03100217 Permit ray rvin,
-
CITY OF CUPERTINO ` "I'l an"
BUILDING DIVISION . PERMIT ( ONTRATbR INk l7ILMATiON
r
BUILDING ADDRESS: ALL BAY CONTRACTORS, INC, PER NO.O 31002I7
QWNER'S NAME: PERMIT ISSUE DATE
E: SANITARY NO. a� CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT , PLUMB MECH
:oa LICENSED CONTRACT'OR'S DECLARATION'
Z I hereby affirm mm
at T am Bnsed un cr provisions of Chapter 9(commencing Job Description `
< with Section )of Division 3 ofthe Busies nd PoidessionsC Ic.andmyliecoacis .y
m ,o m roll forte fleet.
;qZi? I`'cen,e look- Lk.p / TENANT IMPROVEMENT
C v Dave cum '
e g ARCHITECT'S DE RATION vs
1 understand my plans shall he trod ae public records .soli"
JyU
O Licensed Prorded.ml
OWNER-BUILDER DECLARATION -
,2 1 hereby affirm that 1 am exempt from the Contractor's License Law for the - ar
i O O following reason.(Section 7I131g Business and Professions Code:Any city ser county
$ff which requires a permit to construct,alcor,improve,demolish,or repair any structure
as prior to its issuance.also requires the applicant for such permit to file a signed sukmenl
X50 That he is licensed pursuant n the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Va}I ion
at 1- (commencing with Section 7")of Division 3 of the Business and Professions Code)or
mat he is exempt therefrom and the basis for out alleged exemption.Any violation of
Section 7031.5 by any applicant for a penult subjects the applicant to a civil penalty of 3��jyi'pQyi(gi�er00' O- uane
not more man five hundred dollars($500). - p y'ryese
❑Las owner of the p e someone
is employees wire wages r ales(sok eW,Business
will do Prme work,and the rte,Com intended Liceneoraw do snot sale(Sec.too 44,Business q�..
and property
soh obu Code:The Contractor's License Law docs not apply ff an owner of 1te(I 7rC In peCtlOn$r
own enywho builds i id roves that such improvements
who it esauchwork ttimselor nedthrough his
own employees,provided that such improvements are not our of tl mpleerctl for ole.B,
however.me building or improvement is sold within one year of completion.to owner.
builder will have mmm
e burden of proving he did not build or improve for,purposeoseof of
We.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to s
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li-
cense law does not apply to an owner of property who builds or improves thereon,and 00
who contracts for such projects with a cmnmcmr(s)licensed pursuant to the Contractors.
ticanse Law,
❑I am exempt under See. ,B&P C for this reomn Ift�6 r
Owner Data /IV `-'I�1-4'&)'f �
WORKER'S COMPENSATION DECLARATION Tf
.r I hereby aRrre under penally of perjury one of the following declarations: " isles
0hw and will maintain a Ccnificate of Consent to of Nature for Workers Cornier-
Scion,as provided for by Section 3700 of the Labor Code,for me performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for one performance of the work for which this permit is issued.
My Workers Compensation IInmona cattier and red C mMIr r am:
r:� TIFICATE OF EXEMI'1' IkY O WO/KE S��
COMPENSATION INSURANCE 101,(-
mosscdinn neednoth edeadaekdifthe permitisformichundreddiillas(SI00)
ser leas.)
1 eeniry that in the performance of me work for which this permit is ismed,1 shall nut
employ any person in any manner so as in become subject to the Worknf Compensation
Laws of California.Data _
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,JZ forthwith comply with such provisions or this permit shall he loomed revoked.
'Z O CONSTRUCTION LENDING AGENCY
F
I herebyffrrm mat mere iso comtrvctinn lending g ascne forme Y Performance of
C La work for whir this permit is issued(See.7097,Co,CJ
WQ Lender's Name
)
�z Lender's Address
V Q 1 certify mat 1 have read this application and sure that me above information is
1U F correct.I agree to comply with all city and county ordinances and state laws relating to
O V building construction,and hereby nuthodae opoosentatives of this city to enter upon the
mod
CIL,
or
W shove-ms,judgment,costs
fidexpenses
pees purposes.
pli (We)agree to Ove,indemnify and keep harmless the City mf Cupcnino against
Z lieConsequenc Of
gratsing of this cswhich they in anyway eccme against mid City
V Z A APPLICANT
of LW granting tar This permit. i
^' APPLICANT UNDERSTAN SAND WILL COMPLY WIT ALL NON-POINT Issued by: Date
SOURCE)J�GUL ION ,
—12 12' s Re-roofs
Signature of canUCmnt mor Date HAZ ii O, MATERIALS DISCLOSURE Type of Roof
Will a applicant or future building Occupant store or handle hazardous material,
defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code,Section 25532(n)?)] All roofs shall be inspected prior to any roofing material being installed.
Y
Will the applicant or lora bmldiag mcempam ti=c equipment ser devices which If a roof is installed without first obtaining an inspection,I agree to remove -
harardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
evict]
❑Yea po - -
1 have mail the harardmus materials requirements under Chapter 6.95 of the Califmr-
.is Health it,Safety Code,Sections 25505.25533 and 25534.1 unJcrs and that if me building
does not curtemly have a tenant that Ir.my reireme dilly re notily the mcupanl nr me
req Ifemco hmua meltrees5u emfaCemreatemr oeetrp,acy. Signature of Applicant Date
er or im tmr)fgal agent Date All roof coverings to be Class "B" or better
CPERMIT ITY OF CUPERTINO � *�Gy_0.R' �FAMATTON §d
BUILDING DIVISION ,rr.. �
BUB.DINO ADDRESS: ALL BAY CONTRACTORS, INC, PERMRN003100217
2
OWNEWSNAME: PERMIT`LSUEDATE
STARBUCKS
NE: SANITARY O. C NTROL NO.
