02020097 OF
TINO
CJ BUILDI c DIVIiSiONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20410 TOWN CENTER LN # 100 SOUTHBAY CONSTRUCTION CC INC 02020097
'W NEWS NAME: APPLICATION SUB DATE
)EKE HUNTER 511 DIVISION STREET 02/25/2002
HONE: SANITARY NO. CONTROL NO.
'{ (408) 379-0400
"`Z ARCHITECTIENGINEER: BUILDING PERMIT INFO
00 BLDG ELECT PLUMB MECH
aO -I -1 L-1 I_-
LICENSED CONTRACTOR'S DECLARATION
h
5 a 1 hereby affirm that 1 am licensed ander It f Chapter 9lcommencing Job Description
to with Section 700(pof Division 3ofihe Bmine�eem �9 s'cod5 ane my license TENANT IMPROVEMENT .
YES is inay� rce en ci. raWy `I
i it:0 t6i,U •/ a s c AR�CHITECr'S DECtA IO� �'
,°-�14
O g I undcotand my plans mall be used as public rennds APR 0 8 2002
I d p O Licensed Professmwl
OWNER-BUILDER DECLARATION
o, i heady arnrm mat 1 mu,sion,from the Commcl.rs Recuse Law ror me BUILDING $75300
t S C following mason.(Section 7031.5.Business and Professions Cade:Any city or county
which requires a Permit to construct.alter,improve,demolish. r repair any simctua
e 3 _prior to its1 q the pplca t for,such pernint tofile a signed statement - --- -- ----- -
thathe bcemedp n nuathp pr lose flh C mon re Littna Lew lChaplvr9 qG pct ror Valuation
(commencing with Seuio ,70ifrevision S of the B Cnaoi and Nvbastions Code)
or that be Is exempf therefrom and the basis for the alleg d exemgmd.Any violation
-'of "I03P.5 by any applicant fora permit whjecu the epplicam m n civil penalry-
mr a.,otmam.ath.nRvehanareaaouars(ssoo)' lO1\PN'kftDATION ,I, . , Occupancy Type
°I,as owner or the pmpc.y.or my employees with wages as Isar sole compensation. _
will do the work.-and the structure is not mteaded'orofeau for sale(See.7044: Required Inspections
-Business'and Professions Cada:The Contractor's License Law does not apply to an 103 - UFER
.wnc
r of property Who bulkier improves ihermn,and who d es,nch work himself 10 4 - REBAR
or Inmugh his own employees.provided that such improvements an not intended or
cReredfuf tale.R',howa'c.die boleih ant a sola ha din one- - f
gorid,prnveni ream 105 - ANCHOR BOLTS +.,". . ,. • .. - ,
completion,for purpose
p seeo_saile er will have the harden of Proving that M did tat Wile«
i prove pn,w,s )' 106 - SEWER & WATER
;o aartih p.;awy.6�,excroslvdy ci;mmaline 04th iirensed eonvedorito — 202 "= UNDERFLOOR PLUMBING"
= onstruct the project(Sec.7014,Buxm2 0 3 UNDERFLOOR MECHANICAL--
ea.and Processions code:)The Contractor s - "
License Law does not apply to an owner or property who builds or improves thereon. - .. .
"i ..andwbo,comracts.for suchprojects with.a.contmctorls)liccmad.promma.b the ... _._. -...204- UNDERFLOOR--FRAME- ------ ------ --- ----
Contractor's License Law.
c °Iamexcmptund7Stic' _ ',B&PCfmflik tan 205 - UNDERFLOOR' INSULATION
GivneC ''•' Dvie' ' '' 301 - ROUGH PLUMBING
t ._ WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
IM1etidy•Irt,m sneer Penalty of perary brig of the declarations: 303 - ROUGH MECHANICAL
° I have and will maimoin'a Certificate of Consent m selkinsua for Worker's 304 - ROUGH ELECTRICAL
Compensation, as provided for by Section 37W of the Labor Code. for the
_ perform....line work far which oris pe.i,is issued. 305 - FRAME
°I haveantl will mention.Worker's Cone,roatiominsurance
.as required by Section 306 - HOLDOWNS
37M the W LaCoo forto vert rma c of the' k'r which thisperam,is 307 - INSULATION
is
sued My w k s Co pe t o I once ca cr a Policy be
30;8 „ _...:. .
