ROUGH ELECTRICAL
My Worker,Compensation Insunnce carrier and Policy number am: 3 O 5 — FRAME
Carrier: Policy RO 306 - HOLDOWNS
CERTIFICATE OF EFI
X .1PON FROM WORK ERT
COMPENSATION INSURANCE 307 - INSULATION
(This section need not be complclod if the permit is for one hundred doll.1$100) 308 - SHEETROCK
orm,r.) 309 - EXTERIOR LATH
employ certify ny err the nary mannas the work rnr which this Permit is iasucd,1 shell not
Law'oanypemnn in any menneraoumbecame object to the Workeri Cnmpensehnn 310 — INTERIOR LATH
vplio canramia.Dam 311 - SCRATCH COAT
NOTICE TO APPLICANT:IL after making this Coni ficale of Exemption.you should 313 - ROOF NAIL
become subject 10 the Worker's Compensation previsions of the Iiwr Code,you must
DZ forthwith comply with such provision,orthis Permit hall bedcemcdranked. 501 — FINAL ELECTRICAL ENERGY
z� I
CONSfRUCTIONLENDNGAGENCY 502 - FINAL PLUMBING ENERGY
T hereby affirm sen them ha constriction ending agency rnr the performance or 503 — FINAL MECHANICAL ENERGY
yi the work for which mix permit Is issued(Sec.3097,Civ.C.)
�7q Lender's Name 504 - FINAL BUILDING ENERGY
=)ZLndarSAddres 505 - FINAL ELECTRICAL
p 1 certify that 1 haw read this application and sum that the above information Is 506 — GAS TEST
P comma.I agree to comply with all city and county ordinances and sate laws relating to
�U building construction,and hereby authone,roprcumatin,of this city to color upon thc F NAL PWFING
G
1 awn (We)agree
to property(Or inspection l eep e.h
ti
(We)agree m rave,indemnify and keep hartnleas the City of Cape
ninn against 0 8 F I L
;JCn Iiobllities,judgments,eosts and expenses which may in any way acerae again sat d Ciry 5
,Z, mmn,equenceofthegmmiingofthis permit. Issuedby:5 Date r
ti APPLICANT UNDERS ANDS AND WILL COMPLY WITH ALL NON-POINT
E RE ATI
2114 Re-roofs
rare f0i,maptcrurroactior
HAZARDOUS MATERIALS DISCLO"Ofirr Type of Roof
Il dm applicant or(umrc wilding umupanumrc or handle herardOur m uchid
vet by he Cupertino Municipal Code.Chapter 9.13,and tbe Health and Safety
c.Section 255I2(a)? All roofs shall be inspected prior to any roofing material being installed.
❑YesNo
Will the applicant or future building occupant use equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove
emiI havmdous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
Dixuict?
0 Yes
1 haw renthe waardmis rear srequimmcnu under Chom,6.95 ofthe Calif.,.
ria Healds&Safety Code,Sawtu 75505,25573 and 25534,1 undersmtW thatifft wilding -
�ilpr
rrcntly hew a he vee Nu it u my mocra ihility m family tM occupant or the
i astsrsae4CptifinW.r a cy. Signature of Applicant Date
/� 3 All roof coverings to be Class "B"or betterear t Jagcm Dm