05100207 C[TY OF CUPERTINO r > "g'
BUILDING DIVISION PERMIT �N..,TRAC,T$ORIVFRMATION
ILDING ADDRESS: HARRINGTON PERMIT NO.0 51 0 0 2 0 7
350 HOMESTEAD RD
ER'S NAME: PERMIT ISSUE DATE
THOMAS E. HARRINGTON 10/26/2005
PHONE: SANITARY NO, CONTROL NO.
BUILDING PERMIT INFO
ARCHITECT/ENGINEER
:
BLDG ELECT PLUMB MECH
At" CONTRACTOR'S DECLARATION Job DBSCIIPhon
V 1 hereby affirm that l am licensed under providons of Chapter 9(commencing
with fh5«ll aucea]�nd @cDivision Jafthe Busi W
aPro(ssioesCod ,anamylicw isin TEMPORARY PERMIT - COMMERCIAL -COFFEE SHOP
,q3 ld<cnm Class Lk.N FOUNDATION ONLY
t=o Dam Contractor -
ARCHITECTS DECLARATION -
5a -s 1 understand my plans shall W used as public records
;p� Uemcd Pmfcramnal
S OWNER-BUILDER DECLARATION
g1 hereby affirm Nat 1 am esemPL from the Conun
aors License Law for she
E o o fallowing mason.(Section 71n 1.5,Business and Pmfec imu Code:Any lily or county
a m which requires a Permit to consw<L aust,improve,dcmnlLsh,or repair any structure
IaZj, primtoitsbauame.alsortquimstheapplicantforSuchpermittofile.signedsu¢mcnl Valuation $0
s< that ha a licensed pursuanttothe pmAsiomofthe ConuactoriLicense law(Chaptm9 Sq.F[. Floor Area
(commencing with Section]OW)of Division 3 of NC Businessend Pmkssinm Curia)or
i 3$
that he is uempl Nerefmm and the basis far the alleged escmption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil pcnatty of 3 Ap7J NTpmber00 Occupancy Type
a0,mare than five hundred dollars(S500). 2 6 M 101$ .
❑1,u owner of Ne propmy,a my cmpl.yces with wage as areir sole campewu.n,
willdo the work,and the Ywnme is notinmMed or offered Inroads(Sec.7W.Business
and Professions Code.m¢:Conuactle.Liccnsm Law does apes apply m an owner of
p,opinywhm buddsatsmpr' Ne¢on,and whod.1,uch work himself.,through his ] ♦
...r-- ._
own employees pronded Nas suchimprovementsare not u dW aOBacd for sok If Y}�• h C
'
however,the Wilding to jeepeovc.ocrat I,soldwithin one ya.ore.mpl iso,Ne
budder Bh ve Jia,burd fp ng Nath did not Wild ormp f7purposet,
1 p a Property,oY g. on liansrd ono. W
s Of da, am exclusively Professi ...._. ._ / {
sale
who contraochre Law cts)r such projects with arc f on tur(s)1,c se Pursuant m the Convacmp I
construct the mels(Se ]Oas,Bus nev vad PrOPssrom Cole)Th<ConuaclMSln_. __._......__.._.__._—__._..___._.....,_.-.___.............._'.__._.__ V�_._...._..___.._.-._._,_...__- ...
not apply pr pe Y w Proves thatemr,and
[KC LAW. ' h, ,.♦ ..v _�1` � ..
nm u no t undo Sec. .B&P C for Nis resson
r /
Data L
J1.WORKF`'SC M NDECLARATION
LL v
ebY alarm underpen ryof perjury as Of the fallowing d«Iansions:
,..___.,.._. _._.._________,__._..._..____._._....__.__.____...
❑Ihsm and will mainulneCcnificom of Canscmm.ulbinsum for Workcfs Compcn- -
CI action;as provided fooby Section 3700 of the labor Code,dor.No pedormence o(.the;
.... ,ore �,
work for which this pamil is Issued.�n:;i:::ar••... (<ecv.fn:r.,+ml,-;•Src,_i• .
