04050159 CITY OF CUPERTINO + s '* 7477 a' G
BUILDING DIVISION PERMIT tdCONT RAC ,TOR, TNFRMATION
BUILDING ADDREss: COFFEE BEAN CAFE/REDA ALSU 6V'04050159
OWNER'S NAME: PERMIT ISSUE DATE
COFFEE BEAN A
E: SANITARY N0. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
°00 LICENSED CONTRACTOR'S DECLARATION
w❑ I hems,affirm that I am licensed under provisions of Chapter 9(commencing Job Description
iW with Section 7")of Division 3af the Business;And Profusions Code.end my license is ..
nor`n mrmurrttanderrea. REVISION--ELECrj' DETAILS/
5qZ Li,r.Claim tie.A
Dam Comuomr NO "NEW PERMIT ISSUED/ ORIG. 404040108
ARCHITECTS DECLARATION
s< 1 underwnd my plans shall W used u public records
is E
3 G y Licensed professional
3 OWNER-BUILDER DECLARATION
1 hereby affirm that I Am exempt from me Commnm's License Law for the
p O fallowing reason.(Section 703 L.5,Business and professions Cole:Any city or county
$ which requires a permit In consumer,alcor,improve,demolish,or repair any structure
poor mits issuance.also requires Cm applicantfor such permiuo file asigncdsmwmcnt
< that he isReret.edpursuant notheprovisions ofthe Contractor's ue=na<uw(Chapmr9 Sq. Ft. Floor Area Valuation$gg
y€� (commencing with Section 7000)of Division 3 of he Business and Profusions Code)or
— mat im u exempt therefrom and the basis for Ih Alleged exemption.Any vialauon of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
m
not momart five hundred dollars(55 L 34716087 . 00
P Y YP
❑1,as owner of Ne property,or my employees with wages as their sole compensation,
will do me work and be,swcum is not intended oronered for sale(Sec.704,1,Business
And Profusin.Code:The Conuimme.License Law dues mot apply In an..in of Required Inspections
man enywho
yees,poothanestheoeon.antlwho daeuuch work.toreador.ffor We his \ \rf�,own employers,builds
oriprovided matmch improwmenm doe not intended err red far ugh his \
however.me building or improvement is sold within mre year of emapimiud,me owner-
builder will hese me burden of proving that he did net Wild or improve for purpose of `
salt.).❑1,ds owner of Lha property,,B sinesand conessins wire:)Theed ermocmrs i.
construct des jou(Sea 70x4,Business and Professions Code:)The Contrumr's Lid
ecru law does not apply m an owner of Progeny who Wilds or improves Contra,and
whence La,for such projects will umr(s)a cantrlicenced pursuant m me nnh
Conto
License law.
d Am uempt antler Sec. .B&P C far anis reason
wre,4.w Dam
WORKER'S COMPENSATION DEATION
1 hereby aIDmt under penalty of papery one of the following declarations:
1 hoe and will maintain a Cenificax,of Consent to self-insure for Workers Comped.
.tion,As provided far by Section 37M of be IeWr Code,far tW performance of me
work for which this Permit is issued.
❑1 have and will maintain Workefs Compensation Insurance,u required by Section
3700 of me ISWr Code,for the,performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number art:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cnissemon need not W completed iHhe permit is for one hundreddoliars(SIM)
or less.)
1 unify mm in to performaxc of the work for which this permit is issued.1 Nall not
employ any person in artpja�As to become nubjecno me Workers'Comprnsadmi
Laws of California.Date
ApIdesel
NOTICEO to
IL after making mus Certificate or Exemption,you should
become se, t m me Worku's Compcasation previsions of me La Wr Crtic,you moa
., z forthwith imply with such provimmus or this permit shall W deemed conked.
z O CONSTRUCTION LENDING AGENCY
[—ice I hereby affirm mat mere is a construction lending agency for me Performance of
!�
be work for which this permit is issued(Sec.3097.Civ.C.)
ll7 A Lenders Name
D z Lenders Address
U Q I ttnee ren 1 have with
thisapplication
and coup y o sure met and
sure
information to
lL Ubuilding 1 onstr m comply wire all city And county nNinanaaand curt laws misting Be
V abovengcotioned roma he¢bywmonatposes. wives of anis city winter upon
Q. shove(We)are progeny for emnify purposes.
(We) i,cove.indemnify Andkith may
an whe Cityof Cogent id City
F' st
raj) inconsequenctmcnc,craning and of this
may in anywAyaccmc against said City
V z A APPLICANT
NDERr the TAN S A permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITN ALL NON-POINT ISsoed by: Date
S RCEg�GULATIONS.
eX _x 5Re-roofs
gnatur o atricmr am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or room Wilding occupant store or handle havaNuus material
u defined by me CPPCNm M.Mapal Code.Chapter 9.12.And the Health and Safety
Code.Second 35533(- All roofs shall be inspected prior to an roofing material beim
E3 Yea CTN.
P P Y g g installed.
Will the applicant or future building occupant use equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove
it harardnus it condom nanm As defined by to Bay Area Air Quality Mavgcmom all new materials for inspection.
District --//
❑Yes t�Nu
I have mail the havamous materialsrequiroments under Chapter 6.95 of me Carlo,
.is Health&Safety Code,Saunas 75505,25533 arW2553,1.[understand Nazilme Wilding
docs not comedy have A tenant.ren it is my nespooddlity w Truly be,recupant or the
req- t.���..ttttmhmunWmeI tihate
to m
cupr. Signature of Applicant Date
k4!;�ItX - 5� / _ All roof coverings to be Class "B"or better
wn
Oau11i aged. " Dam