04120088igup�
Z�
��u
I-
�ipi
�yC
30t
HZ>
nFc
1
z C
Z
d Q
�z
UOV. _
OU
�W
a
�z
CITY OF CUPERTINO
» - *°-� -'
BUILDING DIVISION PERMIT
� IP7EORMA, ION ;M
-
cOMRACTOR
BUILDINGADDRESS:
SMI CONSTRUCTION INC
PFxMITNO) 4120088
OWNER'S NAME:
I'ERMTT ISSUE DATE
ONE:
SANITARY NO. CONTROL NO,
CHITECT(ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Q 0
LICENSED CONTRACTOR'S DECLARATION
under CWde.9(commencing
1ion7 affirmthat lamfthe
Job Descri E� fg S
Business nd Proovof
with Section 7IXIU)of Division NC Businaa and Profcssinm Code. and my license is
r�{gU@Wtgryf
I full form and effect
Lmerne 1 Lic.6
Iryl1�!
TI -FAST FOOD RESTAURANT
��
Da¢ Commarla
ARCHITECTS DECLARATION
I understand my nas records
am][ W aidco
��� ��
JAN
plans public
o
Licensed Professional
R D RATIO
OWNER-BUILDERDECLARATIONt�J
p��� _
I hereby affirm thatOW I am ucmpt Ne mis License Law for the
following mann. sect on 7031.5. Bostonian; and Prorstumns Code: Any city or county
fyj`V'�@
which ou uims a permit to construct glut, improve, dcmmksh, or repair any structure
priono its issuana..Is. requirea do.,licam for such permit to file. sigtwd suu:ment
that he is ranged pursuant a the provisions of da Con=wr'3 License Law (Chapter 9
Sq. Ft. Floor Area Valuation
(commencing with Section 70)0) of Division J of tW Business and Prafeuimu Code) or
and he as exempt therefrom and the basis for the mlcgcd exemption. Any violation of
Section 7031.5 by any applicant fm a permit subjects the applicant to a civil penalty of
3 69TV4 p(fft10 0
Occupancy Type
not mom than RK hundred dollars (odor).
❑ I,vowns of the pvpcny,mmy employers wiN waguv Meir sole crmpewran,
will do the work, and aremanum, in nor intended croRned forms, (Seer. 7044, Business
and Professions Cade: The Commoner Liceve Law docs not apply at an owner of
Required Inspections
pmpeny, who Wilds or improv thereon, and who doessuch work himselfmr through his
own employees, provided thatstch improvements are rat intended mrffered for We, It,
however, the building or improvement is sold within ors, year of completion, Ne owner.
Wilder will have the burden of proving that he did not Wild or Improve for purpose of
sale.).
❑ L as owvf of are pmpeny, w udusively conu acting with licensed roa.,. to
Conswct the project (Sec. 7)44, Business and Professions Code:) The Contractor's Li.
cove law docs not apply to an owner of property who Wilds or improv arcmon, ad.
who contracts for such projects with a conmcar(s) licensed pursuant to the Conuaelofa
License law.
❑ 1 am exempt undo Sec , B & P C for this season
Owner Dau
- - - -
WORKER'S COMPENSATION DECLARATION
1 hereby affm under penalty of perjury one of the following declarations:
have and will maintain a Cemircam of Consent to selFivuv for Worker's Compen-
. an provided for by Section 3700 of the Labor Code, for the performance of the
k for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, for required by Section
37W of the labar Code, for are perfmrmanm of the work for which this permit is issued.
My Work,,',OCompensation Imun rce carrier and Policy number me
Carman.aZZ
r %s((s����/7.q�rw��.{t� Policy No.: 7-
�LE
ICATEOFE%EMPfiON FROM ORK
COMPENSATION INSURANCE
(This uVinn need nor W csanplead if the permit u furors. hundred dollars (SIM)
or less.)
1 certify that in the performance of the work far which this permit, a issued, I shall not
employs, person many manncrsn as he become subject o the Wmieri Compevmion
Law, of California. Dau
Applicant
NOTICE TO APPLICANT: If, after making this Cer ifale of Exemption, you should
became -object a are Wohc's Compensation provisions of the ISWr Code you most
foMwith comply with such provisions or this Permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affrm that them 6. construction lending agency, for Ne performance of
the work for which this permit Is issued (Sec. 3097, Civ. C.)
lender's Name
Lenders Address
I certify mar I have read this application sad lute that the aW ver information is
Correct. 1 agree to comply with all city and county ordinances and suis laws reining to
Wilding construction. and hereby sunbeam mprosenutiv of this city to enter upon on,
aWve-mentioned property for inspcedmn purposes
(WC) agree l0 IIIC Cityrf GYperinn .game(
lndem Nd keep hn11in
csave;on, n
costs and pwuwhich may in any wayattmc agemn said City
/\
inconacque ce of th.
mconsegmncc of the Branlin rmit
rN
^ �
3
APPLICANT UND STA WIL OMPLY WITH ALL NON-POINr
Issued by: Dale
SOURCE REGUL NS
Re -roofs
3 tr
Signaafe of AppiicauC tmurr au
H ARDOUS MATERIALS DISCLOSURE
Type of Roof
Will thc applicant or future building occupantnom m Mdmlc haardous material
U defined by Ne Columnar Municipal Code. Chapter 9.12, and the Hemth and Safety
Code. Section 25532(4)?
❑Yea 0Nr
All roofs shall be inspected prior to any roofing material being installed.
Will rhe applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
I havardoue air contaminants as defend by dre Bay Area Air Quality Management
0'11
all new materials for inspection.
0Yes ON.
1 have mad the haxarmasm ucrials mquirements under Chape rli.95 orthe Califon
nu Hular&Safcry Code, 355]7 anJ 25534.1undcrsund thuifarc Wilding
Jac -not curtcndY have rant tit ytns nsihilitYm notify arc occupant of Nc
rewltamentxwjgfmr Ecmatprir m m ceniraa¢rra?rotr��
Signature of Applicant Date
All roof coverings to be Class "Bat or better
Owner amhomcd eat
P