00070172 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PP thl
19191 VALLCO PY PEACOCK CONSTRUCTI of Mb 000701.72
OWNER'S NAME: APPLICATIONS IIArt
COMMERCE ONE 3421. GOLDEN GATE W Y �1�/2E/2000
PHONE: SANITARY NO. CON-TRO1.NO.
(925) 283-4550
In \HCHI'fLCT/IiNGIN1ir;R: BUILDING PEI1MIl'INPIIBt.FG ELECT' PLUME MF.CII
LICIiNSEU C(INTRACI'OR'S DECLARATION 1 nnaffiJob Descnp[ion
itWt r7rNpnision3nflhcBu.incssundPrnfeminn.GWe.anJmylicense 2ND FLOOR/TI 65000 SG!. FT.
n full Ibrmuudellku. 1.,mne Class Lia.nUde S I)I;CI.A ors hill he'1"S .,Publicrec N
gg� 1 understand my plans shall he uuJ as Public record.
wa p O Licenvcd pode"ourol
OWNER-BUILDER DECLARATION
uu,,=m I lean by aero..that I atn excn,pt Orion the Contractor's Liecrvc Law for the
F>< following reason.(Section 7031.5,limina%and 1'mrrcsslons Code:Any city or county
P S C which requires n permit to construct,alter,improve,demolish,or repair any structuret Po prionuils lxsmnuc,uI.a....it due uppli,ar,bar such retail a ti le a signed smlcmmnt
3— that he is licensed pursuant to the provision of the Contrll Ucen.0 l.aw(Chapter 4
faninmcnc y ing with Section 7(XXe of Divi.inn 3 of the Business and Prol'ew9ons Calc) Sq. PI. PIOOf Area s �3�.1`�n000
of that he is exempt therctasi
' an
rntn d the hv for the alleged csumptioa Any violatl�n, ],�11Q
of Section 7031.5 by oily applicatn fill a permit suhlens the applicant to o civil litany
at a a man eve hunthnl dnBam(a504)). APN Number Occup: cy pe
01.us ow netonmyemp
hepropenyormployceswithwagesastheirsolecoencation. 31Es20074. 0101 '
ll do h k a I Itic lorrour I,rol rOrd,d or alfald I (Sac.7044, -
B ,mr dl ,r..' Carle:The Contractor',Lictato,Uw doe, it, pply1.an Required Inspections
rproperty Who builds inquovestn d who doessuch workn ,alf 101 — FOUNDATION
oil....611 Ily p"d lint t t , noundcali,
urea(or-le.If.looleca. he lain r. p t' .. IJ withinyear of 102 — PIERS
,plt ,h c h haveIJ row 11 he the b Jen of proving that M1e did not build or
,nprt r p In. (sal I 103 — UFER
01 of setr Iy conucoil,withl : 1 ut t ,t, 104 — REBAR G
mnw aah P i b7lua d 1 I .. il' Jou Contractors
=en 1 does fp n na'IJ. n tn
105 — ANCHOR BOLTS
cold who son:uv losell pmttus with a<,ouruur(s) licensed Pnuu t I,, he
Landlaw. 10E — SEWER 8 WATER
0[aorstarlit anger see .B&rc rot this maon /p/
owner late 21012 — UNDERFLOOR PLUMBING
Q
'O3 — I_INDERFI_OOR MECHANICAL_ /O
WORKER'S C(IDfYENSATION U[CLARAI'ION ,'
t hereby alrrtounder Penalty ofperuryone arThe following declarations: 204 -- UNDERFLOOR FRAME
0 1 have and will mamntm a Cleittificae of Consent m xell.msare but workers205 — UNDERFLOOR INSULATION
CoorPro,o le. as prowded far by Section 37W or he latbor Code. for he .
