02050046CITYt OF
c m ESSION PERMIT
CONTRACTOR
INFORMATION:
BUILDING ADDRESS:
PERMIT N0,
19333 VALLCO PKWY
02050046
OWNER'S NAME:
APPLICATION SUB DATE
COMPAQ (1ST FL.)
05/08/2002
PHONE:
SANITARY NO. CONTROL NO,
ARCHITUCTMNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LLD 't L_j
LICENSED CONTRACT'OR'S DECLARATION
Job Description
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000)of Division 3 of via Business and Professions, Crdc, and my license
TI --CEILING REPAIR
is in fall farm and effect.
Lic<nx Clazs Lic.4
Data Craormor
ARCHITECT 5 DECLARATION
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19 r: ten m an sha be used as pub is rtcorda
3 0 2002
Licensedmfe.ional
ON;NER-BUILDER DECLARATION
JUL
1 hereby affirm that I am exempt from the Couturim's License Law for the
following reason. (Section 7031.5. Business and Potasslom Code. Any city or county
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which requires a permit m construct. alma improve, demolish, m repair any svunum
prior tons issuance, alw require, the applicant ❑a such permit to File a iignad am¢mem
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F ` i• i-3 1-,p 1b 9, 9 !•--dit A, I:Y+ �. ?.v -•
Valuation
that misli.dvm'suanimthe piaisionsof the Commnol, License Law (Chapter 9
(commencing whh Section 7000) of Division 3 of the Business land Professions Code)
or that he is exempt therefrom and the basis for the allZged uemptibn. Any violation
..,
-'
- of Section 7031.5 by any applicant for o permit subjects the applicam to a civil penahy
:or not more than five hundred dollars (5500k
101-PN-PT)UNDATION
Occupancy. Type
O I, as owner of Nc property, or my employees with wages as their sole compensation.
will do the work: and the structure is not intended "or"offered for sale (Sec. 7044,
Business and Professions Code: The Contractor'a License law does not apply m an
103 -
UFER Required Inspections
owner of property who builds or improve, thereon, and who does such work himself
nil intended
improvementstisso
104 —
REBAR
orthrough own employees, provided that such not or
m tned for within
- unam rot ,ale: If, However. he building - ..tis sats annm d�e-ta� nr
y
gorhnen
. __..- .— . _ .._ --
105
...-.- ..
ANCHOR BOLTS '• ' '•
the owner -builder will have the burden of proving that he did not build or
completion.of pro
-
•
iompinion,
mprove fmpmpnxur,ale.),
106 -
SEWER & WATER
_. - .. _ _. .._.. .- contractors.--
"onsuertter avec p(Scr.7.am exauslvdycontrocssions nhaenxaeCarrrn
--
202 —
" - - .-..
UNDERFLOOR PLUMBING
e
et the project Iappl Ito a, Busies pimand Professions who
consumer law encs not applyman owner arpmperty suns buses or improves Hereon.
License illsCosor The Co thereon.
203 -
UNDERFLOOR MECHANICAL— '
and who convects. for -such projects wiN.o commemfp) licensed. purouent.m Ne
.. ..
204 -=
'
UNDERFLOOR FRAME
Commetor'sLicenseLaw .,.
O l am esempt under Sec .B& P C for this reason
205 -
UNDERFLOOR 'INSULATION
''safe
301 -
ROUGH PLUMBING
'owner
WORKER'S COMPENSATION DECLARATION
302 -
TUB & OR SHOWER
I hereby affirm under panabty tar Parjury one none mlmwmg dedmitinns:
303 —
ROUGH MECHANICAL
❑ I have and will maintain a Certificate or Convert to self -insure for Worker's
304 -
ROUGH ELECTRICAL
Compensation, as,�pruvided for by Section 3780 of the Labor Code, for the
performance of Ne work for which,hi, permit is issued.
