05110057 CITY OF CUPERTINO £� , ' �, ?:
BUILDING DIVISION PERMIT r,CbNRAC ,ORINFURMATIQN,�„
BUILDING ADDRESS: OPI COMMERCIAL BUILDERS PERMIT NO.05110057
OWNER'S NAME: PERMIT ISSUE DATE
-LOUIS AMMATUNA 445 LEIGH 2006
E: SANITARY NO. CONTROL NO.
408) 377-4800
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
op BLDGO O PLUMB MECH
O O
Y00 LICENSED CONTRACrOR'SDECLARATION J b-D ri ti n
1 hereby&Herm that I am licensed under provisions of Chapter 9(commencing Q
with SeNon 7000)0 'vldan3o(tho Busiur••And Pr fyssh,pt Co .and mYlicenkh � B
in full forceandcf L BUILD NEW YOGURT SH P TI (>+b AL
jBiELicenm Cl Comtractor •4
F Dae Con
ARCHITECT'S DECLAkiRATION •v
I understand my plant"I he used as public March
4U
sod
Licensed Preload onal ( �y
OWNER-BUILDER DECLARATION
pN Iq�l✓fl( p
i n$ 1 l. Affirm that 1 1. exempt from the C-.4.. h :License Law for see
Lao whichfolkoire rtuan. rmhoo comm,Bminev and Pc.&m m Code:Any tiny ar county 11V� C
g§0! which requires•permit to ermu[et cellar.improve,demulldt.or repair any.inure
$37500
prior In its Issuance,also requires the apple=[for such permit to Ne A signed statement
p <
that heIs licensed pursuant to the provisions ofthe Contractor's Liecom Law(Chapter 9 Sq.Ft. Floor Area aluation
y 9 (commencing with Section 7000)of Division 3 of Me Bminess And Professions Code)or
..
that he is exempt therefrom and to bask per 0m alleged exemption.Any vloletlan of
Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of p Occupancy Type
not mom than 0w hundred dollars WOO).
❑I.as owner of Ilia property,or my employees with wages As their role compensation.
will do the work and the mumure is not ntended or offered for sale(See.7044,Business Required Inspections
and Professions Code:The Contractor's License law it=not apply a e an owner of 9 P
property who bui Ida or impraysts thereon,end who does such wart himaul f ar through his
own employees,provided that such Improvements art ret Intended oroRered for sale.If,
however,the building or Improwneent issold within me year of eampledon,the owner.
builder will have tie burden of proving that he did not wild or Improve four purpose of
sole.).
❑1.As Owner of the property,am exclusively contrasting with licensed com ucions he .
comuutt the project(Sec.7064.Business sod Proressions Code:)Th Contractors Li-
cense law does not apply to an owner of property whe builds or Improves themon,and
who comm cta for such projects with aanua[mG)licensed p...A.,to ted Comuss me.
Lice=law,
❑lam eaemptundersac .B h PC for this a..
I Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under porosity of perjury,ars of the following declarations:
I tum and will maintain ACenifi=k of Cmneent k self•Insum for Worker's Camper.
sa0an,As provided for by Sectan 3700 of the labor Code,for the performance of the
work for which this permit Is Issued.
1 have and will maintain Worker.Compensation Insurance,as required by Section
00 of mCod0.fom oflhewark(or which kis parent Issued.
My Workers omCode.ar th Art curies And Polity num
Cartier. r Polity No.:
ERTIFICATE OF EKFMPIION FROM WORKERS'
COMPENSATION INSURANCE
(This auction reed sot M completed Ethic,Permit is fwmchundrW eallst($100)
or lay.)
I certify that In the performance of One.,it for which this Permit is issued.i shall tan
employ any person In any manner an As in become subject to the Worker.Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT.If.after making this Certificate of Exemption,you should
become subject to the Worker.Compensation provision.of me labor Code,you MML
.700 forthwith comply with such Provisions an this Parrott Shall Its deemed mvnkcd,
q tiCONSTRUCTION LENDING AGENCY
F Ihereby AM.that seem h a constmmmn lending agency rot the Performance of
ai 2, the work for which this permit Is issued(Sec.309'(,Civ.C.)
Q Lenders Name
7 z Lendaes Add.
U0 I certify that 1 have r=d this application and state that the Above Informadun is
ly P correct.I agree to comply with all city Audi county adimne=and auk laws relating a
DU building convection,and Mehl,suthorim rtpresenmivu of this city to Omar upnn the
W almve-mentionod property for Inspection purymes.
6, (We)agree to sow.indemnify and keep harmless the City of Cupertino agalmt
y liabilides,judgments.cats and expenses which may In any way tceme against Wd City
U z in consequence of the granting of kis permit
APPLIQQQQQQI�AAArOO7N7NP9VS't(rttr''''UNDER ST NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR 'nn ���\
Reproofs C7f
Signuu— r pplicaMCmARDam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Willtheto Cupertino
future building ,Chaptr9.12, ad the
Health and
C dented io the Cupertino M icipsl Code.Chapter 9.13,end see Health and Sandy
catic,soden 2553:(.)7'Yes No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or mum Wilding occupant sok eguipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
0 hm.dnus.0 canumni u v deserted by tte Bay Arc.Air Quality Management all new materials for inspection.
inricR
❑Y= No
read the hvardou makriWnquimmemundcrCluper6.95ofkeCalifor-
nkFlet & arcryCode. 25505,2533and75534.1tmdowv ifine Whim&
does c mty have a that it k my rmpamibility to ratify the Occupant of me
require n senrtoissusKcancenin=aaroct SignatureofApplicant Date
Owner authorimtlagcm `f DA All roof coverings to be Class"B"or better