05020106 CIfin/,v •rl rr.., ^rFti Jtl w ,,let ' ' ,
OF CUPERTINO
BUILDING DIVISION 1kX6T0IV1I -11,
MAT.a 1,„9N 5R]
T
BUILDING ADDRESS: PERMIAN BUILDERS INC. PERMITNG05020106
050 PRTJNRRTnrTP. AVE.
OWNER'S NAME: PERMIT ISSUE DATE
AMES AVENUE AS
E: SANITARY NO. CONTROL NO.
510 979-9081
ARCHTIBCr/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Z O O O
�Op LICENSED CONTRACTOR'S DECLARATION bf��scri von
Z i hereby affirm TNI 1 un licensed under previsions of Chapter 9(commemJo
in� bird ip -
with Suction 7000)of Division 3 of the BusiM••and Profcssimu
'rS�FZ Code,and my Holme is
aaandrcem
iceroCam DEMO (INTER. WALL/ELECT(//nn
�AF /OFF)Dm
Contractor
LO ARCHITECTS DECLARATION /I/J b
I understand my plans M ns shall used u public natural 41162,
7
u
Licensed professional
,3 OW NH a wraDER D the Col TION UB OS
'v� f I Mosby effuse that I am scampi from the Gonias o Lienee city
o roe the
D D followhich re mean. smell n]11313,Business and improve.
doeon Cade:Any caty m county ((//��
$�a which its issuance.
•permit recuses the aha.imprew,d such permit t,fie a sigany annumnon
xN
poor roiuiuwnoe,tlstarcquims pro inion nt off Courrermilm filcense,Law(Chned ental(Chapter
$< (cannot ncarnedpumnmmNeprevisision3 NConuammYLaemcliw(CNpmr9 Sq.Ft.Floor Area °U Valuation
(commencing with Sedon7000th basisofr nfde Businnssand ProfeuinmlU,an)of
Out N u aaempt Wertfrem and Oe souse fm de alleged eaemp0an.My v1oIW'a a(
section 70313 by any applicant for a permit subjects the applicant he a civil penalty of er0 0 Occupancy Type
not more than fin hundred dollars(5300).
❑1,u owner offt property,m my employce,with wages u Wetrsele aw
mpe0on,
will do the work,and Wencom a Isom Intended oraReled foraale(Sm.7044,BIILmH
and Prefusimu Code:The Com ider's License law does at apply he an owner of Required Inspections
preperty who builds or ImPmwa thertan.and wed does such wart himselfor Omagh his
own employees,provided that such Improvements art not inteeded morcered fmaale.If.
hawmer,the building or improvement)s sold within aft year of carnpletimn.me mwtn-
holder will haw the burden of proving that he did not build or improve for purpose of
sale.).
❑I,u matter of the pmperty,am exclusively contracting with licensed contractors in
consmat the project(Sec-7044,Business ad Profession code:)The ConuumM1 Li-
ane law does not apply to a ppan r pro Iy who builds or improves Hereon.and, .
who contracts far each pre W n r(s)licensed puts nto the Cunractoh
License law.
❑Inst exempt .Ba PCI this
Caner Data 7
7r ,13y
SAMON DECLARAnONI herebyffirmrjury am of the following decIan6.nf:
NwandwlllmsifConscn11ose1GimureforWarkertCompen-
provided fmf the labor Code,fur ted performance of Oe
1307M
for which this permit is issued.
Nw ad will mainWn Worker's Compensation Insurance,u required by Sedan
of the labor Cede,(ar Oe petormaa of drc work for which this permit is InucdWorker',CamlKmeda lnwnnce carrier ad Policy number arc:
er. Polley No.:
CERTIFlCATE OF EXEMPriON FROM WORKERS'
COMPENSATION INSURANCE
(This recd..mad not M compleedlfthe P5"h is fre on handled dollars f$100)
or ,
1 certify diol In the perform c ht this permit is issued.I Nall We
employ any person in an cash ttathe WorkeriC mpcnedon
Laws o(Callfomla.Dal
Appllanl
N017CE III APPLI orkr's Co imp Nis Certificate of Eaem ren,you Nau1J
become abject m de enation provision of On Isbor Cade,you must
.J O foMwith comply with such press ns car this permiuhall be deem d rtwkcd.
Z^” CON CDON LENDING AGENCY
INreby all.that ft.a.connotation lending agency for de pcdormance of
dte work fm which this permit Is issued(Sec.3097,Civ.C.)
GQ Lender's Namc _ —
=z lender's Address
U Q I edify Orel I have mad this application and cute Oat the above Information I, '
{L" correct 1 agree to comply with all city and county y ordinances and slaws mating to
Q building construction,and hereby auhodx mpresentadws of this city to enter upn the
W aMvmmendomd pmpcny fm Inspection Purpwes
(We)agree he saw,indemnify and p hsrrnleas the City of Capetian against
.�.t VJ Imbiliti judSmenu.c u de sen hmay In ay",isocrue.gaimamid City
neonU APPLICANTca O t f s ILL COM LY WITH ALL NON-P01 Issued by: Date
SOURCE R J
Re-roofs
signals rc f I US MATERIALS DISCLOSURE Type of Roof
111he app am arum buil ding occupat store m handle harardon material
e defined!by Irk Cupert MaiNpal Cade.Chapter 9.12,and the HcsiN a0 Safety
cede.sella.ss33z(a) All roofs shall be inspected prior to any roofing material being installed.
❑Ya ❑No
Will the applicat car furore building occupant use equipment m dcvtaa which If a roof is installed without first obtaining an inspection,I agree to remove
he farm air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
le17
❑Ya ONO
I haw mad the basrWma ma¢riay quimmenu under Cham,6.95orthe Csiifnr-
niaHrulNd:Safct C/c, I .3336 333 ad 253N.I unMnwd Ouifdw Wilding
does no,cu ) a s s my fponuhiaily es unify We occupant of the
requiremra h R i/ CI oisaua ofaccrinateofocaupacy. Signature of Applicant Date
own . I to e D
All roof coverings to be Class"B"or better