04020047 CITY OF CUPERTINO
BUILDING DIVISION PERM
LDPERMIT NO
BUILDING ADDRESS: .
ALL BAY CONTRACTORS, INC. 04020047
Zue
johnnn pgRADTISSUEDATE
'S NAME:
SANRARY A02. 0 OL NO.
PHONE:
BUILDING PERMIT INFO
ARCHmicrIPNGiNEER: BLDG ELECT PLUMB MECH
0
G LICENSED CONTRACTOR'S DECLARATION Job Description
Y 1 Manby&MOM that 1 we licenced unPon
der of CWpmr 9(ammucb{
yg NIM Seeaa]IXD��ttfDl don 3ofthc Budnw PmfeWam Code.and my license is
infullrmakv
CI '— IJeREVISION--IN HOUSE USE ONLY
2 License .
Dun � " u NO NEW PERMIT ISSUED/#04020047
I molmstand my plans shall M used as public march
SLicensed Pmfesdoml
m OWNER-BUILDER DECLARATION
I Manby offtm that I am acmpt from the Copme"Oes License Law rat tic
p o folMwing OWOM(Section 703 1.5,Businessand Pmfcadam Code:Any city or cmM y
which mqui=a permit to emunue4 alar.bnpnwe,demolish.or term my vacuum
PH,an itslSSuance.alas requlm de applies ,in,,, pemitmrilea laAlgnd summant Sq.Ft.Floor Area Valuation e�0
< That he u ikenac l punwnt m the pmNdon of the Canmsemfs Liana w(Chapter 9 X77
sC�
(commencing with Seeder,7000)or Division 3 of the Business and Pmfu,idna Code)or
g dm he is exempt derefrma and the bun for the alleged exemption.Any vloladm of
Section 70313 by airy appbam fora permit Subjects the applicant m•civil Penalty of APN Number - Occupancy Type
win.u,e It.hundred dollars(55001 35907005 - 00
[3 1,u owner of the pmpeuy,Wmy. =ploy=with an{e,m then ale eompenudun, Required Inspections
Na do see wort Ms themtum u mrnot mteMN or offerd for accountsRC(Se"7061,Budnq P
and Prefeulom code:The Conuaetoh Licmee law der at apply an an owner of
property who build,or Improves lhemem and who dee,ouch.,it Mnuea or thmuN his
man employer.provided dal Such lMPr°wnlanu me sea Intended or offered I.am.U.
Summon.Ne building or Improwment is$old within enc Year of mmpledon,the owner- C
hWldm will have the hueden of proving that he did Out build or Improv for purpose of v
sale.). f�
❑1.as owner or the property.w wludwly=owing with limned anuacmn to ` V
comtnott the pmjem(Sec.7061.Business ad Pmfecdam Code:)The Conucrm',Li-
cense Law don not apply b m owner orpmPmY who builds w impmws dentin.W. \ ✓
who eanmeu forsuch lattice,wish a conusmor(a)licensed punnnt eras OmlmmQY, V V
Lice=law.
am exempt under Bac .B kPC(m th4 nasal
Dam
WORKERS COMPENSATION DECLARATION
1 bunchy aOlres under Penalty of Perjury orte of de following dolorsaonc
❑1 Mw end will maintain a CerdTmata of Convent m self-imam forworM6Compen-
nam,u Provided for by Second 3700 of the labor Cade.for the Pcrfmmemn of the
wort for which this permit Is Issued.
❑1 Mw and will maintain Worker Compemadm insurance-u mqui un by Section
Myof,e labor Cnde.rm aepedamanaarae wale( which that pemitu lvueA.
My Workel, tom/penis/pa loSurana alrilm and PoI' mW ase:
TF�IY7 O RKI
CERTIFICATE OFEXEMPTIONCOMPENSATION
INSURANCE WORKERS
COMPENSATION INSURANCE
(Th,search need nothecompl,ed Irdc pecan,fmannhundrud dollars($10IR
unless)
1 certify that in the performance of de wort for which this Permit u issued.I shall not
employ any person in my mmnerm a m become subject in the WOdun'ComPemaaa
Laws of Califomla.Dam
Applicant
NOTICE TO APPLICANT:If,alter making this Cenirmam or Exemption,yes shaW
become Subject to the W&IM(A Cempemalhon pmWom of the Labor Code,you must
�Z forthwith amply with mend pmvidoro or this Permit sh41 be deemed mated.
