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CITY OFCUPERTINO
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BUILDING DIVISION PERMIT
,CIO1iTRACTORINN'UI.tMATI.(�
gT51615DDgTEVENS CREEK BLVD
EAST BAY REST SUPPLY INC
PERMITNG03030143
WW7'EIN"HID'OR BAKERY
49 4TH ST
PERM"S`ff 30/2003'
NE:
(510)465-4300
SANITARY N0, CONTROL NO.
ARCHITEC iENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
Job Description
I herby afRrm Nal I me licensed under pmvislou of Chapter 9 (commencing
with Section 7") of Division 3 of the Budneasand Profeuimtu Code.md my he.. u
in full from and affect.
TI -ADD EXHAUST HOOD TO EXISTING KITCHEN
Llei,ma Clus Lic.N
F I V AL E S
Date Comrecmr
ARCHITECTS DECLARATION
1 underaund my plana shall he used u public records
-
JUN ]. P 2003
LictimedProfessional
OWNER -BUILDER DECLARATION
License law for the
1 thereby .(Sec that 11. ,Bumph form Lha Canton;
(Section ]031.5, Butts and ons Co Any city or county
whichmeson.
oo. de h. or
which rcquiru a permit m cnnswm eller, imprcve, demolish. or repair any nnrcmmill!m
p
prior m its issuance. arm requires the applicant far such permit to File a signed statement
Nat he is licensed puauanuo Na provisions of the Contractors License law(Chapter 9
Sq. Ft. Floor Area
15 �1 tion
(commencing with Section 7808) of Division 3 of the Business and Professinu Cnde) or
that he b exempt therefrom and the bub for the alleged exemption. Any= of
31A&WG-fljMer0 0
Occupancy Type
Section 7031.5 by airy, applicant for a permit subjects the applicant to a civil penalty of
not more tun Ittm hundred dalbrs (S50y.
I,uowner of the prcpusy,ormy wploycn with vnguutlsu rete eampenuton,
dins fictions
p
will do the work. and bemuctum is not Intended or offered for sale (Sm. 7Bad. Bustled
and Pmfesdons Code: The Contractor's License law doss not apply m an owner of
102
- P I ERS
property who builds or improves thereon, and who dos such work hlmm1f or ulrcugh his
awn employes, provided Natsuch impremmenu are not intended oroffered for sale. If,
103
— UFER
however, the building or improvement is sold within ane year of completion, the owner.
builder will have to burden of proving that he did not Wild or improve for purpose of
104
- REBAR
"le'j'
105
- ANCHOR BOLTS
❑I, as ower of Lha Inaptly. am=elusively conuutng with licensed centnewsm
106
SEWER WATER
construct the project (Sec. 7014, Business and Profusions Cade:) The Committees Li.
- &
cemeLaw it= not apply toanmaw ofproperty who Wild, orimproves human. and ,
202
— UNDERFLOOR PLUMBING
who contracts for such projects with a cunmantor(s) licensed pursuant in da Contractor's
nm Law.
203
- UNDERFLOOR MECHANICAL
I 5. B&PCfat this—
/
204
- UNDERFLOOR FRAME
Data
205
3 01
- UNDERFLOOR INSULATION
— ROUGH PLUMBING
RK SCOMPENSATIONDECI RATION
I himeby man under penalty Of perjury ane of the following dcelarations:
302
— TUB & OR SHOWER
❑l lam and will mainwn a Certificate ofemuent m self -Insure ret WorkersCompon.
scion, u provided for by Section 3700 of to Labor Code, for the performance of the
303
- ROUGH MECHANICAL
work for which this PermhisIssued.
304
- ROUGH ELECTRICAL
❑ I nam and will maintain Wortrri CompensNon luurancc. u required by Sotimn
3O5
FRAME
3700 of the laborCade, farthe performance ofthe work for which this peoph is lamed.
—
My Worker. Compensation lnsunnce carder and Policy numberam:
306
— HOLDOWNS
Carrier, Policy No,
307
- INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
308
- SHEETROCK
This section need not M completed ifthe permit is forms, hundred dollan($1W)
309
- EXTERIOR LATH
or leu.)
310
- INTERIOR LATH
1 ani Nat or the performance of the work for which Opts permit b in' Co I snail not
nY permnin an mann anu� bbccUme mbleclm to Wortrn'Campcwuan
311
- SCRATCH COAT
Law °
313
- ROOF NAIL
Appli ,�_
N9TICE TO PPLL NT: rafter making this Certificate of Exemption. you should
501
— FINAL ELECTRICAL ENERGY
oma subject to Workers Cempensstion previsions or the fano Code, you must
iywith such provisions 0,0i,permi tes]Wdccmcdmmkcd.
502
— FINAL PLUMBING ENERGY
503
- FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
Irkthen
Ihemby ifirm that there its construction ardingagency far One per(annasce of
504
- FINAL BUILDING ENERGY
for which this permit Is issued (Sec. 3097, Civ. Cd
Lenders Name
505
506
- FINAL ELECTRICAL
- GAS TEST
Undice Address
I certify that I have mad this application and suss that the above information is
507
- FINAL PLUMBING
emrec9. 1 agree to comply with all city and county ordinances and sate laws renting to
building construction, and hereby aithodm mpcianmives of this city to enter upon the
FINA MECHAN CAL
above-mentioned property (or inspection purposes
0 9
FIN
(We) ague to um, indemnify ad keep harallets the City of Cupertino against
Iiabi uicsjudgmenu, costs andexpcuu which may In any way ucrue against said City
5
G.
in consequence of the granting of this permit.
APPLICANT UND STANDS AND WILL COMPLY W ALLNON-POINT
Issued by:5
WORKS Date
E UL N5.
O
Re -roofs
Type of Roof
in a Applicam/Cmitimi. Ll r Data
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building reception ame or handle hvardom material
as defined by the Cupertino Municipal Code. Chapter 9.12. and to Health and Safety
e. Section 25532(a)7
❑Yu
All roofs shall be
inspected prior to any roofing material being installed.
�No
If a roof IS installed without first obtaining an inspection, I agree t0 remove
Will the applicant or future building occupant use equipment or device. which
emit hazardous air conuminen dc5ncd by the Bay Area Air Quality Management
all new materials for inspection.
District?
0 a No
underChapur A.93 orthe Wilding
I have army the hvardtats mau05,255 spur
rise Health d:Salery Code, Scniaw25s05,23a3]and 25534.1 mnderuryowactupr budding
5
3 25534.
J not cmrtnty nam a an4 dart t b responsibility otify acempant n(the
su ,i c.
yu' h u metptioruissuanceofaCerUfma roc c.
Signature of Applicant
Date
All roof coverings to be Class "B" or better
caner or au ori7ed.ge, Dat