01030135 CITY c mviSSI
IiONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS. n /7 s�� � PERMIT 3
10385 S DE ANZA BLVD tl`'-�"— ayr L .r>,f 01030s1yy35
'MEf"IDWARD S TRUSTEE A03c/23/2001
PHONE: SANITARY NO. CONTROL NO.
i
O rc0 Z ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
2 LICENSED CONTRACTOR'S DECLARATION
vo1 Wreb (firm that 1 am licensed under Job Description
oi_o ra provisions of Chapter RESTAURANT REMODEL
�,_t-w with Section 7D)Ydf Division 3 of1he Businessand Professions Code and ter license
f-t is m full force and effect. O
z x a License Class uc.a 4 60 19
s`e O=U Dae Lmaaem (_
F a a0 1 ARCHITECTS DECLARATION
I}g I understand my plans shall W uad as public rccends
ad z O O Licensed Profiscomel l
i ca OWNER-BUILDER DECLARATION [K'
1 hereby affirm that 1 am exempt from the Comrobbi License Law for the J
1-3 a following reason.(Section 7031.5,Business and Professions Code:Any city or county Q 21000
E¢D which reyvires u permit m cnmmmim
� ,cher, pm
nw,.demolish,m repair am mrticare
3 m priorto its issuance.also requires theapplicant f h permit fl signed statementa.
that he is licensed pursuant to the provisions f the Comarructor's License law(Chapter 9
(co = ng wish Sea 7") f Divi 3 f h B sine. d Profession,Cade) :3 91FF' o9r®�a , Valuation
or that he is exempt durT oulood the basis for the allea'd exemption.Any viulmion
of Section 703 LS by any applicant for a permit subjects the applicant to a civil Penalty
• door anarethe.five hundred did lars1S5r1(B. 101APSVIW_J1gDATION " Occupancy Type
❑I.as owner of the prapeny.or my employees with wages as their sale compensation, 102 - PIERS
-warao the work,and the structureis not intended or oBered For sale(sec.lou. 103 - UFER
B udow,and Professions Code:The Cpmmmor's License Law does not apply to an Required Inspections-, `
1through
owner of property Who builds or improves thereon,and who does such work himself 104 - REBAR
or ered for his awn employees. Wild<d that such imernt is sols are not intended or - ___.
aBe¢d for.the off.w er,bui.. he bonding er improvement n sold hetero one year or 105 ::-ANCHOR- BOLTS
aprovemn,me tse ol"mlaer will have the burden of proving mm he did not Huila or
."
�mprov=rar purpose nr salol 106 - SEWER & WATER
202- ---UNDERFLOOR' PLUMBINGo s as owner m`propnyam exchniJdy commning wish licensed commcmmro
consumer me^Ntiz
--.-_- .------..__--
(See.10H4,Business and professions em=:)Tne cantmute`.
203 - UNDERFLOOR MECHANI CAL 1. .
License Law dues not apply m an owner of property who W;Ids or improves thereon.
' d.who cammde for
_ n projms With a contractors)licensed pursuant m 204 - -- UNDERFLOOR FRAME
,. -and
License law. _ -.-
❑lamexempt gnderSec. `' " :'6&PC for his union 205 - UNDERFLOOR, INSULATION
Owner' ' gaff' 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
Inercbyarrrmunaerpenayyarp<rjurradeortneralmwingaecmaaans 303 - ROUGH MECHANICAL
• o'1 have ma wiu andancia'a cen0laae of consent is xlrnsure for workers
304 - ROUGH ELECTRICAL
campensarms. as provided for by section 3700 of tete LeWT Code. for mic 3 O5 - FRAME
performance of m=work for whim this permit is issued
i .
❑I have and wilt maintain work=,s Campersaii9n]dsumnce.as required by section 3 06 - HOLDOWNS
37W of tW labor Code•for the performance of the work far which this permit;< 307 - INSULATION
ns M My W..ker,C pe t 1 sum ec and yr, mbcr are:
........,,ff.�.. .... - 308', FSHEETROCK _. .... _„ .. .,-.,>_-..._,. _..._... ........
