02010073 CITY DVSOND
IINPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21265 STEVENS CREEK BLVD 02010073
WNER'S NAME: APPLICATION SUB DATE
I TANG 01/16/2002
e
ONE: SANITARY NO. CONTROL N'O,
n'W ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w O BLDG ELECT PLUMB MECH
Im i LICENSED CONTRACTOR'S DECLARATION
7 m I hereby+lrrm that I am licensed under provisions of chapter 9lcammenaing Job Description
:.L. withSection7000)ofDivisionJofrheBusinessanJProfnsionsCade.endmyliccnse TENANT IMPROVEMENT/ COLDSTONE ICE CREME S
(YM-` is in full force and effect.
m u d License Class Lie FINAL a r'w V`A r F n-
0
O u Data Contractor r , ua+
?:a0 as ARCHITECT'S DECLARATION o
< I understand my plan shall be used as public rccmds O ZOOZ
r SEP
aO'J Licensed Pndessiomal
e max., OWNER-BUILDER DECLARATION
=' I hereby affirm that 1 am aeempt front the Contractor's License Law for the
a following reason.(Section 9031.5,Business and Professions Code:Any city or county WILDING DI�� 6 0 0 0 0
E F o which requires a panni,m convect,aper,initiative.demolish,or repair any'wenn AL1
i
3� -prior In its iisomae.alaine,airu lheapplicantfor SuchpermitO flcae
signedstmemnt --- -- - - - - -
thathe is licensed poisoned td the provisions of the Contractor's License Law(Chapter 9 s__ Valuation
com
( mencing with Section 7000)of Division 3 of the Business and Professions Code) \_{,s \., fi13'Z:$
or but he is ex,impt theirfroni and the basis for the allege8 elemjriod.Any violation
-of Semina 7031.5 by any applicam for o permit subjects the applicant to a civil penalty �p t� t��
ifnor ame, ban mehundred dml.,SS ). 10i-PN-P'�7NDATION 1 ' `"" Occupancy Type
❑I,us owner of the property,or my employees with wages as their sole compensation.
will do the work,and the Structure is not intended or offered for Sale(Ser.71144.
Business ane Professions Code:The Convectors License law docs not apply ro an 103 - UFER Required Inspections
owner of property Who builds or improves thereon,and who does such work himself 10 4 REBAR
orthrough for his own emplayeet provided that such improvements arc not intended or - -
"off&fd for sale:If;however.the buildingt rs sold within one f —'---'---' "-
nT urden of re.r° 10 5 - ANCHOR BOLTS
completion,the owner-builder will have the burden of pnrving that he did at buil)or
improve farpatpoxafsme). 106 - SEWER & WATER
v - '- -.a --. _ ..
YLLasowner, oc p(Sec.7am Business
and nnnnisions aba)The Contractor's
License
202 - UNDERFLOOR PLUMBING "
_ License the odsproject(See.]Olin Business and ertyPonwhob Cade:)The Conmmor's s -,
Lmwse l.aw arias not apply to an ownefr,fproperty smn builds°r in,pruves thereon, 203 - UNDERFLOOR MECHANICAL.:
and wbo.contrac,s for such p'°jec,.s with a contemns)licensed pursuant to the _ -... _._ .. .-. ... ..
Contractor's License Law " UNDERFLOOR FRAME_ _.
❑Ism<aempLpndcr Scc. .B&P C for this reason 205 - UNDERFLOOR INSULATION
�w D°tat �` ° '9 3Ol - ROUGH PLUMBING
WORKER' PENSATION DECLAQAYION
'( 1herebyaffirm At,penalty.1 rju, nopf,hefollowing de,wrinnr 302 - TUB & OR SHOWER
303 - ROUGH MECHANICAL
❑ 1 have and will maintain a CemGwtc of Consent to self-insure for Worker's 3 04 - ROUGH ELECTRICAL
Compensation, as provided for by Section 37W of the Labor Code, for the
- - performance of the work for whim this permit is issued. 3 05 - FRAME
❑1 have and will maintain Worker's Compensation Ireumnse.w required by Section 306 - HOEDOWNS
379)of the Lulwr Code,for the performance of the work far which this permit is
t it uea.My Worker's Co. cvimi Insurance carrier we Poh y number an: 307 - INSULATION _ _ _ ..
