02070025 (2) UP
CI nut OF
C nt ERTTINO CONTRACTOR INFORMATION:
ISION PERMIT
F
ILDING ADDRESS: PERMIT NO
20300 STEVENS CREEK BLVD HOWARD WRIGHT CONSTRUCTION 00. 02070025
•NSf� ' TEE CORPATION (3RD. FL E) PIER 9, THE EMBARCADERO # 1PtICATI`V'J6'T/2002
PHONE: (206) 447-7672 SANITARY NO. CONTROL NO.
C s i ARCHITECTIENGINEER: BUILDING PERMIT INFO
C BLDG ELECT PLUMB MECH
�Q,nU IJ I_7 C.:J L:I
y Z LICENSED CONTRACTOR'S DECLARATION ��h �ENTP
i w o I hereby aRrm that T am licensed una<r provisions of Chapter 9lcommcncing TENANT IMPROVEMsc NA Le®
;ort-; with Section 7010)of Division 3 of he Entine,,and Pnrfe.laws Code.and my license
is in full tame and effect. Q49 AUG 2
Om z a License Class /L Lir.x
u U Dale '�1 y'� Contracmr O 9
Ia G h ARCHITECT'S DDIEARTION e,0
S - I un R rid plany5pall be uKd aa ¢rnrda
s r 1 BUILDING
i
ax ca O Licensed Prtd' attln:
=Pt OWNER,BUILDER DECLARATION
1 hasto.(ruin that I an,exempt s of he e"kncmrt :Aeme Law for the $108713
t. followingreason.(Ballon 1onstruBusinns and Professions Ca le:Any city errcounty
o which "1itrequires n permit to construct,altar.improve,demolish,or ensu any mmctue
ac pnu11.ifi,iauonec.Wm requires the applicant forsuch pern,inn Elmi signed smemem
a3 — Na he is licensed punuant m the provisions of the Contractors Liam Law(Chapter 9 _
(Commencing with Sect too 7tl()0)of Division 3of,hc Bpsinesa and Professions Cede) a�3 ]91fk�Jf]tI3�Afk®;:at[ 1.4,� . Valuation
or thm fie I,exempt therefrmn and the basis I'm the wlegalexemption.Any violation
of Section 9031.5 by any applicant for a Permit subjects the applicant to a civil penalty
of not more than five hundred dollar,(s500). 10APN-NU MNDAT I ON Occupancy Type
❑h as owner of property.or my employers with wage,as their sale compensation. 102 - PIERS
will do the%ork,and we'.arocime is not intended or offered for sale(sec.7641. 103 - UFER Required Inspections
'
Business and Professions Cale:The CwrmO is License Law does not apply to an q p
Owner of properly NTa builds or improves thereon,and who does such work himself 104 - REBAR
or tlueugh n,own employees,provided char such improvements we nm intended w
"l offered for sale.If.hdwever,the building or improvement is sold within one year of 105 — ANCHOR BOLTS
ioinpinion.the ownerbuilder will havetha burden afpmvingthat he did oat build or 106 — SEWER & WATER
mprove rorpmpntanf,alo).
- 202 - UNDERFLOOR -PLUMBING -' - - '
' ❑1•a,owner erratic pmpeny,om exclusively it Procting with Ecc:)The mmcmrs to
Uammetthe project(sec.7to a.Owner o property
whops caroti Thecnmrama„ 203 - UNDERFLOOR MECHANICAL,
andwho
law trra oat apply to an owner of a contr who bullas or improves thereon.
and wba 's Livens for such projects with a eommmoa,)licensed pursuant to to 204 UNDERFLOOR -FRAME -
Can
e Law.
pl wo ...p.under Ser. .B At P C farthis reason 205 — .UNDERFLOOR INSULATION
Data 301 — ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
�ne Ihereby anion under Penalty ofPerjury one othe following declarations. 303 - ROUGH MECHANICAL
❑ I have and will maintain a CeniRcam of Consent In telrnsum for workers 3 04 — ROUGH ELECTRICAL
Compensation. au provided for by Section 37W of the Labor Care, for the 305 - FRAME
performance of the work for which this permit is issued.