0
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
iM0z LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that I am licensed under Provisions of Chapter 9(commencing
i with Secd..TOOD)of Division 3 of she Buu.and Pmfeuiom Code.aM my it--is
^<
in full ett TENANT IMPROVEMENT
5 Lteense Class
LIC.N
Dem cumracmr REVISION--#04020047
ARCHITECT'S DECLARATION
3 < 1 mukri and my plans"I W used u Public recerds
U Licensed Professional
j OWNER-BUILDER DECLARATION
> 1 hereby affirm that I am commit,from de Comrectola License law for No
o following reaeon.(Section 71131.5,Busimu and Profession Code:Any city or county
9 which¢quires a permit to construct,elect.improve,dcanMfih,or repair any structure
poor m its issuance.also acqulrn to applicant for such permit o file a signed statement
FF that
W Ts licensed Pmnunt in the Provision of IW Convector'sConvector'sU..law(Chapter 9 Sq.F[. Floor Area V""000
C g (commencing with Section 7000)of Division 3 of Nmfc
e Business and Puion Code)or
3
that he is exempt tie¢from and the bats far the alleged exemption.Any violNun of
Section 7031.5 by any applleml for a penult subjects the applicant la a civil Penalty of APN Number Occupancy Type
oat mon Nu the hundred dollars($500). �"`n
01.as mvmrofNeproperl many employes with wgnuNe'v tole ampennthon 5:907005 . 00
will do the work. ad ft ahucture ie not Intended or cull fcsain(Sm.7014,Businua „ ';j ` �- IHS cellons
and Profession Code:The C.mamr's License law dao not apply m an owner of '� iJ_J,1 j
pmpeny who builds Or impromuhermn.aad he daasuch work himself Or through h
own=Play..provided that such Improvements see notlnmMed m.Rued fm sale.
however,the building or improvement is sold within one)ev of comptedon.Ne own L�
builder will have de burden of proving thathe did oat Wild m Improve(or purpm
sale.).
❑1,as.war of be property am conclusively...hearing with licensed ecntrac'msa to
construct the pmjact(Sec.IDN,Business and Professions Code:)The Commences Li- r. _
caro law don out apply to an owner of property who Wilds or Improves themes,and,
who contracts for such projects with•c.nhactor(s)licensed pursuant an Out Coronation
Licence Law.
O lvnexemptundu Sec. ,B&PCforthsresa.n
Dam
WORKER'S COMPENSATION DECLARATION
1 hereby Eaton under penalty of perjury one of the following declaration:
have and will maintain a Certificate of Content m self-insert for WortCompen-
on,u provided for by Seal..3700 of the labor Code.fm c e performance of the
work for which Ns Permit is Issued.
❑1 haw and will maintain Worker's Compensation Insurance,u required!by Section
3700 of the labor Code,fm the performume,of the work for which Ns permit Is Trued
My Woheh ComPemtion Insurance esrtiu and Polity number are:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Ohs section teed Int W completed If IW Permit is forum hundred dollars(5100)
or lose.)
I certify that in the Performance of dem work for which this Permit is Wood,I"I not
employ,any person in any manner sou of become subject to the Wm1moV Campemda
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.After making this Cenificam of Feemption.you should
become subject m the Wohei s Compensation provisions of thte labor Code,you muse
Ofon iwith comply with such provisions Or this permit shall W deemed revoked.
Z y CONSTRUCTION LENDING AGENCY
[—t 1 hereby affirm des dmrt is a conuucdnn lending agency far rax Performance of
the work for which this Permit is issued(Sue.3097,Civ,C.)
W Q Lenders Name
7 z Lenders Address
U 0 I certify,hast I have read Nis application and sum Nat dem move informmiun s
U.F cormim 1 agree to comply with all city and county ordinances and sum lawn mlating in
C V building construction,and hereby a dhorim representative of this city to enter upon Ne
W mow-mentioned property for Inspection purposes.
(We)agree to save.indemnify and keep harmless the City of Caperton against
n.t y
liabilities,judgments.cats and expenses which may In my way sena against lend City
I.
() APPLICANTOof the UNDERSfANDS ANDof WILLWILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGULATIONS.
Re-roofs
Signature of AppliuHAZA DO Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII theapplicantor forum Wilding occupant more or handle Health ad Safety u defined by de Cupertino Municipal Code.Chapter 9.12.and to Health and Safely
C10wroc,
dcSection 25532NI1 All roofs shall be inspected nor to an roofing material bei. installed.
❑Yrs ❑N. P P Y g 8
Will dm applicant or future building arupant use oquipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
bromomm air contaminants u defined by the Day Area Air Quality Management all new materials for inspection.
tint?
Oyer ONO
1 have rob the buaNnm materials requirements under Chapter 6.95 of the Califon
ealth A Safety Code,Scd.n 25505,25533 and 75534,1 undernsud thv ifde Wilding
am currently have a mnana that It s my respons hillty m mdfy dm cecupant of the
immcrm which must be met Our m instance of a Ccrdficam of Occupancy. Signature of Applicant Date
rorauthorn<dagent D.ec All roof coverings to be Class"B"or better