02050077 CITYOF
ppDIVISION
PERMIT CONTRACTOR INFORMATION:
EUILDING ADDRESS: PERMIT NO.
10050 S DE ANZA BLVD 0 C MC DONALD CO INC 02050077
CWNER'S NAME: APPLICATION SUB DATE
CUPERTINO HOTEL ASSOCIATES 1150 W SAN ,CARLOS 05/14/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 295-2182
090ZO ARCHITEC(ENGINEER: BUILDING PERMIT INFO
E w C BLDG ELECT PLUMB MECH
fn a i t:..D L-1 LJ
LICENSED CONTRACTOR'S DECLARATION
5„? Job Description
(hon 70Y))of that of
B under provisionsofCode.
apter 9lcommecense PLUMBING REVISION-INSPECTIONS TO BE
F=h w is in Section fell perverted
of Division 3 of the Business end Professions Cade,aM my license
�xs3 LceseClaseandeRea DONE ON ORIG PERMIT #01120080
z z a License Class Lic.p
R! a y Dole Contractor
C
ARCHITECT'S DECLARATION
<u
1 understand my plans shall lie mudof ed as public records
ii p O Licensed Professional
OWNER-BUILDER DECLARATION
of I hereby affirm that I am exempt from the Contractor's License Law for the A
F Z a fallowing reason(Section 703 LS.Business and Professiors Code:Any city or county
IFC
which q Permit to construct, he,,improve,d...li.h,or repair any sdctme
i30 -prionto itsqires theapplicomfur such fiction t fl .,ndnaemem
M m I n;dy m mtothepre Bios Ith S d t L nu La ons Cade)
f- ,T� Sq. F[ Floor Area , ,.i-� rr11 aluation
or mm cg- m,with Sauom]000)ofhe basis l thehe Bd band Pmf nyvi Code? ;-J?;j a,hiv., I }.tl'x ,.4i ,Ji'.!�:
or that io ns exempt tnemfmm and the for the alleged uempnt t Any violation 7031.5 by anydred oll for a500). subjects the applicant macivil Penalty
.of not mom man.fivenandred Colon(ssan. APN NOccupancyType
°L as owner of the propeny,or my employees with wages as their sole comp<nvtion..
-willdo'the'work-and-the Structure is not intended or offered for sole(Sec:]MC,'
Duiiness'anJ•Prefessions Cole:The Comomfor's License Law does not apply to an 202 - UNDERFLOHa4uiRBUR ft1M§'1`Si't A
owne
r of property who builds or improves thereon.and who does such work himself 301 - ROUGH PLUMBING
m through his awn employees.provided Na such improvements art not intended or
'comple i le:If.h- - the building a pm emrov Id' N d one Ymr of -`'"-"- -"-'-"-ROUGH
meowdebela will have the orprvvigmtnmenotbuileor 302 - TUB- & OR SHOWER • ' - .
improve far purpa.eof'.1o), 502 - FINAL PLUMBING ENERGY
13 1. owner of tM1e property,am exclusively mctmgwithlicenscd<onracmrx-m-� ---�----- - -_-- -
- -"GAS-..TEST--------'--------- --- - — -,- '-_.---
conswct the project(Sac.IMC,Business and Professions Code:)The Contractor's
t
- - License law does not apply to an owner of progey who builds or impri thereon. S 0 7 - FINAL PLUMBING
n
_..ad.whe effort forsuch pmjeas.wirb if coafamrlsl licensedpursuant of the. _.....___._____._..___.___
- cnm law..
Coonan I L '
_ ❑1 e mgt ndci Scc �-''B&P C for
WORKERS COMPENSATION DECLARATION
• �: . .1 therebyaffirm under It f' u ne ori¢followin dalamtions:-
a Pena y^ Per! rya.. . g
'.:I�- ❑ 1 havc'and will'n aiiiisin la Cenificam of Cement m self-insure for Worker's
Compensation. as provided for by Section 37M of the Labor Code, for the
--- _ performance of the work for which this permit is issued.
