04080220 CITY-OF CUPERTINO '^ a° X9kwd� ".t>k•euia %`
'BUILDING DIVISION PERMIT ,I �,Ol� �•'Tr0]j�•y0.rc' --
BUILDINGADDRESS: HALLMARK CONSTRUCTION INC PERM"NC04080220
2080.7 STEVEWS CRK 200
OWNER'S NAME: FERMITISEUEDATE
PEETS COFFEE & TEA 3360 DE LA CRUZ BLVD 01/04/2005
SANITARY NO. - CONTROL NO.
(408) 727-4422
AR CHITEcT/ENCINEER: - - BUILDING PERMIT INFO
B ELECT PLUMB MECH
iomg LICENSED CO DECLARATION .
fi W Y Affirm that 1 am licensed ro Wain of Caspar 91 mmcmial Job Description
a OOO)af DiHdon3afne Buv Professions Cade.aM mylicease is
in full ffE L 0 j p 2 �� TI--PEETS COFFEE & TEA �$
z Lie d
"zg' Data
�l 1 M _
G ARCHTIEC SDECLARATON- r CONTRACTOR TO BEDETERMINE
I and my plain shell a mucd u puhlic mrnrN /� _.�S l T ,
Licensed Profcsdoml DING'/� -
5� OWNER-BUIWERDECLARATION fJ�At /Ij(HHU
��X 1 eroby aRrm that 1 am enerop,from the Canueetor's License Law for the - - a�/(J IUf �1Eft} - -
-00 fallowing mssan.(Seeman NO I.S.Bavrcss and Prefessivan Cade:My city m counts,
2 9 which means a panni,w construct,ells.Improve,demolish.m repair my structure
In prior m its issuance,also mluiros me applicant for such permit m file a signed autrmmt
�t< that he is licensed pursuant to the provisions of the Constance,Limnm Law(Chapter 9 Sq.Ft. Floor Area � -c� -Valuation '
.' d� (Commencing with Section 7000)M Division 3 of the Business and Professions COCA)or, - ',$140000
I,t cast he is exempt WmGom and the basis for she alleged exemption.Any violation of
Section 7031.3 by any applicant far a permit objects the applicant m a Civil Inanity of - APN Number _ -- ., .Occupancy Type- ..
And,mom mm to.hundred dollars(5500).
0 La owner ofthe property.or my wplayen with wages As thetrmleeompcmton,
wince lice wink.and theawctureu Mt(nlended me@red fmssk(See.]Os/,Basica Required Inspections - -
md Prafeasions Cade:TTu Canuan Ws License Law docs not appy an an owner,of , q P - .`-"' - ---'•- .•
propenywho build,crimproms themon,and whodouauchwarkhimalfm through his tt��a
awn employees,provided that such Improvements amnm mended croffered fcomm.If, - ^' - ,pr"Y -- -.- - _ -
however,rte building ar Improvement i,old within one year ofcompletion,me owner. iiilll ---ill"`
builder will ham the burden of proving dist a did not Wild or improve for purpose or _ -
. asm.). ['�
O 1.a owner of the property.ani exclusively cunuaning with Imemed eomsaccon to -. API
Manama tis project(Sec.7044.Business and Professions Code:)The Conuannes Li- ..
cense Law data not apply m an awner of property who Wilds or improves Merton.and -
who Comment for ooh project,with aeomaouar(U llcerned pmsumt An me Cammumes E.
LiceAm Law.
❑Iamexemptunder Sec .B&PCfrthumuo.
Owner Dab ,
WORKER'SCOMPIENSATIONDECLARATTON
1 hereby affirm under penalty of perjury arc of me following declwions:
I Mm and will maintain a Certificate of Content m self-imam fur WorkeesCompton-
-Ion,As providad for by Section 3700 of the labor Code.for the performance of to
work for which this permit is imine,.
❑'I ham and will maintain Workers Compensation Inst ance,as inquired by Schon
3700 ofme labor Codgforthe perfamoance of the work for which this permit is blued.
My knees COlmpemlW�tonfl�murmMEerier and Policy number
CERTIFICATE OF EXEMPTION FROM KERS'
COMPENSATION INSURAN
(This=am need not he completed time Permit Is foram hundred dollars(SIM) -- - --_
or less.)
1 ceNfy that In the performance of the work for which this Permit is issued.I shall not
employ any pcmn in any manncerm as an become subject m the Workers Campewdon - -- - '
law of Califoria.Dame - - --�
Applicant .. -
NOTICE TO APPLICANT:IL afar making this Certirtcare of Exemption.You sbMW
become subject m the Workers Compemetion provisions of she talar Code.you mus
0 O forthwith with Comply with such provisom oris permit shall Weem
demand revoked.
„z„m CONSTRUCTION LENDING AGENCY -
'tti (hereby affirm that Nett is a Conumction lending agency for the performance of -
ai> the walk fur which thin permit is issued(See.3097,Civ.C.) -
LE Lattices Name
=2 leaders Address
U C 1 ceify rtthat I have read this Application Arm,um thou gas sham information is 1
U,:•! comms.s.I agme m comply with all city W county ordinmaa and sum law rtrating m
0 Sl'J building cannmction,and hereby amnesiac representatives of this city to anis upon the ,
u1 above-mentioned pmpcny for inspection purpoas. -
(We)Aju agree to cove,Indemnify and keep hamiless w City of ruCupertino iagaimo
d City
f�jl Ilabllitu.Judgmenu.com mdexpcn ra which may In any way ocrvc agd nadd City
V F77 Ineansequmccofm graningofth' permit.
V-4_
NT I' RST S ND WILL COMPLY W N-POINT Issued by: Dat
REGU T
Re-roofs
of PPii on
HAZARDOUS MATERIALS DISCLOSUR Dau Type of Roof
WI meapplicantor fwum gsllding acupam etarc ar handle Montanus material
a dermad y the Cupertino Mua'mal Codc.ChaPur 9,11,and the Health and Safety
ode,S❑Yin ulazo 15531()?'. )dNoAll roofs shall be inspected prior to any roofing material being installed.
IWill the applicant or future Wilding weapon,me equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
II Ice amnm air ContuniAsu need by the Bay Area Air Quality Management all new materials for inspection.
District?
OYea u
,
(have mad
,be hy+/Nan els requirements under Chapter 6.95 or me Califon
Malicaltha Sefay Ca C,Sec'afis,1 5,25$77 and 13334.1 undcraund moltno Wilding
d "not c ndy he a int. at it u my responsibility m notify me occupant or me
m ,a whleh m wine rarnciasmammaoc ask ear eem Signature of Applicant Date
1 All roof coverings to be Class"B"or better
m autho rA a6 Dam