02010026 CI nuDI^NC.DIVISIONNO
BUILDING CONTRACTOR INFORMATION:
BUILDING ADDRPSS: PBRMIT NO.
20580 HOMESTEAD ROAD 02010026
OWNER'S NAMII: APPLICATION SUB DATE
RITE AID 01/07/2002 '
PHONE: SANITARY NO. CONTROL NO.
(q Q ZO ARCHITECT/BNOINEER: BUILDING PERMIT INFO
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Z Ss�SSSS LICENSED CONTRACTOR S DECL Job D05CIlptlOn
O Z=1 1 hereby vRrm that I m licensed ode pro,. n 9 me
Fat with Srehon7000)ofD 3onna❑ dPror n Code,an p OF E _ FROM TERMITE DAMAGE
is,n full forte and effect
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Data Content.
ARCHITECT'S DECLARATIO
ru�unntI 1 understand any plana shall he used ns pnhlo aren
'3 p o Licensed Professional l
0 Pt� OWNER-BUILDER DECLARATION
,+� N 1 hereby affirm that 1 am uempt Into the Contractors License Trow for the
t following`!exon(Section 7031.5,Business and Professions CoJc:Any city or county $25000
p which requires n permil m emoswc6 alcor,improve,demolish,or mpmr any swemm
$ prior to its isamnme.also requires the applicant for such permit to rile o signed statement
m — 11vt Mixliryn¢d pursuant to the Provision,or the Ccmmetors Licence Law(chapter 9 Ft. Fo ArC$ Valuation
(commen'cingwirn Seeded 717100)of Division 3 of the Business and Prefosaksm Cale) I 'h�ly;^1'13 O'IjO1a� 'i OU�++.tit
or Ihni'he hi cxemPt themmand and the basis far the alleged c ieinption.Any violation
of Secdan7031.5bynny applicnm torn permit wb?cv,theapplicani toncEvil Penalty Ngmbe P
of nmmaethan risehumhmdollars($50m. 101 AP' FVL bATION Occupancy Type
❑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(Sce.7W, -'- '-'
'Busines and'Pmfessions Code:The Omand,',License Low does not apply to an 103 - UFER Required Insp'eetions '-
owner of property Who builds or imPmvcs,hereon,and who dna much work himself
or through him own employees provided[list such improvements am not intended or 10 4 - REBAR
oriental far sole.If,however,the building or improvement is sold within one year of
'-
cmarilltion,the owner-builder will have the harden of proving that he did not build or 105 - ANCHOR BOLTS
improve for purpose of sale.). _ _ 106 _ —_ SEWER & WATER
q1.as roomer nhhe propeny,am exclusively contracting with Imarmot contractors,m UNDERFLOOR PLUM_ BINceramic,
consct the Prsijec,(Su.7044,Business anJ Profusions CWe:)The Conven202or's �
License Law does nm apply to an owner of prnPlrty,who he Ids at i,oproves,Ihemon, 2 03 — UNDERFLOOR MECHANICAL
and who contacts for such projects with a canmctood Iiccomed pursuant 3o the
Contractor ',LicenseLaw. 204 — UNDERFLOOR, FRAME.
❑lam eisempt hmile�Sen;'.°"' ,B&cera`thin rta°n 205 - UNDERFLOOR INSUa` ION
Date
W,ORKER'SCOMPENSATION DECLARATION 301 — ROUGH PLUMBING
"o thertbyatR,mand<rP.aal1yofPeVor
arynheline,followingdeclarations: 302 — TUB & OR SHOWER
❑ 1 ou'a"Ind will innintmn or c�mricnte of cousin, in.elf-insure for worker. 3 03 — ROUGH MECHANICAL
'S compensation, as pnwided for by Section 3700 of the Labor Care, for the 304 — ROUGH ELECTRICAL
``�i perrom,dacd'ar
be work to which this PewJ is issued,, 3 05 - FRAME
" 0 have and Wt'nininmmWorker.Compnisniion'Insarnncx.uzreovimdbySehion 306 - HOEDOWNS
I boo of the Labor Code f6r the efforarorm&of the wo,y m which this perm ii, 307 INSULATION
issued My We kers C/gq�aPe at on Insor tt c rid/e r. Ey n l�lie a`c
, CII3TIFICATINOfEXCMvDiddlFROMIWORKERS-r { Q,41' 30;8'.5` .SHEETROCK.:.N,,; 1,� I,
COMPENSATION INSURANCL s' h3'O9 3iEXTERIOR' LATH' ._ .