305 -
FRAME
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
306 -
HOLDOWNS
3700 of the Lalwr Code, for the perfotr ie of the work for which this permit is
307 —
INSULATION
issued: My Worker's Compensation Insurance carriu and Policy number are:.
-
cam. I f ``I' Policy No.:
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SHEETROCK.... •.•il.' t
CERTIFICATION OF EXEMPTION FROM W pRKegsi+=
t3a0t8r:=,[
.I 309-`-
EXTERIOR'•LATH-
COMPBNSAOON INSURANCE-
_
310a =`•:INTERIOR"liATH
r,:;r,.•: `i`
ffhis seaiori neeJ not the completed if the permit is for one hundred dollars
311
r3
SCRATCH COAT'
Isloo)orie,s.)
-
I rtryNtlnN per unnew kr ti nm pe t aI
- 313 -
_._. -..-
ROOF --NAIL
nn empl y yPcalr a �W�QeZ tt N w kers
501 -
FINAL ELECTRICAL ENERGY
Com
502-._-F-INAL
-PLUM BING ENERGY - - - —
IceTo Amer- e�fiF-e t s N s cel n cat I E pt yap .n uIp
esub3cnmNCWorkcriCompcnsauonpronsonsofNclaWr Code. you must
503 -
FINAL MECHANICAL ENERGY
NwimenmplywiNsuenprnvidunsurtmspemr.naen aeemea vukea.
504._-.
FINAL -._BUILDING ENERGY.._ .. ... .
' "CONSTRUCTION LENDING AGENCY -
505 —
FINAL ELECTRICALof
1 her this there lending agency for Ne petfomtance
issued
.. ..
thefor which isRron
a workforwhich this perms is issued l5e<. 31.7, Civ.. " ,
S O 6 —
GAS TEST
Lender's Name. _. �.. .....�.. _. ..... _. _.__b
Len
1-endersAddress
—__ ..
507 -
_.. PLUMBING __._—.... _
FINAL PLUMBING
1 certify Nm I nave. reed Ni, application and smm that the above information is
508 -
FINAL MECHANICAL
Correct. 1 agree to comply with AI city and county, ordinances and state laws missing
509 —
FINAL GRADE
to building construction. and hereby authorize representatives of Nis city to enter upon
the above-mentioned property for inspection purposes.,
510 —
FINAL PLANNING
(We) agree to save, indemnify and keep harmless the City of Cupedin6 against
liabilities, judgmems. costs n s nus which may in any way accme agunst said
C'nj in consequence of the gmneng o - n
"
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F I NA PU I C WORKS
APPLICAry7 UNDERSTANDS COMPLY WITH/yj„L. ]JON -POINT
f-
Issued by:
Dale v
SOURC' JLA IONS. S 2—
n are emr ate
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE '
-
'.. 'pp g sun . ectal
Will thea applicant or future Wilding cecu t store m handle harardoue met
Type of Roof
as defined by the Cupertino Municipal Coda, Chapter 9.12. mature Health and Safety
s "';
-
Curie Sec! n 25532(e) ..
qua ON .:�, :;. !" •f , ;
All roofs,shall be inspecte.d,prior to any. roof ng material being installed._
Will th applicanto fur Wilding nei pmt xcquiyme to devices which
Poor
If a roof is installed,
_ _
without first obtaining an inspection; I'agree.to remove
incumbents air contaminantsas defined by he Bay AreaA Quality Management
Dismct7
all new materials
for inspection. Applicant understands and will comply with
0ya . ❑Np
all non -point source regulations.. ,.
1 havc�tead the basd.al'odarn.H requircmarr' under Chapter 6.95 of he
califomia Heath & safety Code. Section, 25505, 25533 and 25534.,1 understand Nat
if the building Joe, but ammel7+ .1,muff that it is my respomibility to notify the
of Ne requirements wbit irior to issuance of it cmificme of
-
pactp'
Signature of Applicant Date
Al roof coverings to be Class "B" or better
=
- OFFICE