❑Ihave and willmainta wpror a Compe f Insurance.as"wred by Section 306 - 'HOLDOWNS
3700 of he Lifirw Cede ra me pctrorma e r m k ter which this permit is 3 07 - INSULATION
issue Myw kr'sCampeet'onlsurum c lea pulicyrimerrme D 308 — SHEETROCK '
N�C.Z(pG /U-D 3 / �/ 309 "1 EXTERIOR�'•LATH-
CERTI CAT�6 IOC OF E%EMYTION FROM'WORKERS'•
COMPENSATION INSURANCE '" '.' i . .. _ ._..31.p-----INTERIOR .LATH -- -- ------ ---- -- -- - ----- --__ -
mas section nein not be completed if the Permit is for one hundred dollars 311' — SCRATCH COAT
S[Offimlett') , 313 —. ROOF ..NAIL...
I dcnify that in the per"nown,of the work for"Mall this permit is issued,1 501 - FINAL ELECTRICAL ENERGY
shall'no""_
ot employ any pars-`in any manner so as to became subject m the Works_
call no"tian laws m"'Idrmm."ra 502 — FINAL PLUMBING ENERGY
NOTicant
ICETO APPLICANI:IL a per making this Cenificamof Exemption.youshould 503 — FINAL MECHANICAL 'ENERGY
Z become mhjm to the Worker's Compcnsaion previsions ofine Labor Code.you mus,
O fmWithcomply with such revisions orthis parmit shall bedeemed revoked. 504 _ FINAL BUILDING ENERGY
h t
CONSTRUCTION LENDING AGENCY 505 FINAL ELECTRICAL
I herebyn m.that there is commuctionlendin Cane for the Performance
?, of the workOTwhich this spenntisisaued(Sec q.1097,CN.Cj.
IemillxNamd 506 - GAS TEST "
y o - 507 — FINAL PLUMBING "
U z Lanae.,Address 508 — FINAL MECHANICAL
1 cm;fy ohm 1 have rand this apphi atimi dna state that the above informal. is 509 — FINAL GRADE
s canner 1 agree to comply with all city and county mdlnuncr,end sone laws relatngi
O r, mbuilding emanuclion.and hereby aut tionno aprcsemutivesofthis only In.(wupon 510 — FINAL PLANNING
y the above-memmaed property for inspection purposes.
E„C y (We)dgr¢esave,indemnify and keep harmless the Cu,of Cuverlmo agmnst 514 — FINAL PUBLIC WORKS
h liabilities,judgments,costs and expenses which may in any way acente against said
V z Cit a of the gaming of this permit. r
PLICA TU. ERSTANDSANDIVILLCOMPLYWITH'ALL "ON-POINT Issued b r Date v
r SOIL E F 10'S: qq y'
I , 7.3 -0
si wtn ,f ApplicanVContmmm " :Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
• Will the applicant or future building Occupant stow or handle Bazvaom material Type of Roof
as defined by the Cupertino Mumci Code,Chapter 9.12,and the Health and Safety
Code.Section 25532(al', -- - •, "' '
°Yea Xll_roofs shall be inspected prior to afiy-roofing material being installed.
Will he.,]loan,err rut lidia,Occupant a,e aquipmcnt or desias which If a roof is installed without first obtaining an inspection, I agree to remove
h hamrdons an conmminuy .R.edbythe Bay Area Air Quality Management
D1,ihr,? '�\ all new materials for inspection. Applicant understands and will comply with
1!1.-;
DY`s J "o, all non-point source regulations.
I avread Ne hazardous materials requirements under Chapter 6.95 of the
Cairo � th&Safety Code;Semlone 25505.25533 and 25534.I understand that
eing da of currently have a tenant,that it is my responsibility to notify the
occup t of the req re U"Mich must be met poor to issuance of a Candia¢of
°""0 Signature of Applicant Date
..
451r All roof coverings to be Class"B"or better
•„ _ - OFFICE