02090189CITY OF CUPER'1'tN0
` > Ww,A
BUILDING DIVISION PERMIT
CONTRACTORINFORMATION
BUIf1rgN69)0R112V DE ANZA BLVD
CALIFORNIA SIGN
PERMIFT2 0 9 0 18 9
SE@J AGO PIZZA & BREWERY
17805 COMCONEX
APPLICAT&9/ 849Tf2002
rHDNE:
2092393339
SANITARY NO. CONTROL NO,
ARCH ITECT!ENGI NEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Lm tNSEDCONTRACnORSderp DECLARATION
IWrebyaffirmthat lam underprovisionsof Chapter 9(rommense
Job Description
SIGN FOR BJ p
withSectiononTXX)7nIDivisionlolNCBusinewenJProfcuionsCode,and ylicenui.a
the Bincides,iond is
In lull force
FINALED
! coil clfcct� y
Licensed Profossinnot
OWNER-BUILDER UG Ce
CL
1 hereby allot thatOW 1 am exempt from Cont'ION
CeatraOlml.{ License Law lits the
v}�,{1� {bsUjjUf 6YV
BW JVG
li lowing reason. (Section 7031.5. Business and Putfeuinns Code: Any c'ny or county
which mquims o permit to construct, aper, Improve, demolish, or repair any structure
! poor it) its issuance. also requires the applicant our such permito, l ile a signed statement
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 1)
3St{BQEU03AM Valuation
(commencing with Section 700)) of Division 3 of the Business and Professions Code) or
that he is exempt Nemfmm and Ne basis for the alleged exemption. Any vimatlnn of
Section 7031.5 by any applicant for a permit subjects the applicant N a civil penalty of
PN _7
Occupancy
araC OGCII Type
not more Nan five hundred dollars (55N)L
103 — UFER
CD 1, as owner of the pm,xty, or my employees with wages as their side compensation,
will do the work, and the structure is nut intended or offered for safe (Sec. 7044, Business
and Professions Code: The Contractors License Law does nut apply to an owner of
184REBAR—
105 - ANCHOR Igkr�Inspections
pmperty who milids or improves thereon, and who does such work himself or through his
mvn employees, provided that such improvements am not intended or offered for sale. If,
304 — ROUGH ELECTRICAL
however, fie building or improvement is old within one your of completion, the owner-
505
budderwillhavetheburdenofprovingthathedidnotbuildorimprovefurpurposeof
- FINAL ELECTRICAL
sale.).
514 - FINAL PUBLIC WORKS
❑ 1, as owner of the property, am exclusively contracting with licensed contractors tat
constivct the project (Sec. 7044. Business and Professions Code:) The Contractors U.
come Law does not apply to an owner of property who Wilda or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant o fee Comractori
License Law.
I sin exempt under Sea ,B&P C far Nis reason
net Date
WOR K ERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ Ihaveand will maintain aCenificneof Consenuo self-insure for Worker's Compem
sation, as provided for by Section 37M of the Labor Code, for the performance of the
work for which this permit is issued.
1-1 1 have and will maintain Workers Compensation Insurance, as required by Section
371X1 of the Labor Cada for the performance of the work for which this Permit is ossuud.
My Worker's CommPon�sm�ion Insurance carrier and Policy numMam:O �7�
Cartier. S'T//✓i7 Policy No.: /L/G , Z
C �RTIFICATE OF E%F'.MPTION FROM WORKERS'
COMPENSATION INSURANCE
(This seetion need not W cnmpleted Rthe T<rmit is fortune hundred dollars (S IW)
nr 1css.)
I unify that in the pulinmance of the work lin which this permit is issued. I shall not
employ any Person in any mannerso as to become subject to the Workers' Compensatina
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of gumption, you should
become subject to the Workers Compensation provisions of the labor Code, you must
forth%I lh comply with such provisions or this permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm Nat there is a construction lending agency lin the Performance of
the work for which this permit is issued (Sec. 3097. Civ. C.)
Lendch Name
Landef's Address
1 unity Out l have ithJ Nis and state the atone information mmating is
correct. 1 agree las comply with all city and county oNinances and.nam laws relating to
city and county us
building construction, and hereby mourim rcprescntatives of this city to enter upon the
ahnve-me properly for epenses purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
judgments,
incoisequnceifth,"ohlind expenses which may in any wayacerae against said Ci Ly
Aconsequence of the graining of this permit.
