03090040J�
CITY OF CUPER'1'INO
BUILDING DIVISION PERMIT
3-CONTRACIORINFORMATIO`N `.
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BUILDING ADDRESS:
ABC DEANZA PLAZA PARTNERS
PERMIT NO 03090040
ER'S NAME:
PERMIT ISSUE DATE
ABC DEANZA PLAZA PARTNERS
NE:
SANITARY N0. CONTR04 N0.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� o 0
0
LICENSED CONTRACTOR'S DECLARATION
lob Description
I lovely affirm Thal 1 am licensed under provisions of Chapter 9 (commencing
p
With Section 707ab of Division 3 of the Business and Professions Com, and my license is
Clma and affect,
in full to.Class
Licenti
se
NEW SIGN FOR RESTAURANT
F9YL E
Con
Itl
ARCHITECTS DECLARATION
lanaemand my pinna man Waeedmpanfie reenms
NOV 13 2003
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby ,(Bens thin 11. exempt from Ne Contractor's License Law for the
en e'e �'�S
maso ID Business and Professions Code: Any city or county
mason.
MBS U ,eke' YG
BUILDING
which reyuircs a pctmio be cnnss Car repair any.tmctum
which Permit 1 An attic, improve,
/■
the h Permit t
prior mits issuance, a6omquiros thevisio (if for inchpermitW01essigned nhaptert
the Coctrumri Llensc Law
that be is licensed purttion700)
Sq. Ft. Floor Area
Valuation
or Diviomof
msColCr9
(commencing with Section1000)M Division3M exe andColn) or
35918058.00
on. Any
that he i. exempt therefrom and Ne baso for He allogcd emmption. Any viohuon of
alleged
APNNumberOccupancy
Type
Section 103 1.5 by my applicant for a permit subjects the applicant o a civil penally of
not mart Nan I.hundred dollars ($50)).
"
I, u owner of the property, or my employoes with not u a a Heir sole compensation,
i0l — d Inspections
will do Ne week. and the structure Is not inunmd or offered! fouale(Sec. 7044, Business,
and Profusions Com: Tho Conaacoes Limine Law sues not apply m an owner of
P -
_
10 3
y who builds or improves Hereon. and who does ouch work himself or through his
property
- UFER
ownemploycn, provided that such improvements an not inumed oroRered fusion. If.
104 — REBAR
however, the building or improvement is mid within one year of mmpkuon, He owner.
builder will Mw son burden of preving M&I M did Out Wild or improve for purpose of
105 - ANCHOR BOLTS
Nle'
304 - ROUGH ELECTRICAL
I, a owner of ct Sec.70.. Business ss and contracting with licensed contractors t.
ceme the project Coda) The Conusemh Li -
an
505 - FINAL ELECTRICAL
ba ofand property whoop.
Intrade.not applyWanownerofpropertywhosetinsorimprovesdesmon.red'
La apply owner
514 - FINAL PUBLIC WORKS
who
who contacts for such proJecu with a mntncmr(.) licensed pursuant m He Conumorl
License Law.
m erupt unmr Sec..B&PC�j�/PPP/thau-rWORKER'S
COMPENSATh f E RA IONI
hereby a(fmn under penally of perjury oro of ollowing delantiomeave and will maintain a Certificate ofComent m self -insure forworker's Compere,
I
m provimtl for by Section 3100 of He Labor Code, for the performance of the
for which this permit is issued.
ave and will maintain Worker's Compensation Insonmen, u required by Section
of the Labor Code. for He performance of the work for which this permit is issued.
muco. Compenwtion Insunnoo Carrier and Policy number me:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(TMs in. reed not W wmpleud ]fine Permit la for ort Inndreddoll.n (SIM)
or Ina)
1 unify Hat in the performance of He work for which this permit is issued. I shall not
employ any person in any manner an as W human subject to the W9rkeri Compensation
Law. cf California. Dau
Applicant
NOTICE TO APPLICANT If, after making this Ccoblluu of Exemption, you should
become subject to the Worker's Compcmation PUOYWdm of He Labor CWCyou must
funhwith comply with such provisions or this permit shall bo tlemcd rernked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that More its constructing, lending agency for the perfurmanec of
He work for which this potmit is issued (Sec. 3W7, Civ. C.)
Lender's Name
Leader's Address
I certify that 1 have read this application and nasi Hat the above m ormuiun is
COMM I agree to comply with all city and county ordinances and sou laws relating to
building construction, and hereby amhorim reprounotims of His city to enter upna the
above-mentioned pmpeny for inspection purposes.
