00120125 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
10122 BANDLEY DRIVE 00120125
OWNER'S NAME: APPLICATION SUB DATE
WANG 12/19/2000
'HONE: _ SANITARY NO. CONTROL NO.
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a ce a ARCHITECT/ENGINEER: BUILDING PERMIT INFO
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LICENSED CONTRACTOR'S DECLARATION
z N - Job Descri tion
1 hereby affirm Nat I am licensed under provisions of Chapter 9(commencing p
FwF-3 ,.with Section 70001 of Division 3 ofine Business and Professions Code,and my license REMODEL SUPERMARKET
¢m pIs ce full(OK<a0 t
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8. License C ac Lit, a C
I-LL O Date Z�} Contractor V¢__
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ARCHITECT'S DECLARATION /
I- , 1 understand my pli m shall be used as public records
se
or p O Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
t < following rcawn.(Section 7031.5,Business and Professions Code Any city or county $3 0 0 0 0 0
Exp
which reg Permit t n tract alter. p demolish,o paes
r any same
i3 m
Point In is isluainc.rill.naiminislibePplcam finstishp ' t fl aign<dsmtemrnt
'hat b< flicensed function to thprovisions ofthe Contractors License L' (Dander9 C
(cum oe Y With Sect 70-80 of Division 3 of the Businessand Professions _Code) ; ;.,, r''3 2�3it ftro a'.''? "t,1 ( Valuation
mr` y
or that he is exempt therefrom and the basis for the allegfd ex=mpoon.Any violation - )
--ar Section 703 Ls by any applicant for a permit subjects the applicant to a civil penalty'
I of not more than five hundred dollars(S500). 101 APN FI6AT I ON Occupancy Type
r
❑1,as owner of the property,or my empluy=es,an wages as their cf,compensation.
will do the work,and the structure is not intended'or'offeredfor sale(Sec:'701 :
Business'aad'Proressiom Code:The Contractor's License law does not apply in an 103 - UFER Required Inspections' "
owner of property Who Wilds or improves thereon,and who does such work himself
arm .through n' n employees provided- -hat such improvements awi t intended or _ -_ 4"-.. _--_ - "' -- -_- .. . -._. .. ......_.. _._.
core er If,h th tiildngonmproofprovn Id m' ,t build 105 - ANCHOR BOLTS
inn Pletion,the owner bti(der will have the burden of proving that he did not buJd or •�
mproverorparpnseorsale.). 106 — SEWER & WATER
❑Las owner of the m n __ ___.._._..-_-
r P p= xam e.ewswety contracting with ficertsed contractors 202 — UNDERFLOOR PLUMBING
umama the Pmjeet(Sec.7tH4.Business and Proress,nns Cedes The Contractor's
s<nse law sues cat apply to an owner of property who builds Or improver thereon. 203 — UNDERFLOOR MECHANI CAL '.' .. t
.and who.contraau for sucb.projecmwim a.connections)licensed pursuant to the
eamt tnr ueenula —204 -=—UNDERFLOOR 'FRAME""— - 'of.. ' BPCfor this reason 205 — UNDERFLOOR"INSULATION
owner: " &D�td -8/IA1' � 301 - ROUGH PLUMBING
- OR MP_fAT10N DECLARATION 302 - TUB & OR SHOWER
IM1ereby alarm under nahr nr perj�.y doe once rnuowmg eeaamaons:" 303 - ROUGH MECHANICAL
..°C 1 navdand'will'maintain on ccidficateof Caawat to self-ms„re list worker's 3 04 — ROUGH ELECTRICAL
ompensation, as provided for by genian 3700 Or the labor Code. for the
_ 'cermrnandeann<wark{arwmm�miaperninsisaaed. 305 - FRAME
0 1 harocard willmmat Worker's Compensation Insurance, y dbysermn 306 - HOLDOWNS -
d700 1 theLothar Code,for the performanice of the work for which th's recruit is
sspd My cars- C p t nInsurance, r dPol y bet -e 307 INSULATION
' c4LDEALrA61� :PnryNn..�W( 31`�43$'�� ,. 30.8' 1-_SHEETROCK_ .
