01120080 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10050 S DE ANZA 0 C MC DONALD CO INC 01120080
OWNER'S NAME: APPLICATION SUB DATE
KIMPTON HOTEL/RESTAURANT GRP 1150 W SAN CARLOS 12/20/2001
PHON@ SANITARY NO. CONTROL NO.
(408) 295-2182
O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
I-'m— BLDG ELECT PLUMB MECII
a
Nim u u u u
LICENSED CONTRACTOR'S DECLARATION
1 hereby firm that 1 atm lcemad under '' nal of Chapter 9leommenein Job Description
Q N_p Y^ Ppd Ppdg
p_ a wim5¢tion]WO)ofUivisionJofmcBusinessandProfessionsCoqJe, ndmylemxe PLUMBING PERMIT-138574 SQ FT
ay -a sin full forces t �,�/.`L/ ��7!'a� y
read Llceno,Ilan✓ -��sl'vj Lac. / 208850 LESS 70276 GARAGE
e'0 Da¢ Contractor
F a LLO� RCHITECr'S DECLARATION
I understand my plans shall he used as public records
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a.a p O Licensed Professional
OWNER-BUILDER DECLARATION
=It1 hereby Teflon that I am exempt from the Contractor's License Law for the
z a following reason.(Section 7031.5.Business and Proac,00ns Code.Any city or county
f F G which requires a peanut to construct,alter,improve,demolish,or repair any structure
ad
3 m prior w its issuatttt,also requires the applicant for such pamiuo file a signal statement
o. that he is licensed pursiimp to the pr9visionz of the Contractor's License Law(Chapter 9 r Sq. Ft. Floor Area a nation
hat mcncing with Section 7")of Division 3 of the Business and Pnefessions Code) ` O.s i li,r4''9 ' t, r k �' .1,�
or that he is exempt therefrom and the basis for the alleged estimation.Any violation e s -
-of Section7031.5 by any applicant fare permit sfbjcam the applicant tc a civil penell,
:of not more than file hundred dollars(SSW). umber Occupancy Type
[11,as owner of the property,or my employees with wages as India sole compensation,
will do the work.'and'the suucom,Is not intended or offered for sale(Sec:7044,- - - - - -- -- - - - —
Businesk aid'Prefeasions Codd:The Contractor's License Law does not apply to an 301 - ROUGH PJ rPjtbspections
owner of property Who builds pro thereo d who does such work himself
Ter Through his own employ - Provided tht such improvements arc a.,intended or 5 07--,7-FINAL,_PLUMBING,
le 1 rp a thebuilding- improvement s sold hedwithin one year of
_-. .
o-improve
r the owne budder will have the burden of prmvmg that he did not Wild or
r
c
improvef pryns ofxal.) fir► fffppp
01 'm pp,,—rt'an,ex I elusively cot i gwith 1 1, he t t t
construct av project(S .]614 B . ❑erty w Cade)Th Contractors
License Las d m apply to an owner with
progeny who lice se peruves thereon,
Contractor License
such.projects with a.conmanor(s)licensed pursuant to.the. _ ___
acs n
and.who.compacts NOON.TION.. _. _. - —....- -..___
Sec �� 2 6.2002 .
❑lat� over Sec. .'.R�rcror mix rea.on j r�,rr,'.
w^v�
WORK61CS—COalfifENSATION DECLARATION BUI1_D1jvG
I hemby stir under penalty of perjury one of the,following declarations:
_ I have stud will maintain a Cdnificate of Crtaxi ism self-insure for worker's
Compensation, m ppoidcd for by Section 3700 of the tabor Code, for the
'partnance of the work for which This Ixput is issued
1 have and will maintain Worker's Compensation Insurance m required by Section
4]00 lthe Wbor CoJ for the p rfn n of the work f h' h'thisIT dramil is
iss J Wm; Co. s i aspirin1.c c and Po c
,.: ..r .,. .. ..,, _ ,_ ....,....
C - Pola
72
No
No:
iCERTIFICAI .M.WORKERS:-
O-RKERSI'' _31, 1
]!
COMPENSATION INSURANCE
Th s section need not be complaed if the permit is for one hundred dmllaa
IE I Off or las.) .
certfY that a pe in. cri of the ortfor whmh thisct toths Isske 1 - - - isCompensation '-
II mpl y y p n any le as t become subject to IM1e Wo kers ' `
icnt taws nl Cul'fom a Dae'
_Applicant •.. - ...
.... __ ._. ..__...___NOON_... ___ .. _ ._... .... _ .. . ....._.__.......
NOTICE TO APPLICANT Work If,Compensation
this Certificate of Exemption,you should
femme subject m the such previsions
@ions or this prom cions of the labor Coda,you mutt
z Q
forthwith comply with such provi.donz or this permit shall W deemed invoked.
Zr.r .. ... O LEON ._ _. _. _. .....,-. . ._. . .. _.. NOO N . NOON. .. ._._.. _. .. -. _
y,„ Pe gagePc .
CONSTRUCTION LENDING AGENCY .', — "' ! • ,.,
I hereby Rpm that there is a construction lending ne5 for performance
.� of the work for which'hi's snit Is issued Sec.3097,Civ.C.)
L Q - Lender,Address ... _._.:.._.. -._...__....
Lender)deIncl I havd read This application. s
V Y and tate that the above information is 1 1
ka=E. 'cunea.I agree topomplY with all city and county ordinances and stale laws relating
Q:V orbuildin8constmcomI:and hereby amhorixe r<presemap se,of'his city mater upon
;;m-W the ibove-mentionedproperty for inspection purpsi .
ti-0. (We)agrce m save.indemnify and keep h.lcsi bECu,of Cupenino against
fn liabilities,judgments,casts and expense whichmay in one way serve against said
C.7 Z City in consquence of the gramint,of this permit' , (.I
,APPLICANT UN DER STANK No W'1 LL'COMPLY II'ITH•ALL NONPOINTJ sol' �',NS Issued by: Date
��-z .�,L ZI U/
tgnamrc of APPImaMC mIIecmr Re-roofs •/
HAZARDOUS MA RIALS DISCLOSURE. 'Dine',•',
\\Turn applicant fru Wilding oeeupsomsome orhandleha:,tdou.,mt 'I _-Type of Roof
Nandefined cr meta rt M 'spat env Chapter 9 a and m Halm tadSafety
f All roofs shall be,.insp
Coe S I o r 553 O - c'- .a 1. t
-- ected.prlor.to-any roofing material being.mstalled,
w llm ppre I n b m god occupant equipmento device,
rah If a roof is installed without first obtaining aninspection,d agree to.remove
eno;ha.ad r contaminate, der cd by h B y Arca Air
• Q ahty Management Di tact - 1
all new materials for inspection Applicant understands and will comply with
all non-point souice regulations ' -
1 litwe s d he m,a,wa,rapperfal,ra,ei,ams.,urderChaiucr 6.95 of the /�/-/�/ /�/�/
Calfo t1althsSe 5konty Col aSections35505 itis nd355JJ1 d rend Nat —1% s, / (j''G/L O( ..
doh building dsum console a to m that ti'mY .p -6It t
occupant f the m,ti ms which must b I prior to is. n e at a'Cemf m of
occ p hey Signature of Applicant Date
_.
mor.egem— Dgte All roof coverings to be Class "BIT or better
-OFFICE