01080115CITYI DEIN DIaVISIONNOPERMIT
CONTRACTOR INFORMATION -
BUILDING ADDRESS:
PERMIT NO.
10889 S. BLANEY AVENUE
01080115
OWNER'S NAME:
ED LEE (SOGO BAKERY)
APPLICATION SDATE
08/23/2001
,HONE:
SANITARY NO. CONTROL NO.
zo ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
n
1_J I_I L .1 LJ
i LICENSED CONTRACTOR'S DECLARATION
I hereby affirm ma, l am licensed under provexurs of Chapter 9 (commencing
Job Description
Le , fir Sectien 7") of Division 3 office Business and Prolessions Code, and my license
TENANT IMPROVEMENT 2335 SQ.FT.
Lin full farce and effect. 1
IJ
icntse Class Lic. a
notm[
Date T �' D 7 r n _
G
ARCHITECT'S DECLARATION
4 I undemmrd mY plans shall be used ac p.hire records
Licensed Professional
OWNER-BUILDERfrom
I hereby affirm ohm 1 3m exempt from me C
he Col.,., Law for the
ssions o . Ary, c
a following reason. (Section 703 L5, Business and Professions Code. Any, city or county
o which requires permit mngmn. alcor, tit
m repay any swment
APR 0 8 2002 $170000
issuance. re
prion,,hrmaalso the applicant for
for su h Permits Lfile aicense ned
- --
arntoas
- math gted pSecti to the, row.' ,i of the Contractors 4 (Chapter9
Compactors Lawt9
(commencing insect Section 701 of Div 'sio 3 ftWBusiness and Professions Code
'p,
`, ].3.��p
✓ .S, �',:' �-x, Valuation
,
or that h thee( and thebast f the alleged eA p ton Any viola on
�
of Section 7031.5 by any applicant fora permit subjects the applicant, a civil ,malt,
of not more he. fivo hundred dollars ($500).
10 fI&N''8ftDAT I ON ^' Occupancy Type
01, as owner of the property, or my employees with wages as their sole compensation.
1 02 _
' will do the work. and the suueture is not intended .1 mill ned'for'sale (see: 70
'Business and Professions Code: The Contractors License Law does not apply to an
103 — UFER Required Inspections" • -
ons
w •r ofprapeny who builds or improves merry^, cad who does such work himself
or through employees, provided ' ,h t . uchimprovementsa e of re or
'
10 4 — REBAR
sa a.
cffircelomple f ' 1 If, how a th W have t e P o , oldhm ih year r
mampintan one owner by Idcr will have the burden of pnning that he del not builder
-- '-" H
- --'-' 105
1 0 5 - ANCHOR BOLTS
proveforparpaseorxalez106
— SEWER & WATER
❑ L as the propcny, am exclusively contracting wain rteensea comtmcmrsm
202.. _.=_.UNDERFLOOR...PLUMBING.............__..._____. - - -- ---
"'' •;''
construct theA r
Licenathe project (Sec. ]Doan Business and progeny
Lawdoes nh apply man ownerofpropemywhobu0dxoed
who b Code:) The Carlthere, ,
-' s
203 — UNDERFLOOR MECHANICAL
and who, pursustherton.
-. and.w d.n's Licca for -such h.pmjecu with.. contmcmr(s) licensed pursuant ,,sone:
commctorxuande ,
_.._
204 ---UNDERFLOOR— FRAME"--
See
' ❑IamexemPtunderSec. ;e&.PCfor this reason
205 — UNDERFLOOR'-LNSULA'TION
Date" '
3O1 — ROUGH PLUMBING
: WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
Inertnr aRrm uneer,pen.hy or.arlpry,one onhe mnow;ng a call man
303 — ROUGH MECHANICAL
I have and :vie maintain : Cenificae of consent to selr.imate for workers
Compensation, as provided for by section 3700 or the Labor Cade, for the
3 04 — ROUGH ELECTRICAL
perfonm ince of be work for whim this Peer�it is issued.
