03100219 CITY OF CUPEWHNO s �' `»�"�'& '
BUILDING DIVISION PERM CONTitAC1ORANFORMA N `.
BUILDING ADDRESS: RICHARD JULIUS PERMIT NO03100219
22368 HOMESTEAD RD
OWNER'S NAME: PERMIT LSSUE DATE
RICHARD JULIUS 10/31/2003
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMP MECI{
l reOp LICENSED CONTRACTOR'S DECLARATION O O O
F 1 hereby affirm that I am liceved under provisions of Chapter 9(commencing Job Description
?zw with Section 70B):(Division 3 of the Business and Professions Code.and my licenm is
>>u, infell force andcrfeet. SIGN--A WORLD APART
>n? Dmc Class Conoractor NEW VINYL STICH—ON LETTERS FOR (E) LIGHTBOX
A.shelf W roe DECLARATION
I�< I undersand my plans shall be used az public records
>b,V
_0 Liccnsco Professional
_ OWNER-BUILDER DECLARATION
on
a S I hereby affirm that 1 am exempt(rum[be Contractors License Law Ibr the
OO following onenn.(Section 7031.5,Business and Professions Code:Any city or county
<m which requires a Morch to construct,alec improve,demolish,or repair any structure
o—'^ prior In its issuance.also rectums the applicant forsuch permit to rile asigned staremeal
IhathcisliccnseJpursmnuotheprovisionsoftheContracmriLiecomLaw(Chapter9 Sq. Ft. Floor Area Valuatio
alt-$ (commencing with Section 7")of Division 3 of the Business and Professions Code)or
x
that he is exempt Ncefrom and to basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjceu the applicant to a civil penally of Li Occupancy Type
not more Nan five hundred dollars($500).
❑1.as owner of the property,or my employees with wages as their$ole eompereaion,
will do the work.and Ne swnum is Bolintended urofr[led for sale(See 7W.Business egg a..,
and Proposition:Coda:The Contncmrs License law does not apply At an owner or SIJ aN�iNf �L em Required Inspections
Property who builds or improves thereon,and who does such work hims[R or through his
own employees,provided dal such improvements are not intended aroffered for sale.If,
however.Ne building or improvement is sold within one year of completion,the owner- I`IJ,/ eraoo�
builder will have the burden of proving than he did Bol Wild or impowa for purpose of !
sale.).
❑I.as owner of the property,am exclusively contracting with leased contractors to
consumer the pmjecu(Sec.7044,Business and Profusions Cade:)Thc Conmclor's Li. �UTA ®'�Q1
come law docs not apply to an owner of property who Wilds or impre ovthereon,andatm, G
who contracts far such projects with a coneactur(e,)licensed pursuant o the Contacmrs
License Law.
�,I'fnh e[mpt and ,Blkpcfir isr on
Oyne Deu�� se,
t WO 'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury me of the following declarations:
have and will maintain a Certificate ulceration,to self-insure fmWorker's Cumpem
sation,u provided for by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Workces Compensation Insurance,u required by Section
37W of the Inbar Code,for the patten ce of the work for which Nis permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W compleed if IW permit is for one hundred dollars($100)
nr less.)
I certify Nal in the Perri man ra of the work for which this Permit is issued,1 shall not _
employ any person in any manner so as to become subject m the Worked Compensation
Laws of Cal ifornia.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cent fica4 of Exemption,you should
become subject to the Worker's Compensation Provisions of the Lalmr Code,you mug
Z forthwith comply with such provisions or this permit shall be deemed mooted.
ZO CONSTRUCTION LENDING AGENCY ,
1 Mmhy offifm Nm there is a emendation lending agency for the perfmmamx of
L'7 be work for which this permit is issued(Sec.3097.Civ.C.)
A rZ Lender's Name
Lender's Address
D
J 1 eenify that 1 have read this application and suite that the above information is
LF coffect,l agree to comply with all city and county ominmocs and auto laws relining to
D U building consuredim.and hereby authome represenua tivof this city to enter upon the
„ above-(We) re in Sam for inspection keephs. /
(We)amen to save.actualexpenses
and kith harmless the City of Cupertino against
N liabilitie,judgmcnts,cmn,and cxperhscs which may in any way accent against said City
Z in ennsequenec of the graining of lhi emir.
APPLICANT UNDERS NO ILL COMPLY WITH ALL N-POINT Issued by: DatLr
SO HIS. If
3Re-roofs
Signing fApptiamucced r Data .
