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05110002 & 05110003CITY OF CUPERTINO 0. to 777777 7777x MCON,RAC Qii INFORM TION .,, BUILDING DIVISION PERMIT BUILDING ADDRESS: ...rNO. 05 110002 10026 ORANGE AV PERMIT ISSUE DATE ff' 05/04/2006 PHONE: SANITARY NO. CONTROL NO, ARCH11ECTIBNGINBER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions Of Chapter 9 (commencing with Section 70W) of Division Sof the Becomeas And Prolummin Com, and my Ilmust, 1. in full prom and Affect. MULTI USE-COMMER 1,932/RESID 3022/GARAGE 47161 Liccust Class . N RETAIL 10026/CLINIC 10028/RESID 10030 ORANGE Dam- Coal=. ARCHITECTS DECLARATION 1ST FLR RETAIL/CLINIC 2ND FLR RESIDENTIAL I understood my plans &hall he used As public =arm Licensed! PrOfessionat OWNER -BUILDER DECLARATION I hereby sifter that I Am Attempt from abse Contractor's Licensc, Law for the following ocamn. (Section 70313, Business and Prefemions Code: Any city or =my which mpoon a Permit w coneramer, sher. unprave, dcamollish, or rapur my stromma prim A, its inuom, amu requires ft applicant for Such permit On rile a signed comment t1.(ch%Puur9 Sq. Ft. Floor Area Valuation that Am is IMnAcd purecoulothe Pnoisims.famccomwesij.. (Commanding with Section 7000) of Division 3 of the Business and PFOICWOAS Code) Or $676567 ,at k IS exannin �fmm and the Mail far the WkScul exemption. Any violation of Section 7031.5 by any applicant for I Permit Schism; the applicant W A Civil Penalty Of N Number Occupancy Type ma, now, thon, flw hundred dollars MM 0 l.u"mofftprGperly.mmyemploymwlLhm9muLhc4wlccQmP�d0fl,9. 0 Required Inspections will Cut the work. and the structure in natimsenstd., offered follue (Sao. 70", Bull=& and Pradessional Code: Th. Commumel License LAC, dom, Act apply an an Owner of property who build& ar and whodoessuchwar1rhimucelfor through his am employees. provided domarch Improvements m mat intended arraffercal forsole. If. however, dam building or Improvement ustaid whaincurs, year OfCOMPlek", dus culem- builder will haw alle hurtles, of proving that the did Cut build ar improve for purpose of L Z AS Cm. of an, muttony. Am anottesvely connecting with ficlonsed contralmors So Contract the Project. (Sm. 7044. Bonfinsem arld Processions Code:) The Commumm'S U - came Law does not apply An, an owmer or property who Writer or impraw, thereon. and. who comostrus for such projects with a contractor(s) licensed pormarn, to the Contractors License Law. ❑ 1 Art "Crept under Sao 3 IS P C far this Accomen Data I - 4 - 04 , WMICER'S COMPENSATION DECLARATION I hereby airman under penalty at perjury One, Or me, following decurations: 0 Ih.vcmdA,IIIAmimAiAaCAmAflC*WQfC - Am - 1WSAIf-IAAAAAf0rWmmesC-mP--- sation, a proAded for by Section 37W of the Labor Coda, for mr, performance of ran wart for which this permit is issued. 0 1 haw and will maintain Workers compensation Tinacurum, As m4ulted by Section 3700 oftha LadomCaft.far the penforomence Arrive, Avalk forwhich this Permit is lasua My Workers Compensation Instrument Cartier And Policy number M: Cmur,. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE mals scemm lead mat no Compuma tragi permit is for One hundred dollen ($IW) or to.) I ccrilly also in the perfarersoul of ft waste for which this parecit is blood. I "I not employ any person in my Man As eMerl wthe Warkers'Compensuarflon CG Laws of CLItfornADPliant 9m - �� become subject AS ran Workers Compensation provissical of ft Lmor Code. You anual forthwith comply with Such Provisions Or this permit shall be, Accrued revoked, CONSTRUCTION LENDING AGENCY I hemby &Mm Our them is. conmanumn lending agency far the ISCrIamearear of are worl, far which this Permit Is Wood (Sm. 3097. Civ. C.) Landers Name Lenders Address I Certify that I haw M44 ties Application AM SIALC that the Ableva information IS Curtner. I &SM to comply with all city and county ordinance and lute laws miming to building convection, and hereby authorise reprarentativeSt of Oil city to enter virm the albove-mentioned property for inspection purpose. (We) agree to Am, indemnify and Imp, homeless the City Or Cupertino aSaWt liabilities. judgments, costs and experoseas which may In Any my accone Against Said City in Consequence Of the Smoling Of this Parnank. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURC! L)SUS HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future Wildugmep.19can . handle hastrumbel forlaCrul del y Cummuse Municipal Code. Chap= 9.12, and ft Health and Sarely Section 25532u)? Yes JJ All roofs shall be inspected prior to any roofing material being installed. 0 If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant ar future building oampant use equipment " dcAcan, which emit WCAmous air commalrants a deflned by the Bay AM Air Quality Management all new materials for inspection. District? VN. 7 0Y.3 I law read die hanAmusnumflals requirements underobapsor6.95 oftheCalifor. rdsHoul"S.letyCalle, Soman,25505.25533 md25534. I undualmand Lhatifure building does not Currently new a Molmd, that It is My mabovelhilitY W amity the OCCOPME Of She requiem A It Signature of Applicant Date =WWsweaccofaCertificatoo n 7_ All roof coverings to be Class "B" or better or mthouirml AS& film OworKR CITY OF CUPERTINO"-. CC)1V.TRA..