01050068 - CITY OF CUPERTINO - -
BUILDING DIVISION CONTRACTOR)INFORMATION Ell '
PERMIT
But LDING ADDRCSS: - pp
RMIT NO.
1012E BANDLEYrDR, � � 0105006'
OWNER'S NAME: APPLICATION SUB DA'1'li
MARINA FOODS — p5/p7/2pp]
I10NE:Is a • SANITARY NO. CON'T'ROL NO,
phi O❑❑O ANCHITEC'I'IIiNCINiiF.R: - BUILDING PERMIT INFO
,65 13LDG Fix= PI.Uh1B Mf:CH
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B'Z LICENSRD CONTRACTOR'S DWLARATION oescr
0 =z I hereby mina that l ]accused end,,p ns of Chapmr 9(,re ncl c ng liption '
1;•u�Cpw
with Sccto,
7000),,l D lhcB'conI lrn11 ,fesa+,sCJ"_,
mdny license
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ar
LoisChasLi,.a
GREASE-INTERCEPTOR- INSTy
ALLATI'ON.-
OS I aHIT17CTS D17CcrA7O
bcfee
undenlanA my PARC
in\shallbewadvap -
dos
O Wcmssed Pmluartrnml -
w o w se
OWNIiR-B1111.UEk DECLARATION
1 hereby affirm Ilial l:un exempt from the Canlmclor's License Law for the
C5¢$< dollnwing rca In.rseernn 7d31 s,B"macs,cad Protes,dnos CrNe:Any clay nr many
N M❑ wh sh q pe I t c t I Ileimpose.demolish. rep y gmnure
3 0 peri I t 1 rt4 Ili pili t f h M1 n t fie g d nulentem
lhmhe
I 1p II t.. Pocciliffirs el he Connector's License Low(Chlpter9 Sq. Ft.'F'IOOr:Area
Iso mg with Section 70t0dofUv" n3 fthe ficaul call f am,Cade) - 1• Valuation
or tm he is exempt therefrom and the bases fnr the Ellcgcd exemption.Any viullumin
of Section 7031.5 by any applicant for a Permit subject,the apP1'mam Inn civil penalty
'It nal mor than ave hnnared dmlam(S500) APN Number Occupancy Type
-
0 L ax owner ofthe property,or my etnPmyees wit wages as their sale compensation,
will du to work,and the snmdnt'1 is me imm�drd nr Ichn,I her ball(Sec.7044. "
B.'am s and Per ewinns code The Comment's License Lawdoes nut apply to an Required Inspections
orsof property Who builds(r improves thereon,and who dues such work himself
fir"ugh his own vanployeea,provided Thal such iinprovemenee are nnI imendul or
offered for sale.If,hnwever,the building of improvement is sold wilon one yew of �'��
completion,tito owner-baildenwill have IM1c hurden ofpmving that he did not build or L Ep
improve pnfuce or sale.).
❑I,of Owner of the properly,am exclusildy continuing with licensed contmctom to JUL
construct the Project(See.70W 1,Business and Professions Code)'Dae G,nt
he nmtms - C 9 9001 _
License law doe sfol TryIn adowtrer of Pmpany who bade,or improves thereon.' - J
and who contracts barsuch pmjects'w'Ith a eomrannr(s)licensed pursuant to to
Centimeters,license Law A 1
° mit exempt under Sec. - 11 A P C if,,this reason * .. BUILDING -
..Owner Dale .
WORKER'S COMI'I?NSKI'ION DI..CLARNTiON
IhercM1y affirm anter Pcnahy ofp itry(Inc of tefollowing dectarmacs: -
° I have and will mainmin a Ce"jficale al'Consent tat self-inms for Worker'
ork rmi
s
C..'rention, as provided for by Section 3700 of the Labor Code, for the
perfomence of the wfor which this pet i5 iasn at -
°1 have and will maintain Workei Compensation Insurance,as
required by Section -
3700 of the Labor Cole,for the performance of the work for which this permit is _
issued.My-Wyo�rk'e�r5's Clar"csation htaurmce carrier and Policy nut hit are:
Cmdclsc / N f tee, - Policy Na.: I� t� II �2—�
CERTI FICNI ION OF FAcm 1"11 PROM WOR KE-RS'
COMPENSA'T'ION INSURANCE `
(GTE,xemi"n need tan be completed it perndt is fulfill handled doll...
($100)'or leu.)
1 el"ify That in the pedlerma,ee of the work fur which this permit is issued,I
shall non employ any person In ally manner.an nuame
Ell ,be subject m to Workers' 1 -
Cnmpemaii es Laws of Calil'nrnia.Dale -
.
Applicant
NOG ICF TOA IEYE.ICA1 1 II 1❑ 1 f 11 1,Cerun,all )I_11sImpn7i you sli mrd -
Z hosonh th h) Ito theWorker',C alp sou nP - north,Lata Code.Yea I'll"I'll"f
0 ply wit,such p or'his pen'hall W dreared resellect. -
4 CONSG'RUCiION LENDING AGF-NCY "
I hereby affmt Ihat trm is a nntsuuclum lending agency fur the pedoorm nee -
W of the work for which this permit is issued(Sec.3097,Cih,CJ o.
Q Lender's Name
Z Lender's Address -
V I certify tat I have read This Implic'alimt mW alar tat Thr above infonnu(ion is ' -
CW sorted.1 agree m comply with Ell city and snarly unhnances and state laws mining -
) V to building constmction,and hereby umhorize representatives of this city to enter upon
+W the above-mentioned prnpery Ibr inspection Pnrpnses. "
[r 1t (We)agree to.snve.indemnify and keep harmless the City of Cupertino.'sinal _
V1 Iia les,judgn.at,.c Sts and expenses which may in any way accme against said '•�
y 'ANTU emeseT
a he granting D Wjs L COMPLY
O
'PI 'ANG'U t i'AN)SANDWILLCOMPLYKITHALLNON-PoINT . {•�
S) -REGLI T )NS ��� O.I Issued by: f -
Date
911111 fI A,,P I,I IsConoa"'"r -Dale Re-roofs `
HAZARDOUS MNERIAI S DISCLOSURE'
Will the applicant or nacre Wilding-1IPont Imre or handle monsoons material Type of Root
'a dclincd by t"Cldmn if.MunlcI'll Coca,Chapter 9.12,and le Health and Safcty
Code,Section 25532(a)?
❑res °"° All roofs shall be inspected prior to any roofing material being installed.
W111teapp16d..Im Wmre building fecupam me egnipmerl m deviseinspection,
which If a roof is installed without first obtainingan iection, 1 agree to remove
emit hazardous air enmaminanb as dclincd by the Bay Arta Air Quality Managemem
❑sea Ll P Applicant p -
Di"rieC7 all new materials for inspection. A lcant understands and will comply with
� '
all non-point source regulations.
1 broil read the hazardous materials rcynirements under Chapmr 6 9 of the
Calif a Health&Sltfery Cndq Sec,inna255(15,25533 and 25534,I mal...land that
ift -h ilding dce.m tryhavenlenant.tat it i.a my respmsibilirymnotifythe •'
up t of the it mems w must W tact proof m i's a Ccridcate of
f r mr, "
Signature of Applicant Date
net ..
mamnDate All roof coverings to be,Class "B" or better ,
OFFICE -