�t ^
I /j o
APPf.ICANT UNDERSTAND AND WILL COMPLY WITH ALL NONPOINT
Issued by: Date
SOURCEItEGU NS.
4 —= %
Re-roofs
Type of Roof
gnat Date
IIAZARDOUSMATIIRIAI.SDISCLOSURE
Ne applicant or future building nocupant store or handle hazardous material
termed by the Cupertino Municipal Calc, Chapter 9.12, and the Health and Safety
a.ycaz25532(a)?o
Yes Nu
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant on equipment or devices which
onto hazaNnus cif c'onerninants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District'!
❑Yes
I have mail the hxvatdous materials requimments under Chapter 6.95 of the Cation.
nixllnotcuSafety Cole. Scetiom25Nt5.25511 and 2553x.1Onto rstanJ NmiftW Wilding
Jrcs not curmn n4 that it' y msptunsibility m notify tW memento of Ne
requirent CcoifcamtufOccupancy.
Signatu fiplicant Date
All roof coverings to be Class "B" or better
Own m nr atu nrnx ,gen, Date
CY OF CUPERTINO
BUILDING DIVISION
DE ANZA BLVD
CALIFORNIA SIGN
GWglSiGO PIZZA & BREWERY 1 17805 COMCONEX
PHONE:
ARCHITECT'/ENGINEER:
w p Zo LICENSED CONTRACTOR'S DECLARATION
U E. I hereby affilm that Iam licensed under provisions of Chapter 9 (commencing
[a., w with Section 7000) of Division 3 of the Business and Professions Code, and my license is
a a in full force and
t- effect.,C_ '
-7 62
Z O y License Class .iaJ
OZ -o Datc`p -,,f -G '2— Conror
" n t: W
ARCHITECTS DECLARA
I understand my plans shall be used as public rds
X0,U
w O y Licensed Professional
H 1 OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
LU O following reason. (Section 7031.5. Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
z} prior to its issuance, also requires the applicant for such permit to file a signed statement
< that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
ftp
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
a 3 that he is exempt therefrom and the' -basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ 1 am exempt under Sec. B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ f have and will maintain Worker's Compensation Insurance, as required by Section
3700 of Ne Labor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
�Tl �2 r _VQ - 02 S7
Carrier. ./i'V/✓ Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not becompleted if the permit is foronc hundred dollars(S100)
or less.)
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making [his Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
0 Z forthwith comply with such provisions or this permit shall be deemed revoked.
'Z O CONSTRUCTION LENDING AGENCY
r-rCO)
[� r -r I hereby affirm that there is a construction lending agency for the performance of
fx > the work for which this permit is issued (Sec. 3097, Civ. C.)
W Q Lender's Name
Z Lender's Address
U 0 1 certify that 1 have read this application and state that the above information is
v. "" correct. 1 agree to comply with all city and county ordinances and state laws relating to
0 V building construction, and hereby authorize representatives of this city to enter upon the
a ahove-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
HCo) liabilities, judgments, costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit.
'-' APPLICANT UNDERSTAND AND WILL COMPLY WITH ALL NON -POINT
SOUR�
Date
HAZARDOUS MATERIALS DISCLOSURE
the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Hcalth and Safety
Code, Section 25532(a)?
❑Yes [�No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants az defined by the Bay Area Air Quality Management
District?
❑ Yes &50-
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand thalif the building
docs not current a nt, that it' y responsibility to notify the occupant of the
requirem enif[cate of Occupancy.
Owner or au oriz agent Date
SIGN FOR BJ
103 - U
PERMIT T-2 U 9 U 18 9
APPLICAT(T_9S1)SIDTf-2 0 0 2
SANITARY NO.
BLDG
Job Description
1 V Z
10 5
- ANCHOR IIrInspections
304
- ROUGH ELECTRICAL
505
- FINAL ELECTRICAL .
514
- FINAL PUBLIC WORKS
Issued by:
Re -roofs
Type of Roof
CONTROL NO.
BUILDING PERMIT INFO
ELECT' PLUMB
$16000
on
Occupancy
Date
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signatu pplicant Date
All roof coverings to be Class "B" or better