�# TIS ± 0 BUILDING DIVISION PERMIT t �H �J t I .. BUILDING ADDRESS: PERMIT NO. o 5110003 10026 ORANGE AV R'S NAME: PERMIT ISSUE DATE 05/04/2006 P ONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG EO PLUMB MEOCH LICENSED CONTRACT'OR'S DECLARATION Job Description I hereby affirm that I am licensed under provision of Chapter 9 (commencing with Seen.. 7000)oI'Divistort 3 of the Business and Profession Cade, and my license u i. full tam. wdeffen. COMMERCIAL BLDG. -19321 License Clans m THIS PERMIT IS FOR FEES ONLY/SEE #05110002 tra Dam CConulnctor ARCHITECT'S DECLARATION I understood my plan shall be used u public reenrm Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for me fallowing mason. (Section 7131.5, Business and Profession Code: Any city at county which require a pemtit to convect, alter. ]mpmw, demolish, lir repair my structure prior m its issuance. aim requires me applicant for such permit to Rle a signed statement Contractors U... Law 9 Sq. Ft. Floor Area Valuation Thu he I. licensed pursuant to the provision of Ne (chapter Scedon 7000) of Division Sof me Business and Profession Code) or $206127 (commencing with that he is exempt therefrom and the bash Be the alleged exempdon. Any violation of Section 70313 by any applicant for a permit subiecu the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars (SM. , 1, u owner of the Kepwy, m my employes wire wage u mekmio compemdon, 3 5717069 09 - Required Inspections q P win an mewadr, and me,vucmre is natmunded mattered formic (Sm. 7044, Business and Profedon ax Cade: The Contractors LicuLaw dors uct apply to W Owner of property who builds or improves thereon, and who dues such work himself m through his own employee, provided But such Improvements am not inunded oronered for sale. If, however, the building wimp onament Issold within one year of Completion, the "net- wnedbuilder builderwill have me hurtle of proving mat Ice did not build or improve for purpose of v_k!). IJr1. as ower of the properly, am exclusively contracting with licensed conuacmre to construct the project (Sec. 7044. Business and Prafedon (.'ode:) The C'ontractor's LIS cane law does not apply to an owner of Property who build, or Improve moment. and, who contracts for such projects with a conwcser(,) nemsed pursuant to the eontractnes License law. ❑ I am exempt under Sea . B d P Cs/for r�this �m�oron 046 . DECLARATION I hemby alarm under penalty of perjury one of the fallowing declare0ou: ❑ 1 ham and will maintain aCo snicam of Cometh to self-ineum for WorkersCampm- saBon, as provided for by Section 3700 of the labor Code, for the performance of the work for which oris permit Is baud. ❑ 1 have and will maintain Workers Compemadon Insurance, as required by Section 3700 of the labor Cade• for the performane of than work for which this ponedt is ]need. My Workers Compenauon Insurance carrier and Policy number toe: Cartier: Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE v (This action need antbecmnplered nOle permit Is fmonc hundreddollars ($100) or lost) I count that in the performance of the work for which this Farms is lamed. l shall icer employ any person in any manoerso as to bommc subkct m me worker' Compound. law. of Canis Dalc C_-1 6 ' APPIieanI NOTICE TO CA ing this Conincam of Exemption. you should become subject to the Worker's Compensation provisions of mo labor Code, you muss ' • forthwith comply with such provision or this permit shill be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby ih that mem is construction lending agency far the Fodomramm of s 30 theLo work for which this permit h issued (Sec. 31M7, Civ, CI Win Lenders Name Lenders Addrea j I comfy that i have red this applicuion and sum that the shove information Is ' correct. I agree to comply with all city and county onflo aces and sok laws relating in Wilding construction, and hereby authorize mpresentative of this city to enter upon me above-mentioned pmpcny for inspection purposes. (We) agree to an, indemnify and keep horrnlees the City of CupcnmO against I Imbllltie.judgmcnis.co,usnd expenses which may in my way amus, agalmt.seid City in consequence of the of this swung permit. a APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date 7 SOURCE REGULATIONS, 0 s F. f[ • Re -roofs Sigatic/��pptracf Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant Or frtum building mempanutom orhandlc lecommn mamdal as denned by me Cupemna Municipal Code, Chapter 9.12, and Bm Health and Safety Semon 25532(x)? ,/ All roofs shall be inspected prior to any roofing material being installed. El Y. JNa If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or device which emit hmwdous air conuminnu as defmed by than Bay Area Air Quality Management all new materials for inspection. District ❑You I haw read me haardou mamdehmquimmenu underChapmr6.95 ofthe Califor- ilia Healer& SafctyCUk. Sc d m 25505.25533 and25534.1 undersand muifthc building does not currently haw a meant, mat it h my maponihility in wedfy the mcuPant Of the mquirtmen which muse be met pilar to issuance OfeCcrBOoacul aepartcy- Signature of Applicant Date " -� 44Dam All roof coverings to be Class "B" or better Owner ommarl e m