;CERTIFICATION OF EXEMPTION FRON.w ORKERS;, 3091 )—'COMPENSATIONEXTERIOR LATH ,
,INSURANCE, ... . . ...
310-;,-,-INTERIOR--LATH _
(This act on need not he completed if athe permit is for one hundred dollar
leolmlesa.l _ 311. — SCRATCH COAT
coml adeps I�aw.ynf cm r at a,oaten t - _ . ......,..31.3..__".ROOF
r pent nn - kr n nm pe 't . ..aa 1 501 FINAL ELECTRICAL"ENERGY
:w h<co rte b)eu nr me WO k're '
Apple n' — -" -- —502" " FINAL PLUMBING-"ENERGY " --
NOTICETOAPPLICANrk
�O_h becomes tJoe
mws knPr cma makrrtmga tn provisions
o otsfnant fnOm=fdEe
Labor
anpdt Cod,
nd Ykere-.armost
d
503 — FINAL MECHANICAL ENERGY
0mrtn many,,
Z _ 504. FINAL _BUILDING_.ENERGY.
CONSTRUCTION LENDING A 505 FINAL ELECTRICAL .> Ili ty Hrmmttninsis- a< t leash,agency fm pee �a ..
or yA ' L ,e work lien_ ce tats \097Gv.c) ...._ " 506 - GAS TEST
cenlrsAl . .. 507 - 'FINAL PLUMBING.', .,
Icit In.,Ibase reaaffikii liciliort ad natisdamm,alimeinformation is 508 - FINAL MECHANICAL
E., cortin.1 agree to comply with SB city and county ordinances and state laws relining 509 - FINAL GRADE
:mbuild)ng constmcnlon.end herehy nuthdrireon,nsventmivetnnhii city to enrer neon
`.,y y :meals.'s-me urroOdpmpso,forinspect 0Pu,.N, 510 — FINAL PLANNING
:F.,Os (We)agree_save.-indemnify and keep harmleu the City of Curcio against
m namlmea.jndgmnts.cast,ameapn swhich may many ay ero5agamaton 514 — FINAL PUBLIC WORKS
V Z Ciey ace of th grand g of this ptrm k; `
jxgL?
CAR'1'UNDERST \\ITm Lf\1P wires Al:[lvoly-Pol.�f' 7O1 - ADMINISTRATIVE
OURCE UNDEI S ISSUed Oy: Date
n to fAppl HA US hIATE Date Re-roofs
nU _rut RIALS S SURE .
wntn , -Roof- ..,� ...
asd f db th C Fac 2'.h lath M1eaMo y yp .. _ .--..._.._ ._..
app win ft rcWld Type
y Pero o M etpel Cod Cna 9 13 and the Health d Safer ,
Coca Section 25532m)? _.t -
�Y El No
All roofs shall be mspected.prior to.any_ioofing material being.installed._-_.__.._
ion me appfi�� tar ratnrc wua'eg«<nvant ns=<9nip tot or devices which, If a roof is installed without first obtaining an inspection I Sgree'to'remove
enithazardousit contaminants as deed by theBay Area Air Quality Manage n
D,onth? ' 11 No , -- all new materials.for inspection._Applicant understands and will comply with
. '
- ; * -, all non-point source regulations:. -
1 hr,dread'the hazard k.mrdomajs reyuiremcnrs under Chapter 6.95 or me. -
C5fifomia Health&Safe,,Cade:Sections 25505.25533 an J 35533.Punderxo mat
,;.if then Idong J not tly It a ren t to 1' y ncv,.hsimi Loy machily the
dccupa t of the un met io usuanm of.Certin2me of
m Ontario
Signature-of Applicant _
_ . . Date
Owner nmrae agentmt= All roof coverings to be Class "B"or better, "