zCONSTRUCTION LENDING AGENCY
4 1Mmby Mm that them is.auaation lending agency rM the Pedulumm of
;> the work for which Ni,peau is issued(See.3097,Civ.Ca
1 Q lander,Nurse
3.z, Lender's Adana,
)O I certify that 1 how mad this Application and mm that tM ab°w Mrmmadm is
Y F comet I agree m amply with all city and county ordiwlaa and Aute saws mladng m
U hulldingamwnion.md nde mN andkepmnnudwte this city menmrupon ft
6-Ow
U Above.mentiond property for Inspection Purposes
(We)agree m sew.indemnify e°a Yap harmless the City H-aiis agdn,
„y y Ilablliam,judgmcn,enam and expenses which mrybmy way sec mttdd City
U,4 Inc uenaofthepantingof th,DWI Dat
A ICANi UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
U Ns. 6
h lyl 0�9 Re-roofs
signuum ser AppH HAZARDOUS MATERIALS DISCLOSURE Dm Type of Roof
Will the applicant or totem balding occupant atom m handle heame.material
Vround by the CuPC,ia Municipal Code.Chapter 9.11,and the Health and Safety
on.section 25532(1)7 All roofs shall be inspected prior to any roofing material being installed.
❑yrs °
Will the applkm fucose lou ding oavpanl use equipment m devices which If a roof is installed without first obtaining an inspection,I agree t0 remove
emll hanrdnm air comernhainu,as dented by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Ya
I have mad de hatanf as n W edict mquimmenu under Chepmr 6.95 or the C,I ifor.
nil Health&saretyCde.section,25545.25533 and 31.Iudersmnd thmirthe building
on not currently haw a mnmt,Mut It u MY map b notify the ocuPant of the
e C,c�hmnr,,M�^ety °,nnm serBamoraapm�T. Signature of Applicant Date
ow 1 F.f 2.1.0 2, e,IW P� All roof coverings to be Class"B" or better
Owner or suthodred agent Date
• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng : Sub: Blk: Lot :
APN . . . . . . . . : 35907005 . 00
DATE ISSUED. . . . . . . : 02/05/2004
RECEIPT 4 . . . . . . . . . : 24439
REFERENCE ID # . . . : 04020047
SITE ADDRESS . . . . . : 21000 STEVENS CREEK RD
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : STARBUCKS (INWALLE SPGER)
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : DEBORAH MCDERMOTT
CONTRACTOR . . . . . . . : ALAN ANZEL LIC # 23791
COMPANY . . . . . . . . . . : ALL BAY CONTRACTORS, INC.
ADDRESS 3030 CONVETION WAY SUITE 2
• CITY/STATE/ZIP REDWOOD CITY, CA 94063
TELEPHONE . (650) 298-0577
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPLANCKREP HOURS 4 . 00 222 . 00 0 . 00 222 . 00 0 . 00
---------- --------- - ---------- ----------
TOTAL PERMIT 222 . 00 0 . 00 222 . 00 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 222 . 00 VISA
TOTAL RECEIPT 222 . 00
•
CITY OF CUPERTINO N r - -
BUILDING DIVISION PERMIT CONTRACTOR INFURMATIONM ;,
�e -
JO
INOADDRESS: ALL BAY CONTRACTORS, INC . PERMIT No 04020047
R'S NAME: PERMIT ISSUE DATE
E: SANRARY O. 0 OLNO.
ARCHITECT7ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�oa LICENSED CONTRACTOR'S DECLARATION O O O
Job Description
I hereby&from that 1 am licensed under PPoayytrsi�ons of Clulncr 9(commencing _
with Sant 7MO) fDivIf loids e nacres «d Pmfmahms Code,amdmyliomucis
�� I,full toms d a I// REVISION- IN HOUSE USE ONLY
? Licenu cli tic.«
� Dam �Conamr ERMIT ISSUED/#04020047
✓ ARCHI'IECrS DEc
�i I underaund my plans shell be used as public records
7
3p Liccnud Professional (?
