01090095 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: - PERMIT NO.
21267 STEVENS; CREEK BLVD 01090095
OWNER'S NAME: APPLICgqTION SyyB DATE
TOGOS SNADWICHES (4314) 09/21/2001
ONE: .. SANITARY NO. CONTROLNO.
a ARCHITECT ENGINEEW BUILDING PERMIT INFO
00
RLOG ELECT PLUMB MF.CH
w
U 5
baa
SN= LICENSED CONTRACTOR'S DECLARATION
4, I hereby aRrm that I am liecomed under.provisions of Chapter 9(commencing Job Description
,lot with Seclion]0d0)ofDieislan3oflheBA,inessandPordassimm,Code.Add mylicense TENANT IMPROVEMENT.
.O m lull foM`na c U Liccns lass Lic.p
Date Canoe; FI N A L M!["I.
i LL a'Ga ,.•, 4..•(RC TECT'S DECLA A -- ..
�• >. undentdnd mY Plain nnnll rte used as public records
I ,
DEC 2 1 2001
i p p Liccnud Professional
'a OWNER-BUILDER DECLARATION
As
to S•� I hereby affirm 1 am exempt from the Commdor s License law for the
z< following Mason.(section 7031.5,Business and Professions Cade:Any color Clardy $95000
-
M 0 which qu permit t .amt ll , demolish.Orreparanystructure BUILDING
63 .prim to its Also req rex the ppl If Permit Pe1 In file a signed Atonement - _...... .. _.._. __. _.. ____ — .......
Nat he.gltt . dpu Snilathbpr i sfuseC Contractors License Law(Chapter 9 r••� t g 'g r a e Valuation
(tam n sw ns t 7500)of Division 3 ofthe ButimessandPrgrep.onsCare) •,, t l \ $I�. .... . .. -_ ... . R1Y:\F FO.
or Nal he is excmpi thaefrdm and the basis for Bre alleged demdubn.Any vrolatmn
of Section 7031.5 by any applicant for a permit sabjaxas the applicarn to a civil Penaily-
taf lot lnnRthen five hPandreddollars(s5w1. - - 10 IAPN IODATION. Ir,^`I" `•_ Occupancy Type
°I.as owner of property or my employees'with wages as their sola compensation, O — PIERS '
will-dome'work;'slid the"6om,mra is a.(intended',,,offered for ime'Isee a. 103 - UFER Required Inspections" ,'
�Busirress iande:and CoThe Conuonor's License law does not apply to en q
..net of property Whn builds or improves Ibemon,and who does such work himself 104 - REBAR '
or through his own employees.provided Nat such improvemems are not intended _ _
offed fa Ie If ho the W(ding r mpm t ry Id ih i one year of --—' - '`" "'"�'
completion,the gwncT.Wilder will have the burden of proving that he did not build or 105 ANCHOR-BOLTS ) a .f .I
improvefo,"asafala.). .. .. 106 - SEWER & WATER
_ --------- _. _ . .. ._.__2 02 '= UNDERFLOOR--PLUMBING---- - ..--- -- --- —- -
--01:as ownerof the property,am exclusively contracting with licensed contractorsl°
'= construct the project(See.7 L,Business and Professions Code:)The connector a 203 - UNDERFLOOR MECHANICAL 1':: 4l, l
= - — License law does not apply to an owner of property who build[or improves theme ,
;L ._and,whu.mntmcts.for.such pmjccts.wRb.a mntmmor(s)licensedpursuant to ons. _...._ _—_2.04----UNDERFLOOR-FRAME- --
.. • ;. Contractor's Licari Law.
a - } °l am eaempwader See B.&P C for this Menson 205 - UNDERFLOOR' INSULATION
owner In Daia 301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER
tMnr;Nmrunderpalr_any,ofIlia,Oneofthefollowingdaclandions: 303 - 'ROUGH,'MECHANICAL .
s' arm 304 -' ROUGH ELECTRICAL
]-I nave and will alrdain,a,Cenifeme ar Conxem In 5[If-InSYR for Work[r'S —
ampcmunkm, as previded4oi by''Secnon 3700 of the labor Code, for the
perromunce of the work for which this perrok is issued. 305 FRAME
;. °I have and'will maintain Worker's Compensatlan Insurance,u r wired by Section
w
3700 of the Labor Cade,for then to....no. of the wank for which this pemtil is _ N
_issocdMyWorkersCom' tionmsuranc.Carrkranarolia u ler 307 INSULATION
. , .•,,.. - -.,.-_..... a . _..., ...�.. .r•",m _aR_ .• `'- 308 - SHEETROCK'....., _i.•„,_�.,. t:; --_-_ ----=-
cm44'a,-'r + : tl >I 4oficyblo. ['7011309%L. EXTERIOR L•ATHI:
r .CERTIFICATION OF EXEMPTION FRQM WORKERS'i _
coMPENsnnolv_INSURANCE: .;'.�. _ '---'- 3-10- •. .INTERI'OR....LATH•"-- -' ------------- .__------
._.._..