(We) agree to save, indemnify and keep Canning, He Ci ly of Cupertino against
liabilities, judgment, cons and expenses which may in any way accmc against said City
in comequcme of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL IJON.PPINT
Issued by: Date
SOURCERE LATIONS. 9OL/O
.
Re -roofs
Type of Roof
T
Signature of Applic.nUCon"noor u
HAZARDOUS MA DISCLOSURE
Will He applicant or future Wilding upamstorcorhandlc harudommeuriel
as defined by the Cupertino Mun' 'pal Code. Chapter 9.12. roti the HuIH and Safety
. Section 255331x)1
All roofs shall be inspected prior to any roofing material being installed.
❑Yn Nu
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Ming occupant esu equipment or dcvicet which
0 havardnm air conuminanu de0ncd by tin Bay Arca Air Quality Management
all new materials for inspection.
sin?
❑Yrs Nu
1 have read the Waardous materials requirements under Chapter 6.95 of the Caliar,
nixH.Iffi&Safmy Com,Sccuom25N)5,25533,d25534.1umm.ond Hwif He Wilding
docs not Currently ham a tenant, that it is my responsibility W notify the occupant of He
m ccnu/)whichM.sttbcmet(priurWii...neoraCCNficauofoccu C.
Signature of Applicant Date
^�
_,.4IAc' IL05L�. FF_7�' n bijW
All roof coverings to be Class "B" or better
Owner �—
or authorized agent ,1�
L
CITY OF CUPERTINO
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omahcincing
$
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BUILDING DIVISION PERMIT
CONTI2ACTt7RINF®RMATI
BUILDING ADDRESS:
ABC DEANZA PLAZA PARTNERS
PERMIT NO 03090040
OWNER'S NAME:
PERNUT ISSUE DATE
hk ABC DEANZA PLAZA PARTNERS
HUNS:
SANITARY NO. CONTR04 N0. i
ARCHITE
BUILDING PERMITCT/ENGINEER: INFO
BLDG ELECT PLUMB MECIi
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hemby affirm that 1 am licensed under provisions or Chapter 9 (commencing
with Stedim 1(Akl) of Division 3 of thc Bmioesa and Pro[ e..inn,, Codc. end my license is
imm�rnrceandeffect.
NEW SIGN FOR RESTAURANT
License Class Lic.N
Dam Coulanner
ARCIIITECIS DECLARATION
.
I ander usnd my plans shall be used as public records
LiccnJcU Professional
OWNER-BUILDERestrumDECLARATION
Law for the
1 hereby affirm thatI ore cxcmpt arum the Cssion,
o :An,c
following moenn. (Section "o i Business and Code: Any city nr county
-
ere dcu old or repair any ntrucmm
which tom mnntru0. a1Rp improve,
opinions,
its bast n eertl
for sucContrarmluoiensele a Law(Chaned mem
pat isscensciee.alsant the the h Perlia
Sq. Ft. Floor Area
Valuation
he to ision of
-
othe f Btrinessnd Prorlaw(Chapmr9
wJpursuamoth))of Division r the Business
lames with Section ]and or Dndia vi Code) nr
exempt
3 5 918 0 5 8 0 0
pt on. Any
thcmGom end Ne basis for the alleged exemption. Any violaion of
that he is f the
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the Applicant a civil penalty Of
not more than live hundred doll... (SSW).
❑ I, as owner of the property, or my employees with wages as their.sole compensation,
d Inspections
will do the work, and the smcmm is not intended or offered for sale (Sec.)Dart. Business
and Professions Codc: The Contractor's License law does oat apply m an owner of..
.
103 UFER
property who builds or improve. thereon. and who doessuch work hims0for through his
-
own employcw, provided that such improvements are not immnded or offered for sell. IL
104 - REBAR
however, the building or improvement is sold within one year of completion, Inc owner -
builder will have the burden or proving that he did not build or improve for purpnae of
105 — ANCHOR BOLTS
5i1e.
304 - ROUGH ELECTRICAL
1, a owner of the property, am exclusively contracting with Recused eontracom to
-
505 FINAL ELECTRICAL
,motmct the project (Sec. town, Business and Formations Code:) Tho Conlmemr's Lt.
—
tic Law docs not apply to an owner of property who builds or improves Officer, and
514 - FINAL PUBLIC WORKS
who contracts for such projects with a contracmr(s) licensed pursuant to the Contractors
Licenm law.