❑1 haand will'Wainuin Workers Compensation Insurance,as requirtd by Secti.n�
-' 3700.1`1 Labor Codc:for the perfmniiindcof Ne work(orwhic i thisponab is issued.1
My WOhers Compensation lmunna.iicr vlO Policynumber ore:--'-"_""-"
..s'
%l Caoiec'.',-:•:•avu:n..>P.uh,i!t:u rel as Policy Na.:.:
f %' .CERTIFICATE OF EXEMPTION FROM WORKERS'—.____._.
I,a .- �.r:rid COMPENSATION INSURANCE
,1(This don held not«completed titan,Permit is fararc bundmddOgam 81W)I
mkss.)
-r 'l cmf th1 M P I rrrrFc t Ns tn
wo f, .hc mls sued lsh lltl ...... _ ._ .. .. .....
II c I s•
P
h
c ploy.y on in yman m e n u «iso aWarkcrY C.mpp soup I r (t
r Laws a¢ .. . '
.App)
NOTICET fa n :i iCnlfidis ofEmnti.n yos1W WL ..__ . . _ ..... .......
bttd e s Ito Ne Wo rs o nv to pro s an of No loan Cae Yo mess) +s JP, i t - r.� 'Il' 1 y- .:O
,Z foM N mplj•wIN'such Pm s uv tar N Fe II shall be die d mroked t
.7. l 1,: 1
CONUCTION LENDING AGENCY s "
(-+ � 4 r11 be bY.Rrm SIA
Naz rc
Ncs town nland E Gncylnrthcpefum+rnc 0 _ r f .f...- . .. ._ _ .. . ...
W 9 dit'work f h ch Ws permit Is.old(Sec309] Cu.C)
V j•e 1 comfy Wer'1 h read shrrapplkat er and rude Nan the am.Infoimdbun sl ""
Iy F <64<a,1 agree to comply with all city and county ordinances and sou laws relating in 1
V
building consWction,and h hereby auhads mPresemstves of this city to cater ups the _- _ _-- .- ---� -� ..I
r a, shove mens tined pmpeny for v coon PUT ms :•"l 1 - -
( (We) grt to sae Inde fy and keep harmless he City of C pat o ago ual
`U baEilwcs ludgmcnhe road this
which ,aymany wayacetol againsssaitl Cyt -'-
C) mcottu «cc of the in n6 (Nis permt "" "-' — - ,:, r
A 1 NT.UND N 5 ANDWILL,COMPLY WITH AL NON INTI Issued by: ' Ddle �— (��tw QOM
ERE O
t.� _::_ t Re-roofs- _.. _ ..
i tore of TrenV m ct r- "' - - D i! or
2ARDOU MAT
RIA
DISCLOSURE .-�•n,:: Type of Roof
_-Will Nc pylc a fm b l 6occ pa lsmrc l dl hoard amaterial, .. ............ .. ..-........._._.__ _.. .::: ..rv:..:! - . .,.:-._... _.
Idcfined by,this n. ."u Code1.Capscr 9'1'3'J d lueHallb andSafety l - T.,II I„
eJa S«Uon15532 d)> a a n-e )''^ " "'" " '"`" d I
All roofs shall be inspected prior to an roofin materia
+ - ❑Yelp 1< sC - . I : 3 a. s II P P Y g l being Installed.
I; If a roof is installed without first obtaining an inspection,I agree to remove
W II the app) ant or row c b IJ n & pat ase eyulpmcnl dev c which
coil ha and m m c um nano as d cd ny Nc B y A a A r Q afiy Maoagc a t; all new materials for inspection.
ban a+ a
I - i ❑Yes _.
j.. . e . e a
' l have rtaJt Nc haaaN,Nfmamr'alkrtyuirdmbhu uhr6r Chap¢,695 ofNc CaT or�I
` niaH N Safety CoEc:Scctioris 35 5.3517 ana 355Ja;lundcrstaM Nazif Nc Ful ea,
t; 1 n11ytilM is alt. ro Y po aEl ry'Io tifY lac Putt (Nil
cyte ee nmm d 1 a -facetnn<at<.ra pane,"' SignatureofApplicant
Dale
-poi . �1 I 3:; �` ;'. ;All roof coverings [o be Class-"B"�orbetter•:•11"