00080229 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: _ PERMIT NO. -
TI WUA(C S(6n/S 00080229
OWNER'S NAM APPLICATION SUB DATE_
b NtM Ct.AL 57 IiS13112000
PHONE: SANITARY NO. CONTROL NO.
.�oSr✓ Z
a cez ARCHTfECf/ENGINEER: - - (7BUILDING PERMIT INFO
�Va L , ELE, PLUff ME�CH
Z
ver
ZLICENSED CONTRACTOR'S DECLARATION
?b _ I hereby )of mat I am licensed uncles pnd professions
of ns Code,and
mmenemg Job DeSCriphOn .. _
with Section]OOp)o(Uivi Division Business and Rofasions Code,cera my license
x E_ rnn some arta elle 7�l 179 3 SIGN
CSNz 1 a smense Class l_—� Lic N — -
'e¢ - Corm ctur
L'3 y U ARCHITECT'S DECLARATION
a - .
—G< I understand my plans shall h used as public rewrds
i p C Licensed_Professional
%=isOWNER-BUILDER DECLARATION
'Ou, 1 hereby arm that 1 am exempt from the Conaecmr s License Law for the -
F Z a following reason.(Section 703 1.5,Business and Profie,mit,Code:Any city or county -
xH e whim nyuires s permit rex conswn,cher.improve,derrmlish,or repair my structure -
3 m primto its issuance.also mluire,,me applicantforaueh permit to file a surtax]statement
maiheV licensedpnauamtomept isionsofinecontm¢mesLicenselaw(Chapwr9 Sq. Ft.Floor Area - Valuation '
(cammemdng wire Se�tion 7nl,f Division 3 of me Basinrss R
ara ofe,u ns Code) -
or that he is exempt therefrom arta me basis for Ne alleged exemption.Any violation
of Section 70313 by any applicant fon a permit subjects the applicant to a civil penalty J ,
ofW1,ommdomfile hundred annarsISNIM, APN Number - • ; Occupanpy ype
.❑I.as ownee ofine prape"i or my employees with ones rra theirsole evor,em atian, 4
will do the wools,and the atmrtmim
e is nam muded ar affeed far see(See.70,14. lZZ aired Ins ectlOHs '
Business and Profrssions Code:The Connaaor s License Law does not apply m an q p
owner of Property Who builds or improve,themorr and who does such work himself
or through his awn employees.provided mal such impnorm ats are nm imended or
offered for sale.If,hawc.er,the building or improvement i,sold within one year of, 101 - FOUNDATION
f completion,the o son-Wilder will have the burden of proving that by aid nut Huila o; -1.03 — UFE R .
improve pmpou _
111.as owner of me pmtpsm,am exclusively contracting with licensed contractors to 104. — REBA R .
anNmcl thr:pmject(Ser.7011.Future,and Profe:,ians Cade:)The Cona u', 105 — ANCHOR BOLTS
Law does not apply to an owner of pini who Wit&%or improves Mecca.
and who cont2rt%for such projecss with a conations)licensed pursuant m Me 304' — ROUGH ELECTR I CRL'`-
Contractors License Law. -
❑lamexemptunacrSee.. - ._B&PC for do,rea%an '505 — FINAL ELECTRICAL -
ow"
" WORKER'S COMPENSATION DECLARATION 514 - FINR
PUBLIC WORKS
I hereby aTm order penaltyof peruryanaof he following declarmia"s V
❑ I have dna will maimain a Cenificare of Consem to self-insure forWorker'sWorker's
Compensarian, as provided for by Section 3]00 of the Labun Cadet for the -
- petfomance of the worlicit
or which tis permit is issued. 100""o_ -
- ❑1 have and will meirWm'Worker's Compensation Insurance,as rvyuired by Section r t
.37M of the Labor Code,fon the performance of the work for which this pemut is
sued.M Worker, n,
's Co nation Iaeurence canter omit PolieYnumber are: - v
,,yy���� / Pe
. ixY ardcArA tp'Fwi) Polley No.: l Slf1SDu-94
CERTIFICATION OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sectlon need nor W emr lixed if me permit is future humhcd dallars ,
(SIM)tar le,sj '
mrtify mat in me performance of da work far which this permit is issued,)
shall not employ say person in ammammer so as to berome subject to the W'mkems -
Compensation'Lvivs of California.Date
Applicant"
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you shoudd
Z bcrome subject torhe WmkeisCompensatiov provisiorms of the Labra Cade,youmhst -
C foMuim comply wire suhcprovisions m Ms permit shall be deemed revnked.
z
F•' t7 CONSTRUCTIONLENDING AGENCY -
ye > 1 Hereby affirm thin inert is a ewswrow Iemdinc agentT for me peffmmanee t
W of the work far which his permit is issued(Sec.3097,Civ.CJ
a
Q' Lender's Name -
4vdcr s Address -
V 0- 1 certify mat ave read his application and sore that the above information is
F ro building exon
corcrtA"re,
¢von ly wi b a ardinancrs ova sale laws relmiug
() reyautMrverepre. "movesofmiscitymenterupo"
rM abme- oiled ol,cn for inspection import ,
.H4
We) gore snve,m Jemnifyindkeephmml s,tWCity of C.,mino.,ai ,1 -
h lubilities.j Jgm u,cos and expenses which ma in any way accme act-our said
0 Z City in c or
gaace of r nung of this perou'.
5� RFAE O ANDS ANDWILL . PLY W rB ALL ON INT . Issued by: Date.
00
si - JCon - Re-roofs
o HAZARDOUS MATERLMS DISCLOSURE-
. Win me apphrant or romre buumng occupant pore m nawle haradiwss mamrial Type of Roof '
es defined by the Cupertino Municipd Code.Chapin 9.12,and Jia H<alth'aM Safety '
Code,Section 25532(e)? •' - '
03'eF °No - All roofs shall be inspected prior to any roofing,material being installed.
idlikk Will the applicant or future building oa4panm use rquipment of devices which If a roof is installed without first obtaining an inspection, I agree to remove
vim Wood.,ah conrarmnonts as defined by meBay Area Air Quality Mamgemenr t
:tact? a 1 1, 1 all new materials fol'inspection. Applicant understands and will comply with - -
❑Ycz No -
" .all non-point source regulations. -
I ha me hear ons mm mals mr,tommems under Giapter 6.95 of the
California and m&safety de.seen s+ 505.25533 255}1.1 underhand that
if Ma Wi i does om rurr r - t.that i,i,m,rm,m,MiIity to"reify M, - -
o the rcryimor is x wnco.uf a.Cera" ne of
Oce rY.. Signature of Applicant •- Date
'au orient near Da All roof,coverings to be Class•`B'•or better
- OFFICE
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PROJECT ADDRESS: 10745 5. Pe Anza Blvd, Cupert no,,T gA995014 j r 31 2000
Propose one (1) Illuminated Building attached sign above store front CHECKED B7(
aluminum individual pan channel letters neon internal illuminated Hyl/
DATE_��3/�o
SCALE: as indicated DATE: 07-27-2000 6 si uo.a741793
4
PLANNING DEPT. O ULTIIIMI „TC F7
w ,
Business Approval: DATandlord Approval: 11 Manufactnringlnc y
(Nv . AUG. DEPT.
PAGE 1 of 1 1 1043 Commercial Street • San Jose, CA. 95112
Tel: (408)287-5000 • Fax (408)287-5001