HAZA OUSMATERIALSDISCLOSURE Type of Roof
Will the applicant or future building oeeupanumm or handle havardous material
as defined by the Cupertino Municipal Code,Chapter 9.12.and IW Health and Safety
Code,Section 25532l.)? All roofs shall be inspected prior to any roofing material being installed.
' ❑Yea l�
Win the applicant or fwuro building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it M1aramnu5 air contaminants as defined by Ne Bay Arca Air Quality Manamcment all new materials for inspection.
uict?
❑Yes o
I have read thc ho ad -aerials"'uiremcnts under Come,6.95 of the Califon
Dia H.IO,,Sada Cndceecdnrs 255!1 l 25534.I undcrsund due ifthc Wildin
once,not anti yM1uve :nam. s my expersOully m nouly i c becupN I the
mu' a el tub a CmifealcofOcct c. IS Signature of Applicant Date
q �p /-� pe-3i—d'3
Owner M autumi.olagenl Dete All roof coverings to be Class"B" or better
ADVANCED PROPERTIES, INC.
P.O. BOX 5399 SAN JOSE, CA 95150-5399 TEL. (408) 247-5511 FAX (406) 292-5767
October 30, 2003
To whom it may concern, %N
CE Curs
I ani approving the signage for the Business-at Homestead for "A World-Apart — Healing
Arts Martial Arts"
Regards, OCT 3V 2
BY:
Larry Hull WPPROV D VLOT ,P—
President IN ACCORDANCE WITH THE CITY OR .•t
QUEJERTINO COD AND ORDINANCES •�
DATE DAA
SIGNED P I
• This set t r ar.. ^ — . .i,cations fdUSt
be kep. 5 tl:e i • ,i 11,110's and it is un AAS
I. I to make :,,.y c•,", or aIle n!
c same Wi;hmit W li,1 po!nl:ssior ror.
e by 1c ' Cupe ' part
the nlpic ai ; p a 1110 ecilit ium
aHAL Or e h 1 to I rnil f,l ar
ippfovat m the v oiau r any p c.s Ru
�' nnv Citv Oidinarre .^.r Mata ;aw
Heading Arts /Martial Arts
Post-It'"brand fax transmittal memo 7671 x of pages r
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CITY OF CUPERTINO p
• CUPEkTINO PERMIT APPLICATION FORM
APN# 32(v O 1 _ Qv? Date: 10_ 30 -03
Building Address:
aa3 68 }�ow,e s�zd Road C� C.�+, wb
Owner's Name: "A a r l Phone#:
Rictlx.d J'ul;, �s zit- " L40T -.o6- yoao
Contractor: License#:
Contact: Cupertino Business License#:
Building Permit Info:
Bldg Elec
Job Description:
l��e�,o sir, l -st-,'�k-or. lctkrs �or exi's-hh li 1,-I-6ox
Residential: El Commercial:
Cost of Project: 100 — Monument: El Mounted on Building: El
• Qty f
A Ic le Fee ID Fee Description Fee Group
BENERGY Energy BUILDING
BPERMFEE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BSEISMICOM Seismic Commercial BUILDING
EPERMITFEE Elect Permit Issuance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Rmdl Sings, Marquee ELECTRICAL
BUSLIC Business License BUILDING
Z 24, z/
•
CITY OF CUPERTINO -ct 4� Iir
BUILDING DIVISION PERMIT CONTRACTQR INTORMATION .�
r�� • v a,,. s
BUILDING ADDRESS: RICHARD JULIUS PERMIT NOO 31002 19
22368 HOMESTEAD RD
ER'S NAME: PERMIT ISSUE DATE
RICHARD JULIUS 10/31/2003
F ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INPO
BLDG ELECT PLUMB MECH
+Op LICENSED CONTRACTOR'S DECLARATION Job Description
£w I hereby art,,.that 1 am licenced under pmvisions of Chahar 9(commencing p
Z� with Sceneo]Blgp of Division 3 of the Business and Professions Cade,and my license is
in pull to=and drfam. SIGN- -A WORLD APART
License Cissa Cmd NEW VINYL STICH-ON LETTERS w;OnR�(kL�yIGHTBOX
f O Daa TS DELL r ,V F', a
six ARCHITECT'S DECLARATION
I¢ 1 understand my plans shall W used ss public records
)yU
°oy LMcnscd Pmfcssional ryoO3
OWNER BUILDER DECLARATION NOV. 0 L
ay T hereby It,.that 1 am exempt from the Contractor's License Law for the
00 following reason,(Secdun]ID IS,Business and Processions Code:Any city or county
m which requires a permit to cannot alcor,improve,demolish.or repair any structure
-iy prior m its issuance,also requ,ms the applicant for such permit to file a signed statement —sa ii
< (hat he is licensed pursuanothe provirmnsofthe ContooLm'SLicense Law(Charter 9 Sq.Ft. Floor Area luatio -
2Ftt
0 (commencing with section]000)nr Division 3 of the Business and Pfofcssions Code)or
that he is exempt merchant and the bssb for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of Occupancy Type
not mom Nan five hundred dollars(S500).