t. naa
.ec .le 031 222 1 S . ; I!, IEETROCK;_^
�.�•IwtOwna "- ,
I CCRTIPICATIONOFEXEMMIONFROMWORKERf) ti. .' �g09' --!'EXTERIOR -LATH'
CpMP
(Thissemfon.cad.oneEomoneaNNrmepermfar onennnaadao -.._._.._.31'0" ".-INT$RIOR..`IATH
(5100).r less.) "°" 311 - SCRATCH COAT '
a ... ped:l 313 "-'-'ROOF-NAIL
1
'remi,th n n the performance nn to rk f ma, th ct t .
shall ventpmyanyperson,m..Dre.ne s smWcome Aril m wrkei 501 - FINAL ELECTRICAL' ENERGY
Com .a.Dare ''
502 - - FINAL PLUMBING-•ENERGY
pens
..AppBcanmion laws arca from
Ncome subject
uj APP LIC ANT:IL aftcrmakinginis Ccnincmc ofEnomplion.de.y6uhould s
z n«.mea.nj2cnom.worker'setantpenami.nprovisionaonheLaborCodayommtist 503 - FINAL MECHANICAff' ENERGY r.
Zmrtnw;thcompywimaarnpmviamns.rthisp mit nmlxaecmedavakea. 504 FINAL BUILDING. ENERGY . ... . . .
_14 'CONSTRUCTION LENDING AGENCY " 505 - FINAL ELECTRICAL '
a 7 i I mebyruffirra that thate isicaustracumnI'eadiag agency forthe pe(rm ince l
of work for n h hspe.it a ssued(s 309 Cis.C.) ', 506 - GAS TEST
�.Q Lend N me .. ,.., -, _ .. --_
naer:Aaerasq, ., _ 507 - FINAL PLUMBING
i a ,, , ,
L<
n�fy'the,l have read this nppli ion and state that the aWve information is 508 - FINAL MECHANICAL
Isr E. vmroc't.I epee to comply with all city and county ordinances and stala laws rdming 509 - FINAL GRADE
0_ rebuilding smiorubiion,and hereby auinorize repmsentativaof thiscity menmrupom
� W neaWve-mailumeEpropertyforinspectionpmp.ses.: . 510 - FINAL PLANNING
.`.AI (We)agree to smc!indembify and keep narmlesathe City of Cupeuino against -
m Eabdities.judgments.costs and apenses which may in any w.ay,aceme against said 514 F I NA PU IC WORKS
V z City in consequence of the granting of this permit. ° '"
APPLICANT UNDERSTANDS' WILL COMPLYWITH'ALL NON-P INT' !
: so l�cExFDDLATlDNs: ty,$ Issued by: Date
a-_-lc_ i
. . 3igm a ppL .irucmr . .,
` i ... . .
Data
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE -
,i,. Wllthe ppl ni ft cWld g - Type of R
oof...c
as def ed by dr Cawr no Mun c Code Cnapler 9 12 and the Health d Safety
Code Sen on 25512p1 ' : '
°Y "al t r-,fi ` ll.roofs_shall be inspected prior,[.any roofing material being mgtallei,..__
wn th pplicam f t m b Iding«c p t use equip e t tie :wn fin If a roof is installed;without first obtaining an inspection,-Iagree to remove
snit nmaN 'r contaminants defined by the By AreuAr Qu lty Mangemcm
Disther? . all new materials for inspection. Applicant understands and will comply with
'`
11 Ye. " . ,. all"non-point source regulations , i.,
`fin✓ I have rtad the hoz dour mmenal regwrcm,c 6ndcr Chapter 6.95 of Ine
California lieahh&Safety Code.Seniom 25505s 25533 and 25531.1 understand that
H lba Wading does not curcmly hove a beam.thel it is my msponsibility m tioifY the - ' " - "-' _ .. _ _ _. .L. . . _
.ccupma of the icquiomnenet which mud be and prior m issuance of a Cerifcao of
Occupancy. "t ' - Signature of Applicant Date
3a�
>-, n n, a 'a ant •- . D a' All roof coverings to be Class"B"orbetter • "
OFFICE. .- . . . . ... _ . .. ._..- ..... - -_..