°I have and orlimumni.W l CiMrensitticso la,Joinue,as MtI.imd by Sect on
37M of the Labor C^de,for the performance of the work for which this ormi(is
.. iisibi My Wmkci's Compeniaion loan.ce came,and Policynumbcrim: '
1. T . ... -v .. - x..
ba t a .. �,.{Pol YNn ._ ,.. '.- .. . -- __. _ _.
1 1
CERTFICATION MPTION _
ORKERS
COMPENSATION INSURANCE
'I-
1
_- _
(Th s sectneeJ na be completed if the permit is for one hundred dollars
IS lip)orI ) 1
U 1 len fy that in the performancet ..................« ..T.... . _:.-.-_
ohhe work f which the issued,�1 1 r - S:
shall'not employ any Period,n any manner so is io become sub3en to the Workers! ' '
If
Compensation Laws of C I f a Dam' - -
.:App i
------ -
FZ 0r 'i - - ,
.._....NTO API making Centfano fE pt -youth Id
Z decomesm heWorkr Compensation nPrevisions of m Lae Cade'you mus
forthwith ply with
s h provisions or this permit hall be d med ked. 1
v LEN
...
CONSTRUCf10N LENDING AGENCY
�. 7 I hereby which
th rhe o del . l d n8 v. cY f the pert ,,, f. t n
'ice
'af Jde. ark for hch thsPermit . slued(Sc J09] Cv.C)
a'Q -LendersN - - - - -. . ._. ._.. .... ._ ... ._.. .. .. _____.. ._ ...__... - ___ ---- _.
a.Z Ycnl sAJdrcs (,,p
I certify th t 1 have and this application and state Jut the above info if rs
tT+ [r vermes I agree t c mPIY N all city mid count,ordinance, d win 1 relating
V ,to bu Id ng t neon
and h by amho i pre:mat vc I i1n,c iy in nter upon
}'.rW the b t ned p pcoy f sea purposes
rp, s
Q. (W c7 agree to save.indemnify unit keep hmmlexs the City of Cupmino against
liabilities juegmems,Costs and eapenxz which mry,in any way secret,against said
V Z City in consequence of he jumbri,cliffspeimh. - -
�APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALC
' SONON-POINT''
Issued by;URCE REGULATION-5.,' � t %2 dDale
• ,rsitgnate°reYaefsnppIucanvcomr[c1 ar .
D.
ot ofs
n ' HAARDOUSMATRIASDURE' Re-roofs
Will;he ppl t future belai g p i suceorn menvw .mat 1 TyPofe R
doof_,
C-
1. 1.
- "-"'defined by the Cupertino M 0 1 Cal Chapter 9.12 and to Health d Safety
CdSection 25531(i)', ' tt _.-.-...'..._-
°Y _ A" roofs shall be inspected prior to any roofing.matenal being installed_
Will the appfc m orPomrc lm ldnng cupant use equ pment or des cel which' If a roof is installed without first obtaining an,ins ectiAin;:I'a ree' to remove
coal t h rd defined by the B y Arca A Quality M nagement g p g
District .. ,. _all new materials for inspection. Applieant understands and will comply with
contaminants
°Y °N alCnoh point source regulations
I h-Sc ad be h ra dos mm in q 'cots and Chapter.6.95 of the
Calf is H alth&Safety Codc.Seitimix 25505 M533 and 25534.1 lernwnd that
-dare build ,doe.note mlynve a mnmthtns my rcponsblty to notif'ihe -
oce atYfth<rcP - fct er _ - ----PP . .- - --- --- .. ,. Date
Oce P a 9uirements wh ch must ne t or a its ecce f Cen "
Signature of A licaTit
Oxne m Inonmda ent rteAll roof coverings to be Class "B"or belfer _
,.. .g -OFFICE-- - - - . . .._. .. .... .. .—