305 — FRAME
_ ❑ I nava and will maintain \Yorkers Compensation Insurance. as regnirtd by Section
3 06 — HOLDOWNS
3700 of the Labor Code, for the performance of the work for which this Permit is
issued, My workersComMwsoaooInsurancecarrier'andPolicy.remberare: "...
307 — INSULATION
`sou,t1s.. ...
o t PoEe,No. C 1/S6
_I. cc RnxEMPTIONFROMwoRRERS - '
1 .- '309 f— •EXTERIOR^ LATH
-.--- ,�, COMPENSATION INSURANCE".
'
3'10 = INTERIOR LATH :_ —--....—
f1'h e f n Aced not be completed ,f the Permits for "rte hundred dollar
.... ;...,
t' •' I
311 — SCRATCH COAT
..
.r "� 1 nrytn r' �h reconvenes, one k.ro ncnmspermit ' issued. I
, .. , ..... , 31.3..,.= "ROOF, NAI -L—, ---
nail t employ f nor o xtox<,me..nJe<tt mewprke
Comps , Lawsof r California. Dm
501 — FINAL ELECTRICAL''ENERGY
A,I t -
Ir a(takt g thisCen f t fExemption you should
-- -— NAL PLUMBING EN ERG
Y---NOTICEIOAPPLICAIT '
rthexemeW,kere x encre p 'innsofneLanorcodyou must:
'
503 — FINAL
ENERGYfo
o pry santslirm Permit Wa res ked
_.
..
5FINAL. BUILDINGENERGY
i
chat
he ny offrm th o oherc a cnnnom , od d tagency m
fo
_-._CONSTRUTIONLENDIhGAGNCY
-Di1
505 - FINAL ELECTRICAL
OrmeCi,
pkr, ncnmt permit suealsec 309] .c) •-'"
-. LL-.•
506 — GAS TEST
p' Lends s Niece ...'-+ .., _ .. a.. r. -._
Lemdpr. Aad e.
.. _ __.._.— ._ _ _
507 — FINAL PLUMBING.
neem that d this unificationandslatemama above information vs
508 — FINAL MECHANICAL
coven I g oo<o Ply th by in anticountyod' ores osis la la lain
I to building or, t tonadh by monze p se t ex ,fon to
509 — FINAL GRADE I
city enter sign,
n
me ab ,,money property for inspection p pose,.,.
(We) a, t save demhfy and keep M1u ri S the City of C again.
510 — FINAL PLANNING
pcn
ba'i't i.Qgm a, cot a,w e x s wn ch r n ^^r w r <againstsaid
514 — FINAL PUB I C WORKS
City in q fish g n nB fthiiP t ^-
1PPE1
/'
I
G\D .R TAh DS AID HILL COMP WITH ALL, NON INT
/,--
I
Issued by: d Z
�A 5xc,
Date
Signature of Appucanticommct,r . ("' ,•' '_ •, . - ,//Date'''..
' HAZARDOUS MATERIALS DISCLOSURE ' -
'
e -roofs /
,t..' WII the applicantior f hae building occupant pore or handle hLecrOms material
Type of Roof
as defined by the Cupertino Municipal Code Chapter 9.12. and the Healtn and safety
Code sero on 2553 I 1
. _ _ _
:
ir
Will 'pm
_All roofs shall be inspected prior to any roofing material, being installed.
. th peel c t r , Ii g by t p t e a a x wh en
'th N norm n fn db)Ili ByArc ArOvaIlY M1I gement
If a roof is installed without first obtaining an inspection, �I'agree to Yemove
''" ,, .( _
oY
all new materials for inspection. Applicant understands and comply,with
"all
'
will
non -point source regulations.,,
.
'I h e atl,me hhzallou t tx
C.]ifomtHealt Safety Code Sectmns2550525533 and 1353Jnl undcrvandf,hat
'tithe bo!ofll I does not cunentl have .anathatitis mymsiosmihilityt,muify ohe
'•met
dc'edWm of the re9uirtma i Prior it. issuance of a Cmifcat of-
aacy
_ - - (
Signature of ApplicantDate
All roof coverings to be Class "B" or better
o„ ucr uaori=.egaaem- " ,.;a:', Da