08090190 CITY OF CUPERTINOBUILDING DIVISION PERMIT CONTRA.CTQRTI�'k'f3�'IAT101� `.
Bu1LglVALID1eEsSERMIT NO.
STEVENSTEVENS CREEK BLVD B & J SPECIALTIES 08090190
ad Its.
lipNER'S NAME: PERMIT ISSUE DATE
PINN BROTHERS P 0 BOX 7783 09/29/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITEC/eNGINEER: BUILDING PERMIT INFO
COMM'L TI NEW WLS &8 ' PRTN 'BLDG ELECT PLUMB MECH
O O O O
trop LICENSED CONTRACTOR'S DECLARATION ^^^^ ^ •�^ ^^^--^ --- Description
Job DOn
�a C 1 hvcby JErm Nu I un licamcd umber Provisions;of Chapter 9(commencing -- • •-t^
t� with Section 7")of Division 3 orthe Businrss and Professions Code,and my lkcnxu
m full forte amrd effect II g 70
O Z license Class VtSN
��— Da¢ 9-2 —Cantrarmr
jARCHITECTS DECLARATI J
1 uMenm al my platy shall barred as public means
at 6
bOtm Licensed Prefesvonsl
5 OWNER-BUILDER DECLARATION
qqtyy I.Mmby aRmm Nal I am exempt from the Convector's License Law for the
COO following moon.(section IDl I.S.Business and Paefeuium Code:Any city ar county
$ which rtqut. ,Permit an constmee ahem.improve,demalsla an mPuir any structure
prim in its Issuance.than requioa the applicant forsuch permit to like a signed sumnmnt
xp Nat he s licensed pursuant an the Provisions athe Commutes viae Law(chapter 9 Sq.FL Floor Area Valuation
1-$ (commencing with Section 7000)of Division of the Business mid Proreuions Code)ser
that he is enempl thwarted and the bass for the alleged exemption.Any violation of
section IBILS by any applicator less permit mtaimUr the applicant an a civil porosity of APN Number Occupancy Type
area Free duo live hundred dalsn(SM(B.
0 I,u owora of the pmprsty,w my=Plruyms with wage,u theta tyle cmnpensadon,
will do the work and theaVucture Is.,mounded maneaed forsabe(Sec.70th,Basi"'.•
and ProfessiOM Code TM Comsrxmrs Liernse Law dam Fact appy an M owner Of Required Inspections
properly who Wild,mimpmm tberen,and whodosesuehwokhimuif ar enough his
awn employes,provided Nat sucb imprmemenu are not invaded oro@sed ferule If.
however.Ne building orimpmvement is mid within are year of completion.the owmar.
builder will have the burden of pmring that he did not Wild or improve for purpave of
tile.).
0 1,as mvrcr a the Property.am exclusively contracting with liaerued conRcmn to
construct Ne pmjem(Sec.7014,Business and Professions Cade:)The Conlrmmr's LL
ears,Law dors not apply in an Owner of property who builds or import Norton,and
who eonuacts for such projects with a rnntracFor(s)Incensed pursuant m the Canvu:to',
Liceue law.
OTore uempt undo See .B&PCfm Nismason
ncr Dau
WORKERS COMPENSATION DECLARATION
I hereby aRrta under penally a/Perjury Ox of the Wlawiag declarations:
0 l ham and will maintain a Certificate of Consent to elf-Imam fm Workers Crumpet.
sadmF.u provided fm by Section 170(1 a de Labor Code.fm the perfoon.of the
wok for which this permit is;issmd.
1 Mare and will maintain Workers Compensation Insurance.o minimal by Section
7110 M thc Labor Code,for the perfmmancc of also wok for which this permit is Wed.
My Workers Compensation Whomerux carrier and Policy number are:
c.mW,.3AT6F,mrf16eC&7/3 policy,.AV2V60'/W0?
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This aetim nand main completed trust,permit s fm one hundred dollar,(3100)
or been)
1 cenifv that in IM performmee of the work for which this permit is issued.I shall nm
employ any person in any moneru as to become subject to lie Workers'CoFnpctuation
Ws of California.Dau
Applicant
NOTICE TO APPLICANT:IL afar making this Certificate of Eaemption,you should '
become subject an the Workers Compmuldon provitirer of Ne Labor Code.you most
.J z forthwith comply with each provisions or,this canat shall ha dren¢d mated.
CONSrRUCnON LENDING AGENCY
F+ 1Mmby.Marl and Nem iso anowcdnn Iendintagency far the performance of
C> the work for which this permit s Wood(Sec 3097,Ci,C.)
W�Q L.emder,Name
=z Lender,Roamer
U Q 1 certify that I ham read this application and sero Nat the above utrumstian is
l agree to comply with all city and county ordinances and sass Ian rtlatimg in
building consuucdon,and ncobyauNarien opmxmuum of Ns city in enorupan use
W ahem-mcmiarcA property for inspection purposes.
gym (We)agree m um,indemnify and keep harmlear the City Of Cupenito sgainsl
r-m h liabilities judgments.eons andopensea which may in any way accrue apinstsaid City
U Z in consequence of Ne granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
>2'�7�...-r- �-zs-arr Re-roofs
t P Data
Fn A .rHAZARDOUSMATERIALSDISCLOSURE Type of Roof
Will the applicant an future building aeupantstme or handke hrurdpw material
defined by Ne Cupertino Municipal Code.Chapter 9.11,and FM Health and Safety
.Seenan 255320>7 - All roofs shall be inspected nor to an roofing material being installed.�a
Will thea licant or future Wilding acceptant s e tri If a roof is installed without first obtaining an inspection,I agree to remove
nP e w a Air
or Mann whin g Pe gr
emit havaNnw air conuminanu u mkfincd by Ne Bay Area Air Quality Management all new materials for inspection.
District?
❑Yo �lu
I hew,mad the la atmdoua malarias requirements under Chapter 6.95 of Nee Califon.
nixHcalN&safety COM,Sec9csu253U5,25573 and 15534.1 undemand Nmifde building
docs tat,wrendy ham•Frnane that It s my responsiailay m Fortify de mcuamt ar de
acquire yW�hic�h mem be m}}priarm issuance of a Certificate of Occupancy.
7e /�2-rf -i9-oY Signature of Applicant Date
owmera ori,<aagem Data All roof coverings to be Class';{"or better