N,.:' 308s .;. SHEETROCK,. ,
CaM< t t'.1 i st Policy Nn - .
CERTIFICATION OF EXEMPTION FROM WORKBRSi' t, ^t •s1 '30�9? �'I'EXTERZOR 'LATH"
COMPENSATION INSURANCE_'.. .. ....... ..___.,--.,..
3'10:?; INTERIOR LATH
('i " -
" lli'xaion need not be completed if the permit is for one hundred dolhrs t t
(slW)arless.) 311 - SCRATCH COAT I
i certify that in the pertbmmmce of th�work far which his pem,it i.issa2a,1 - . 31.3`. - -ROOF NAIL
shall not employ any person in any manner sat as to become subject to the Workers' 501 - FINAL EliECTRICAL ENERGY
Cn pen r Laws of California Data
A,,Li.nt 502 -- FINAL PLUMBING- ENERGY-- - - - - - -
NOTICETOAPotherk 1f N, ..king this Cof
pf �Iumld 503 - FINAL MECHANICAL ENERGY become t thesuch
Worker'sC ns sat provisions" ll a Lebo Code you mus,
K Z nhw rM1 comply uch pro i. arm Ia.rmr hull be deemed ked. -_ .._ .504 - .FINAL BUILDING ENERGY .. -
Vi I. " " --CONSTRUCTIONLENDINGAGENCY 505 - FINAL ELECTRICAL
F r 'oftn'I hereby affim,thing there is a eonswcdon lending agency for the performance -
a > e work for shieh mis permits issue,d tsee.3097.Cis.C.) 5 0 6 - GAS TEST
isneer's Name .. . : ..
a'z L dersAddreas 507 - FINAL PLUMBING
U O 1 eenify that I have read this appliwrion and state that he above information is 5 0 B - FINAL MECHANICAL
❑:Ea c'omen.I agree to comply with all city and county,ordinances and sum laws relining 509 - FINAL GRADE
O.V to building construction, ad herlbya°madze ieprescnmdves of this citrin enter upon
the above-mentioned property for inspersion purposes. - 510 - FINAL PLANNING
F„ gy (Wjudagree ts.carvetsand xpennd keep seswitham,IessthcCi,yofarricaainstmo id 514 - FINAL P C WORKS ., J
tq st
liabilities,sequecnts,costa and engem'which ay in any way accrue ngaina said G,,6 d j
City'ILICyr ANTUnc<nfthe grantingofWILL m . n
API'LICANT_UNDERSTA SAN WILLC MPLYWITHALL ON�POINT Issued b Dafe
a Ions. _ Y:
siega,ure nr pv dnrraet to Re-roofs
HAZARDOUS A RIALS DISCLOSURE'
'' Will me ap'plicam or fumreb Mingoccc,arx,mre or handle hazardous material, .Type of Roof .. ..Or defi,tr4 by the Cupertino Municipal Code.Chaplet 9.12,and the Health and Safety
Code,Section'255321a)' (. '` ). ?' ,t „'• s,,;
Dyes - " ' All Toofs_shall be_itis acted nor�to an roofin materia] beim installed.__. . .-
"°. p. p Y g g.
Will,the applicant or future bhpngoccapantuse equlpmwtordeviceswhich If a roof is installed without first obtaining an inspection, l agree to remove
emir herardems air cnnuininana as defined by the Bay Area Air Quality Management
Dmha," all new materials for inspection. Applicant understands and will comply with
° .. _ all nbn=point source regulations.
+ 1 have read the haz 6mdiils requirements under Chapter 6.95 of the
Cdlifd,.'
mia Health Safety Code.Sections 25505.25531 and 2553d.1 undersand that
ifthe building does nm cunrntly huvicem t.
nor
myreuance off tonmify m< - --" '- - -.
dccupam of me iequiremenrs which mu. ton prior m nes,ea of a C<nifcae of
Signature of__A_ pelican[ Date
` r: o oar ar uthndsed agcgr,
are All roof coverings to be Class "B" or better
OFFICE" _ . .