05060229 CITY OFCUPERTINO `-� ;7a X �^ ` "
BUILDING DIVISION PERMIT ,CONTRACTOR,INFORMATION ,t
BUILDING ADDRESS: B & J SPECIALTIES IERMITNO05060229
AsR979 STEVENS
'R'S NAME: PERMIT ISSUE DATE
PINN BROS 714 BLOSSOM HILL 06/30/2005
PHONE: SANITARY NO. CONTROL NO.
(408) 225-9992
ARCHITEC(ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
�Op LICENSED CONTRACTOR'S DECLARATION O O O O
w 1 kohy affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
�zw with Sutian70110)of Division3ofthe Busilrssar ofcWom Code aMmylicenxis
"o tr', in mu more me afhct. DS'/ 73 TI--OFFICES/KIT. /WIRE/LITS &
��Z Liccnx Cl a Lic.N
of a Dam Co.lraevo Ee,q DRYWALL/CARPET
Oti ARCHITECTS DECLARATION
I_1 1 understand my plans shall be need as public records
a
3 G Licensed Pmfcssional
5 OWNER-BUILDER DECLARATION
I bumby affirm that I am exempt form Ne Contractors Liccnx Law for the
following mason.(Section 71131.5,Business and Professions Code:Any eicy car county
5$ which inquints•permit to e..I,eller,improve,demolish,os rural,any s"Ilme
pear Or its issuartce.alcurequires thcapplicam fornuch permitmliilc asigned statement
pF� Maroc islicenxdpusxanlm the prontonesof Ne Cantracmrs License law(Chapmr9 Sq. Ft. Floor Area Valu$*3a000
y $ (commencing with Section 7000)of Division3 car Ne Businessand Profmonm GMe)or
?L that he is exempt thcmfrom and Ne basis for the aileged exemption.Any violation of
Section 7031.5 by any applicant far a permit subjects the applicant to a civil penalty of APN Number Occupancy
ant max man five hundred dollars($SM). 31621029 . 00 Type
E]1,Is nerof Eh.property,or my employees wire wages u Mahle compensation.
will do the work,and the structure is not intended or offered for]tic(Sec.7Dw,Business
and Professions Cade:The Contractors License Law cam not appy m an awnu of Required Inspections
property who builds or i m prow thereon,and who docs such work himself car lluouoh his
awn employees,provided thatsuch improvements am notimandc l aroRexd forsale.IL
however.me building or improwmenl is sold within one year of completion,the owner-
builder will love the burden of porving mat he did rot Wild or improve for purpose of
xl.j.
❑1,as owner of ct property.am a mess and
contracting wire licensed contractors i.
ecoseLconstruct the project(Sec.a nn,Business and rty who
Cade:)The ex tatmon, rad
cense Law does not apply c an tomer of porpeny who Wilds or imPmw thereon,and
who contracts for such projects with a contrutor(s)licensed pursuant to Jac Conlnetors
Liccnx Law. ✓///
am exempt under Sec ,B&PC fu Wsreason
Data
O/
WORKER'S COMPENSATION DECLARATION
1 herby affirm under pemity of perjury arc of the following declarations:
❑I haw and will maintain a CardOcamaf Consomm self-hourmforworkcr'sCompen-
Wmb,as provmed for by Section 3700 of the labor Code,for the performance of Ne
work for which this permit is issued.
❑1 have atm will munoin Workers Compensation Imuanx.as,required by Section
3700 of me labor Code,for the performance of the work for which this faboul is issued.
My Workers Compensation Insurance caner and Policy number are:
Cartier. Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(roussnction reed not be Completed Ifthe permit isforonc hundred dollars(SIM)
or lees.)
I century that in the performance of the work far which this permit is issued,1 shall not
employ any person in any Man ngssn}sJa he��sybjeel to th Worken•Compemation
Iawsaf Calif ia.Data Com lO y
Applicant �r•ar��.ai aThr 79 o
NOTICE TO APPLICANT:If.of itsg ~sC i c of million,you should
become subject m the Workers isio ado,you must
.J O forthwith comply with such prnvisions u this Permit shall h me-d invo
deeked.
Z(7 CONSTRUCTION LENDING AGENCY
[-+ I herehy aRrm that marc iso comtmctinn lcndinil,cncy for the perfo..0.of
ai^ the work fur which this permit is issued(Sec.3097.Civ.C.)
Glenders Name
n7 z Lender's Address
U Q 1 certify that 1 ban mad this application and state that me above information u
O U cosecs I come a comply with All city and county ordinances and sum laws relating e
OU Wilding CmiOncd iomaM bembyauNouaempmaenmiw of Nis City mcninr upon lh
W ahovcmee)agree roNnyto
for indmnify an keep to
(y
(We)age Io fast,indemnify and keep hay in an NC City of Cupertino id City
Zlyi in Cr ioes.planc Of
osts andall expemesmit. may in any way acerae agaimtsud City /
[.7 z A Consequence of the granting of mea permit.
^ APPLIC N'T UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU REGJILAT NS.
L///1�3��
TRe-roofs
Stgnazum of ApphcanUContsacmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will th applicant or future Wilding occupant Rare or handle hsrasdous mamuaf
find by the Cupertino Municipal Code.Chapter 9.12,W Me Health and Safety
@r
Scctiea 23532(x)7 All roofs shall be inspected prior to an roofing material beim
❑Yea �tqu P p y g being installed.
If a roof is installed without first obtaining inspection,I
Will Ne applicant or forum building oceupam sex equipment or devices which g an agree to remove P
emit havardous air contaminants as defined by Ne Bay Area Air Quality Management all new materials for inspection.
District? v P
❑Yes �Nc
I have mad the hvardtmsmaseuals inquirements anter Chapterb.95of the Califor-
me HcnWth SafctyCodc,ScNmn 25505.25533 and 25530.1 tau lerstand thatifdte Wilding
does nor Connolly haw a Imam.that it u my nesponslnillty m notify do,meupant of th
mquim�ytswh hmrath orm' unmeoraceniReawnfoc qs Signature of Applicant Date
Owner or authorized agent / D,m All roof coverings to be Class "B"or better