(Toss A,Ojon ria d let rte c rmpleied if the permit is for one hundred dollars '_s r
a 100)ar less.), 311 SCRATCH COAT .
I con fY tht ni eyorf c f th o k f ch h tw t
shell ria cmPl Y Aliyq on awn 07:t cam subject to the Workers' 501 - FINAL ELECTRI CALl"'ENBRGY”
Compen't S21, .11( 1, 502 -.--F.INAL..PLUMBING..ENERGY ._ . .. _._.
.APPI< IN ..
NOTICE P 1CAJ,(Tlt( m Mg this r TExe ptionyoushould 503 - FINAL MECHANICAL' ENERGY
be2ome se yen tome Workers cadnpra,.uma p ovons rnof Ne Labor Code,you man
ZfonnwiN comply with such provisions or this permit shall be deemed milked. 504 -;__FINAL _BUILDING 'ENERGY.";-:;'CONSTRUCTIONLENDINGAGENCY ' 505 - FINAL ELECTRICAL
1 bei ny from Nor there-¢ con.o cl lending agency(m the perfummnee
of the akrp nlCnm P< ratpae7t' 3097cb.C) 506 - _GAS TEST
�. linden Is me^' ,,. I"' ••."",w`. _`.•.•' ----FINAL;
a.q 507 - FINAL 'PLUMBING
O „Iteray that i have Roe this application and:tate that the above information 15 508 — FINAL MECHANICAL
._ L*.:'p., coirecLI agree 1°comply with all city end roomy;yrdinernees end some laws mlaling 509 - FINAL GRADE - - ---------------- -'
0.p to wildingconsuunion,endherebyAuthodMrapRsnlmivesoflhisequ.carerupon 510 - FINAL PLANNING
F.a (Wa)ag lass ndemn fY and keep hmml ss the City of Cliper'gu against ' 514WORKS-
1.1a
the W t dp pear peed purposes.
m IubJtesje ts,cars.And peas nrnmYi y y SISma —:'FINAL WORKS
U City - e v e r t ng f s pe t _ _
OU IC T ULA IIT. DS ANO 'll OMP 41TH ALL NONPOINT - ISSUed by: -72 Date
grari
" pP is notce HAZARDOUS MATERIALS DISCLOSURE" " Dare Re-roofs _ ...._. ._ ✓
e of A 1 m
!s' WiII&ipplicant orPotu lw]ding Occupant ,&e in handolia>areousmaterial .Type of.Roof ..,.... _..r •, -__ .T_ K, ✓ _ _-. ��- .
as d[fin al by Ne CupeN o Mun clpal Code Chapter 9.12,and Ne Health and Safely t
�, 'sa
1
Code, econ 255532P1 i'.QNa;: ^i, -.
_ -.Allroofs shall be-inspected.prior-to.any roofing material.being installed
Will
._..
Win me apphcand or.future budding occup.�t use equipment o;devices vhicn If a roof is installed•without first obtaining an inspectiori;I agree to remove
emit hassNAos air tvnmmrams As defined by the Bay AMA Air Quality Management
District? . . all new materials for inspection. Applicant understands and will comply With,_.-
OYes ONO ' all non-point source regulations . ..
r 1 h ve d,the haeard o' ' Is req pob AA,under Chapter 695 of Ne 1`
Cal fpmfa HeAlth&Safny Code;Sections 25505;25533 en 2553? I undersand that
ifthe'Building does not cunently have a tenant.that it is m sponsibility to notify.the
•P t of the 'Icme -x i[h must prior t i ..'aof a CenifcaR of
occu
Signature of Applicant -.. Date
o e�pr madaeaagent, ;.I• upk• All roof coverings to be Class"B" or,better '
-OFFICE-. _ .._ . ._ ... . . _ .. . . . . ..