perfilran„ onhewodlotMuchthi,.pern,in.issued, 301 — ROUGH PLUMBING
0Iha.eand will,nurionWorker'.,Compenaionln,urance,nmquiredbySectiun 302 — TUB & OR SHOWER
3700 of the Lalan Code.for the performttna,lot the work rolual, his 10,,,0 i, 303 — ROUGH MECHANICAL
issued.My Work= Compensation Insurance carrier and Policy numhcr are:
arrier:.�aVy Q_Policy Na, W—mlito%13_r� 304 — ROUGH ELECTRICAL
CERTIF XrlON op ExHMPuON FROM WORKERS 305 — FRAME
COMPENSATION INSURANCE
rrhix-clion Decd nt be enmpl<aed if the pcm,it is froane hundred dollars 306 — HOLDOWNS
6lrnu ale,,.) 307 — INSULATION
I cattily that in the perform:mce of the work lot which this permit i,i—od.1 308 — SHEET ROCK
shall not nnploy any person In any tnunecr so zee he"aa,sah,cct to the Worker`
Compen,adon fcarre Date _mss.op 309 —' EXTERIOR LATH
ApMieem ��� - -
NOfICIiTO Pl.lceN bfig" 'i'enirealenfexe,nlm„a,You,notdd 310 — INTERIOR LATH
Becomesubject to the W star,Compensation provisions of the tassel Code,you must '
pG rormwhhcmaplywm,sachPros iion.„rIlk perotashall nedetailed raookm. 311. — SCRATCH COAT
F 0”) CONSTRUCr10N[.END]LNG AGE NCY 313 — ROOF NAIL
:5I hereby allir that`hare isa cunswth
annn lending agency far e pedornal-, —
oftheworkrorwmbchthispnmitisissued(See.3(n7.Ci.'.C.) 501 FINAL ELECTRICAL ENERGY
i ❑ '`td``Addle 502 — FINAL PLUMBING ENERGY
I.andeh S4 Ic
UO 1'eniry11,4,1hav,—d his apps=atiotti ddammmOne aboveWit...oil „i, 503 — FINAL MECHANICAL ENERGY
Li. F enne=t.1 agree to comply with at]city and county nrdiennee,and date law,relating 504 — F I NAI_ BUILDING ENERGY
C U to building consweion.and herebyauthoriae representatives ufrhi,city menter upon
me above-tncelied proparty lot o....loon pto peso. 505 —' FINAL_ ELECTRICAL
F., a
We)agree to vase.indemnify and keep harmless the City or Cupertino again -
m babilaics.iodgtntnt,,cost,and expense,winch may in any way acama again".aid 506 — GAS TEST
U Z City in cnnscyucnct•ill the granting of t his permit.
CANTDNDER$l'ANDS AND WILL COMPLY'WITH ALL"O/O/,,.iwlrw' Issued by:
507 — FINRL PLUMBINGDaIe
.OUR(j.1Qy,l1I.ATlOy✓f� _ _ QJ �O \ ,
..,
'ignawre nf���nppncanuc((o��n��i dor (� Da
Re-roofs
unzngoous Mn'nlRlnls Dlgrlosugr: 509 — FINAL GRADE
WSn ma apphem,t or mtnre Nwdmg rccopant store of handle h...w,u,material Type of Roof
a,dcfineal,ythcCupenmoMunicipalCode.Chapter9.lzandtheucalmandSafety 510 — FINAL_ PLANNING
Cale.Section 25532(0)"
Cve, 01so All roofs shall be fi131fected FrribNfdlan)RIJWlnj QJdiiUMISd"mg installed.
Will the apNicant or mum nuil,nngoceupant list,cyuipmcnt ardeol=n which If a roof is installed without first obtaining an inspection, 1 agree to remove
emu na:,moos cit eontom i.....a.defined by he Bay Arca nn Quality management
rn,tdee all new materials for inspection. Applicant understands and will comply with
❑Yea 0 N all non-point source regulations.
I Ill.read the huv.mdou,racial, equircucnt.under Clariba 6,95nt'One
..1iforniaHealth&Safety CWl.Sec,innn 255`15.25533and 25534.1 undeamnd that
I chuildingdocs not cuncntlyI,,W.a`arum,that it is my rcsp,msihibty tonotil ,he
capant the rcgmren,eyywI I must he mat prior to issuance of Can ifie c of
asap. /_ _/
/�/— oa Signature of Applicant Date
ncror authorized agent ate All roof coverings to be Class "13"or better