0 I,as owner of the prepdny,or my employees with wages u their sold compensation,
will do the work,and Ne svumum is not intended or offered for sale(Sec.]Odd,Business
and Professioes Code:The Canuator's Lt..law dots and apply tp an owner of Required Inspections
pmpeny who builds or improves themon.and who doessuch work financial through his
own employees,provided that such improvements ere not intended at offered for sale.If,
however,the building or improvement is sold within one year of completion.Ne owner.
builder will have Jus burden of proving than W did not Wild or improv Tea purpose of
aalc..
0 1,as manor of the property,am exclusively contracting wish licensed contractors to
sonnet the pmjcct(Sec.]Odd.Business and Professions Code:)The Conuanor's U.
me Taw door not apply to an owner of property who builds or improves shemon,and
who contracts for such projects wish n eonmanm(s)licensed pursuant o he coram can
Lice=Law.
0--r exempt and — .B k PC fm Isisr or
lopr'� Date 'ff
WORICER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury arts of flue following declarations:
0 1 hoe and will maintain a Cenificam of Consent to self-mat m for Worker Compcm
nation,ar provided for by Section 3700 of Ne Labor Code,for the performance of the
weak for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance,as required by Section
37N of the labor Code,for IW performance of Ne work for which this permit is issued.
My Worker's Compensation logo.ce canner and Policy numb,am:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION MOM WORKERS'
COMPENSATION INSURANCE
(list section need not W completed if the permit is for one hundred dollars($la)
less.
I candy that in the p irloonance,of the work for which this permit is issued,1 shall not
employ any person in any manner an as to become subject a the Workers Compensadon -
Law s of Caliromia.Da¢
Applicant
NOTICE TO APPLICANT:if,after maki ns this Ccnifca¢of Exemption,you should
becomes subject no the Worker's Compcnution provisions of the LsWr Code.you must
7Z fon Paith comply with such pmvisinm or this peran, hall W deemed ranked.
Z O CONSTRUCTION LENDING AGENCY
I bemhy affirm that Dart is a construction lending agency for the Performance of
Y. .�. thework ainhthis permit is issued(See.3W].Civ.C.) C
A lender's Name
Z)
Lender's Addddmas
Z
Q I ttnce that I have read this city
and county
and sins that the shave information relating is
LU cortdin 1agreetd comply whey city and coumyoNinantts this city
lawsrelatingto
e
D(J "Now-mennswdtisoetryho¢byauthopurposesenutiws of thiicitymenar upon the
S ahovc(War are property for inspection edibility
purposes. /
(We)agree to saw,indemnify and kith hanallen
an w City of Catacomb against
Iq incoitiequencmenu.emuan .1' I caoMrn may in any way acerae against mid say
J z in conscyucncc of the graining o(shi (mit.
APPLICANT UNDERS NO ILL COMPLY WITH ALL N POINT Issued by: Da[
9
so G NS.
3 Re-roofs
Signa l'ApplicanUConl r Dane
HAZA GUS MATERIALS DISCLOSURE Type of Roof
Will the applicam or future building occupant store or handle hevaduus maarial
u defined by the Cupertino Municipal Cods.Chapter 9.12.and,tW Health and Safety
oder Section 25532001All roofs shall be inspected prior to any roofing material being installed.
0 res 04,
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
emit haaardnus air contaminants al defined by the Bay Arca Air Quality Mangcmcm all new materials for inspection.
District?
0 Ycs
IhavcreWthelocaMnusmare is cntsunJcrChaplxr6.95ofdmCalifm-
ranHealth&SafetyCode,Sccmms2551, J255Jd.lunJerstaM shaif the Willing
dads notc;LI haw y pmmibillty to notify the aYup�tpI Nc
mgnw' swr�iic ['ba@ctp l`�isyande ceninw¢orQdupancy Signature of Applicant Date
/l / O-3/-o`3 All roof coverings to be Class "B"or better
Owner or au(horived agent Date