05080077 B:CITY OF CUPERTINO .tw, aw re Grp i :t •n.* �_ '+�' r,
BUILDING DIVISION PERMIT ' CONTI2A. TURTNFORMATIO .
5INGADDRESS: CONBOY & MANNION CONTRACT Mnlf'o05080077
20807 STEVENS CRK BLV
R'S NAME: PERMIT ISSUE DAIS
/ PANERA BREAD CO 10 LOHE AVE 08/10/2005
ONE: SANITARY NO. CONTROL NO.
(518) 339-8464
ARCHRECr/ENrINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
[� 0
.0o LICENSED CONTRACIOWSDECLARATION Job Description
jdj I hereby Affirm IMI I Am licensed under provisions of Chapter 9(commencing -
with Section 7000)of Division J of tie Business and Profession Code,and my license u
nmB(o=andeffm REVISION TO PATIO CANOPY COVERS
2�2 LiceData class Conu IN HOUSE-NO NEW PERMIT ORIG #04120016
S
Data ConlDECL
ARCHDECTS DECLARATION
1 understand my plans shell M used As public rannrN '
5 C Licensed Pmfcasional
OWNER-BUILDER m DECLARATION
<i I Malo .(lean o n I ren exempt from the Cwions Co license LAW for the
p O fallowing reeon.permit
703 sin t,Arm. Ansi Improve,
dko Professions Code:Any City or county
$ whichitsissuance,
requires a panmlo to ennewet tlmr,m rarsu,dPermit,ore pair ed ,Inemro
thepriorhe iblensedprBontto the tie.pions of far wchpermitmfdeaeLncd,mmmem
< (comma cingwithSemion700epmvi,lomofmcConuiness,,License 6w(CCodItt9 Sq.F[. Floor Area Valuation 0
s (cut he is xampN Sectio n and ftof bash n 3fo,of ese eg einevand on.Any
Cale)of
Wt k u aarmp,shOUeom and tie basis for the Alleged e,nmpdw.Any vlolallon of
Section 7031.5byany applicant fora permit subjects due applicant in a civil penally of N Number Occupancy Type
not mom than fivetransited dollar,(M). 3N32051 . 00
❑Luoww of ria property,ormym amend..ffmexu le(Sec.70".Business will do the work.cads: he Com comes mnmmus La eaad ftn t apply to an o MIwa Required Inspections
Nd Property
wNOM Code:The Cannacmra ndwho ors dew D'JI apply lf rt OWw Of `I P
man enywhobuildsviimprov Nueon,andwbo daceotimwork or
through his
however.the
or(than such impm old wit ii mac year dedofc m ledon.ered orsec,own r. ,a
Wilder shebuilding u anOfpmenti,hathwithin one year oh completion.Ne owner. C'
Wilder will have em Mken of proving the,he did sin build ea Improve for purposes of
❑1,as Owner of the property,am exclusively contracting wish licensed wnwcmts in V ^
comuuc,she prejem(Sec.7014,Business and profession Cade*Tian Contractors U.
cove Law dm,not apply m an owner of property who build,or improv Ammon,and,
who contracts for such projects with A conuacmr(s)licensed punwn,to Ne Contractor'.
License Lw.
/❑Ismeaemp,under Sac. .Bd:PClardes on
r/-ON/,JD L .-/MANN/ ' 3V Data —lo•'O - $/
WORKMPENSA770N DECLARATION /
I hereby afRm oder penalty of perjury ore of de following declareeots: Q
1 MwarW will W twin•Cmtificam afC nAAm¢acct-uwre for Worker',Comport- !/
-don.u provided for by Section 5700 of the lab¢Code,for the performance of the
work for which this permit is issued. U �•
oil
1 have end will maintain Weaker',Compensation IMnce
un ,n required by Semon
5700 of the Labor Code,few the performance of the week fm which this permit is lewd
My Worker'.Cumpemsdw Inwmnce carrier And Polity number am:
Career. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(IM1u sent¢nand rot he completed If tie Permit H for om hundred dollar($IM)
or lcnJ
1 certify shat In the paforma=.of Ase work for which thl,permit u issued,I,hell ne,
employ Any peemn in anypal9er an ugbaome,ub sl to the WwksM COMPcmOon
Iawto,CsilromlA.n / /,
Applicant i T
NOTICE TO APP ': f.after making this Ccnifwm of Exemption,you should
become Auldaut in em Worker.Compensation pmvisions of Am labor Code,you most
.J 0 raMwith comply with such pmM viemor this permit shall M demand
revoked.
'Z y
CONSTRUCTION LENDING AGENCY
[+ Thereby afrum a,Vert is a construction lending agency far the performamx of
ai> the work for which this permit is issued(Sec.3097,Civ.C.) '
W 0 Lendces Name
M ,
d 2 Lendee3 Address
U O I certify that I have mad this application and nam tom the atom inmmumon u
core.I.gran to comply with all city and county ordinances and sum laws mining to
SU' building construction.and hereby authoem repmnumsdv of this city to now upon to
If7 above-mentioned property for Inspection purpMea.
d (We)agree to caw.indemnify and kanp haemkw tie City of Cupcnino alum,
,..,y liabllitiw,judgmcniacmtsande,pemw which may In anywayamuue against Wd Clly
fJ 7 In consequence of Ne granting of this PermiL
�-t APPLICANTINDDERS 5 NDS AND WILL COMPLY WITH ALL NON-POINT' Issued by: Date
Re-roofs
Signmum of AppllcaMComnmor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tieappllual or future building occupant am or handle haurdous material
•,de)ned by the Cupeniw Municipal Cade,Chapter 9.t2,and the Health and Safety
de. 0Yo.iss3l(e? All roofs shall be inspected nor to an roofing material being Installed.
❑Yue ON. P P Y g g
Will the applicant,or forum building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It h4,xdOus air contaminants As defined by tea Bay Area Air Quality Management all new materials for inspection.
WO7
❑Yes ONO
P ham read the hnallou,mamriaurequimmmn,underChapw6.95 ofthe Cables.
nu Health@Safely Cade.Swtimu25505.73555 and235N.l undcmm�d thuif the building
dans nolo oma and NN it umymapamibillrymmeryeeomupwtorte
recur n emetpriorm wMeoracerdfMmofawpwy. Signature of Applicant Date
Owner unuthomcd agent Dam All roof coverings to be Class„B"or better