OetNFina BUILDER DECLARATION l�./s
g a Y I hereby reason.(Srm on 1 am exempt from Me Canwctoh I:Any c Law for the C
p 0 followhich"of=ng aPe mit t 70J 1.5,Businessober. and
esJmu Cao:Any cin or county
acture V
$ which its ism a Permit m cnblwct,atter Impmoe,demolish,or mPair any auucture
F�fy^ pdmmiucensed pursuntto Me thovisios nt or
crouch penniuoicensle e Law(Chapter
C (corhe mibeingwitPSectiouoMcpmvisionenftheeBusinesand:cnselaw(ChaPur9 Sq. Ft. Floor Area Valuation 0
$ (e n ha-being with Section 70M)th Division r a(me Business and on.My bl laMonCOsit)or
mat he u esempt Murt(mm end Js bub for tide aik{cd csempdon.My vialadon of
Section 70513 by any appli.,far a Permit bjm Me applicant to..Ml penalty of APN Number Occupancy Type
.of...Man Eon hundred dollars($5W).
- P Y YP
❑I,u owner or Me property,or my employees with wages u Meir sale compensation, 35907005 . 00
will do the work and the swclum is notinunded oroRered Formula(Sec.7044,Business
and Pmfblsions Code:Tie Communes Citable Law does not apply th an owner or Required Inspections
pwpenywha buildsor improves thereon,and who does u ch workhim elf mdarough his
own employes,provided that such improvements art ant Intended oroRered fe rsala If,
however.Me building or Improvement Is sold within an year of comple0on,Me owner.
builder will hive Me harbor of proving that M did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors;to
construct the pmjm(Sec.7044,Business and Pmf setons Code:)The Contractor's U.
mese law does not apply to an owner of property who builds or improves Memon.and
who contracts for such projects with a conuactar(s)licensed pursuant On the Contractors
License law.
❑Iameaemptundar See ,B@PCforthismawn
at Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pewty of ped.,oro of the following dalantions:
I have and will maintain
a Conificauof Coment to selfdnsure forworkeracompen.
sedan,u provided far by secdan 5700 of Me labor Cade.for(hfm
e pmmamc or Me
work for which this permit le tossed.
❑1 have and will maintain Workers Compebladon Insurance,rat required by Section
3700 of Me labor Gude,for Me performance of Me wart f rwhich this permit is luded.
My Wohere Tema an Inwnnm noun sed PoI mbar art:
Ser. ciT�'!TL �n Poli No.:__-740 _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rrossecdon need wtbcourpleted ifthe permit is fare=hundred doJi m(g(SIM)
or less)
1 certify Met in Me performance of Me work for which this Permit is issued.I shall not
employ any person in any manner an as to become subject a the Workeri Cumpenudon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:Jr.after making this Centrnte of Exemption.you should
become subject In Me Worker's Compensation pmvistau of Me labor Code,you mm
,JD forthwith comply with such proohmsm or this Permit shell be doomed mocked.
'�` CONSTRUCTION LENDING AGENCY
f' IMeet,affirm ones tem iso construction landingagmtey far Me pe,17mon rote of
Ri.moi Me work(ter which thu permit Is issued(Sm-5097.Civ.C.)
WM Q Lenders Nurse
z Lender's Add.
U(] 1 comfy that I have mad this application and rote that the&bow infermadon is
U.F coney 1 agree be comply with W city and county ordinances and sues laws relating to
O U buildingcompunction,and hereby authonx MpmaentsdM or this city On Cour upon Jte
14 shove-mentioned rmpeny for Inspection purPaxCa.
G (We)agree In saw,indemnify and keep harmless in.Cityof uper against
h liabiliticajudgmenu.cosu and espemu which may in any way ace Met City
V z in c quenec of the gnnOng of Nis permit.
.. A (CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dat
E U Ns.
h�NID�/ Re-roofs
Signetum of ApplicanUConmcmr D�
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Me applicant or future building occupant amre uhmin haeudou mamrial
u defined by the Cupertino Municipal Code.Chapter 9.12,and Me Healon and Safety
70-co-r
dc,Scctian25572(a)7 All roofs shall be inspected prior to any roofing material being installed.
WYnwill the eppliman forum bin ding attupam esu cyuipmem or Jcvi<es which If a roof is installed without first obtaining an inspection,I agree to remove
tt herudnm air conumivvv���nnnu u defned by te Bry Area Air Quality Mangcmcnt all new materials for inspection.
Y❑Ycs //'F-'t1 hove read the hvardnuxmatedals rtyvimmenuundar Chapter6.95 of the Califon Hnithg:SafClYCodc,Sootiobl 25505.25577 crest 1a.l umcrsuM theirMc builJing
es t curantly how a tenant.Mu it u my res,___ notify the oaupant a(Me
e Inch ma be et "°'mmnan ora 'neatearOccupancy. Signature of Applicant Date
.' 1WO4 All roof coverings to be Class "B" or better
or authorind agent Dow