Comer hazy 'policy No '11 '4 .
CERTIF ATION OF E%EMPTION FROM WORKERS' 3O9 - EXTERIOR LATH
COMPENSAI'IONINSURANCE -- ,';
. 310: --:I'N'TERIOR....LATH- -
on
ATH" - - ---..._.. ...
ITh t nneed not be eomplemd if the Amit is far ane hundred dollar, 311 SCRATCH COAT
(51001 rle<cl '
certify In-'in m r hr, kr.w' 313 - ROOF NAIL
1:" r r= Kich m pe J is i..0=a 1 .. _.
Thal!net ply ype: ,man ,tob=cmnebjettomeWeakeri
is 501 - FINAL ELECTRICAL"ENERGY
cd clr Date-
_ 502 _-.. FINAL._PLUMBING ENERGY__ ..
NDI'ICETOAPPLICANT If.after making thC-nrg re,01'Eximption,y <nmYSa 503 FINAL MECHANICAL ENERGY
Q 'funh lh bl n meW A C pc t P lthe LVW Cod y t
z'�
nmplrwm cop tan<otm pcmttshallWJ arevnkm. - 504 _ --_FINAL_ BUILDING..ENERGY,
CONSTRUCTIONLENDINGAGENCY, 505 - FINAL ELECTRICAL
' ` 1 he'by fi m t m rc a c t t bn I nd ng becncY for tW perlomrntrce
y anh TAI Isom 1 t d(5 3097 Co.C.) 506 - GAS TEST
:Y Q Lender Name -
Z) y Lirae Ada 507 FINAI PLUMBING
V O I<enlyma,Ihave read ihis appicxtn a and due that the aWveabitmatianis 508 - FINAL MECHANICAL'
t.. c,reii I agree to comply with all city and county orbaances and stau,laws relining 509 - FINAL GRADE
0'F) .,a ildingconstruction, dh by authorizerepresentatives of this tyt ow upon
M. :m= b ap p nde n wg p ma 510 - FINAL PLANNING
E..
M. s5'1 g m. indemnify and keep which la.tnecty fC pen aaga m` 514 - FINAL PUBLIC WORKS
V] liabilitiesj dg a¢o t -ad a pc xs which y in any, ) cane nst said
U Z
city, q e one A t g nn a t .
'APPI TrUND:RSTA\D ND WILL COMPLY'W'ITH ALL PON POINT
_ sr Rer' AnoN Issued by: Date
�o-
�g ofgpplic
HAZARDOUS
'HARDOUS MATERIALSMATERIALS DISCLOSURE Date, Re-roofs
.• tud by t e Cupertino«mut Municipal
ode,Chapter
emredi 2,and he Health as Safety Type of Roof_.. .
-= ° as deo code Sed Section
me cepcninn Municipal Cute.Chapter 9.13,and me Health and Safety
❑v I` 1yv' Allroofs shall be mspected.prior-to.any roofing-material being installed. _
Wll the applicant ornine,building occupant iocepupineat ordinsices which If a roof is i iStalledrwithout first obtaining an ins ection, I agree to'remove
nt outmost, JBnedby theBay ArmA Quality Management e P ,�
• °.`° 'oYx - all new materials for inspection._Applicant understands and will comply with
t I •-, all non-point source regulations..,.
1 have read the Iviararorder Chapter 695of the
Cal f mNa H of ty Cod Sections 25505 25533 d 55"W Iunderstand that
If be b gJ m< byh tont "a'I'
.an e.p 'tilrvt fly the
ioc
tum o qu r ems which'not be met pro,,,in ko an<e of a Cen ficme of
r . s.
Signature,of Applicant Date
Her ant ori=ea nt 'Dine All roof coverings to be Class "B"or better
,. . ,
OFFICE