. (ThhsReefiddneed notbe'completeddonpermitisfaun!hundreddollars 310%:-,i INTERIOR LATHi
(gluo�urle,,.). „ ..,, 311 - SCRATCH COAT
`vd"-'12enify that iodic performance of the work-for which,hiv j¢rinii is iuuW,l 313 — ROQF NAIL ,•,, - --
'Sliall'nm ormiky'any person in any manner,so as to heemara subject,oche Workers •• '
om
Compensation
ens
p! db n ' ICel,farniDa" 501 - FT:4,,%L ELECTRICAL ENERGY
C co
NOTICBTOAIPLICANr11a(levonk,ayd cdi.l. rLe pto .youimdd 502 - FIYvAL PLUMBING ENERGY - 'T - -
Z bee mesubIDctf the woke ac pro a nn s okofn non Cade:You mus 503 - FINAL MECHANICAL ENERGY
O O fonhwuh a mply with such p ns o thispe t hall be do d re okerl
GGG2504 - FINAL BUILDINGENERGY
F" olf .,CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL
oG 1 hereby which that theref Se I d ng agency for the performenc<
Ut the work for n<n ml Permit -issued(s 3o9a c,v.c) 506 — GAS TEST
W'Q _Lend aName ,
Fj Z Lend Address 507 - FINAL PLUMBING : ;r- .
U.O. I rtifythatIh ereadtldsappl i a tat�tbatthenhovc inormnn�is 508 - FINAL MECHANICAL
0 W Ems., rd ai I agme m comply with all city and county ordinances and state laws relating 509 - FINAL GRADE
C.7 to building construction,and hereby amhorire representatives of this city to enter upon
f�: m m mropwproperty r span npHm 510 - FINAL PLANNING
In Ovid ageeloweaM mnifyvnl kept vial si the City against
fp City lines mamumnm,esu and expenses bun may in any y e again,[emA 514 - F NA P WORKS
City m consegh arse!abbe grenung of Ilia P unh.
/ V v
I IC N NDHRSTANDSAM)Wit CO PLY,W1'11111 V 1 NON POINT Issued by;
Date
Sul L t S:'i ..
_ $16namrt,of,APVlicpnt/Com,vct.r "' Date Re-roofs
II� . FIA7ARDOUS MATERIALS DISCLOSURE"',
W II the applimm be future banding residing sore or hondl2'harandous materiel _Type of Roof. _.
oil defrcd by the Cupertino M n ppl CW Chnpmra9 R enJ Ibe H lib end Sn41y
Code Said 23552(is 1 r a 'a
QYeal I °i +'1 ! All roofs shall be': 'pected prior to any roofing material being installed.
-"' W II N nPI!li oaf `Rave nuilJ n6 ae�9n t nevie�s whi<h If a roof is installed without first obtaining an inspection,)agree to remove
'einil as defined by,he Bay Are,Air Quality Manag<mmai
DistoctT a, all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
�— 1'
`111m4 rehd'Ihe haem ous maieriols'myu,mmems under Chapte'6.95'of the
Cahfomha Heollh&Safety Cade,Sctions 23505,25533 end 2}574 I u derstend Ihm
if the hh dd g Iwsnot currently h c I that t any p bl',y m nmify,bc - -
oceuppn,ofd qct h I'which must be met prior to i.sn ite of a,C rflricate of '
°c Signature of Applicant Date
/ It oz-
ovine th rT—', Dine All roof coverings to be Class"B"or better
;_
.. ,. ., OFFICE