❑ I nor �pt under Sec. Bd PCr rthis u
c C 0 on
Owner (R � ! Data
5,r
WORKER'S COMPENSATION EC�6��RAjION
I hereby a11'mn under penalty of perjury one of thKallowing declarations:
I have and will maintain a Ccnific to of Consent m act binsure for Worker's Compao
!�% !`
nation, u provided for by Section JOW of the tabor Code, for the performance of the
work for which this permit is defied.
❑ 1 have and will maintain Workers Compensation Insurance, u required by Second
37W of the labor Code. for the pco ormancc of the work for which this Permit is issued.
My Workers Compensation Insurance Cartier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EKEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(This section need trot he completed if the Permit in far one hundrad dollars (SAID)
or loss.)
'
1 certify that in the pi formonce of the wars Tar which this permit is jawed, I shall not
employ any person in any manner so az ua became subject to the Waffo ri Compecei
Lawn of California. Dam
Applicant
NOTICE TO APPLICANT: IL after making this Coni Bcate of Exemption, you should
Nordic subject to the Workers Compensation provisions of the Labor Code, you must
frdwi Or comply with such provisions or this pe,.i,shall he deemed revoked.
Q
CONSTRUCTION LENDING AGENCY
y
agency for the performance of
1 herebyaffirmhis
that there isaconsou,.
dee work for whim this permit is issued (Sec. AYP. Civ. CJ
3097. ON.
G Name
Unders
z Lcndcr's Address
Q 1 certify that 1 have read this application and sum that Inc above information is
'
cancer. I agree to comply with all city and county ordinances and state laws relating to
U building construction, and hereby authorise represcoutivice of this city to order upon NC
UJ above-mentioned property for inspection Purposes.
Q. (WO) agree to save, indemnify and keep harmless the City of Cupertino against
Imbi buts, judgments, costs and expenses which may in any way accede against said Ci ty
Z in conscyuence of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL O[N�-P INT
Issued by:L. Dale
SOURCE RE CATIONS. CA
193
RC -COOLS
Signawrc of m
HAZARDOUS MATER] DISCLOSURE
HAZARDOUS
Type of Roof
Willy fmure builI C upanw handle asmamrial
-
the Cicanttar
ss defined by 0c Cupertino MZipal,Code. Chapter 9.13, and the f{cahh and Safety
912. Health
Codc, OYcs�3532fa)n
All roofs shall be inspected prior to any roofing material being installed.
Na
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant of award [ding occupant Oil equipment or devices which
emit harardnus air contaminants dcfincd by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes Nu
I have mad the hvadnus materials hay oderma u under Chapterri.9S ornhc Califor-
nia Health ffi Safety Code, Seeduns 255(15,255)] and 25516.1 undersand tha if the trilling
dues n t omocady honor anent, that it is my respmsubbity m modify the eeeupant of thc
m enRwlllchm5tbemetpoortomadaeeor Cemrcaaofaaaney.
Signature of Applicant Date
__ Ivl rC-9DSC 9&7G. �,'y�`�,11
All roof coverings to be Class "B" or better
Owner or agent •.J m�
amm-
•CITY OF
CUPERTINO
L.
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L -
CITY OF CUPERTINO • �D
SIGN ;4- Div 90
PERMIT APPLICATION FORM
APN # 3
6
BUILIDNG
Date: 9
Q.3
Building Address:
i0s-25
A Qn 8N
-
BUILIDNG
Ow erygs NamZe:
C ay)Z Q/12 £
Seismic Commercial
Phone #:
/-26 d
Contractor:
eu�rz
7de P�
License #:
%
Y,3.3
Contact:
T,T
Elect Permit Issuance
ELECTRICAL
Phone #:
97,7
Applicant/Contractor:
BREMSIGNS
Rmdl Signs, Marquee
ELECTRICAL
Building Permit Info:
Bldg
Ele "Plumb
Mech
Job Description:
Residential:
Commercial:
Sq.Ft. Floor Area:
Business License
BUILIDNG
t::
Architect/Engineer:
Valuation:
Type of Construction:
Occupancy roupv: /
Qty. if
Applial8,
Fee ID
Ur
Fee Descrintion
Fee Gmun
BENERGY
Energy
BUILIDNG
—� BPERMFEE
Bldg Permit Fees
BUILIDNG
BPLANCHK
Plan Check Fee
BUILIDNG
BSEISMICOM
Seismic Commercial
BUILIDNG
EPERMITFEE
Elect Permit Issuance
ELECTRICAL
BREMSIGNAD
Rmdl Signs Add Branch
ELECTRICAL
BREMSIGNS
Rmdl Signs, Marquee
ELECTRICAL
BUSLIC
Business License
BUILIDNG
17
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