04080253�t
a
CITY OF CUPEIITINO
CONTRACTQI INFAR, ION <
BUILDING DIVISION PERMIT
•� �.-r ,•,„
BUILDING ADDRESS:
SWINERTON BUILDERS
PERMIT N64080253
0800 TORRE AV
• OWNER'S NAME:
PERMIT LSUE DATE
CITY OF CUPERTINO LIBRARY
1995 LAURELWOOD
10/15/2004
NE:
SANITARY NO. CONTROL NO.
(408)450-7018
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
j LICENSED CONTRACTOR'S DECLARATION
Job [IOn
b D P
1 hereby affirm that 1 am Hunted under provisions of Chapter 9 (commencing
With Section 7000) m Division 3 of the Beat. aM Peressions CoM. and my license is
-
ranmroeandeffect.
TENANT IMPROVEMENT -CAFE
ein
License,Clsss Uc.0
a Dam Contractor
ARCHITECTS DECLARATION
DECLARATION
NO FEES CHARGED FOR CITY JOB
I understand my plans shall be Bud a public records
J
3 Licensed Pro(essinml
DECLARATION
OWNER
-BUILDER
E I herchy affirm I cecmps from the Contractor's License Law for the
iota Code: Any city ar county
7n3 L5, Burltmi3 0ntl Co
.
e follWhich
reins a perwt(Section
which uyvis a s pmmil m improve, de sig any structure
altar, improv, demolish, Irfile
alms the a
n pdanuslicta dpumourcquirhe she applicant rarsuch Control Law(uammcm
mthu
hcisning
theeB uacwr'and
Sq. Ft. Floor Area
Valuation
punuunt of
Prulsw(Chopur9
(cut
(cummorningxempthndeion of Divisio
it of mton.AnynsCMc)of
S
$8005500
Butaleedexess
. patlandthebuiainnr
that be is "crept Underpart violation of
li and basis for the alleged exemption. Any
APN Number
Occupancy Type
P Y YP
Section IDIS par l
any applicant for a permit subjects the applicant to a civil penally of
applicant
not more than Ow hundmd tlalhra ($5(1)1.
five
❑ I. as owner of she property, or my employe" with wages as their sole compensation,
36931033 00 Required Ins
will do the work, and thessrunum is nos intended or offered for"le(Sec. 7044, Business
and ProfnsIona Code: The Cmaretav's Lt.. Law does not apply to an owner of
q p ectlons
property who builds or improves thereon, and who tloeuuch work himself or through his
own employees, provided Nat such improvements are not Intended oroRend for ole. If.
however, Ne building or improvement Issold within am: yinr of completion. the owner.
builder will have the burden of playing that be did not build or improve for purpose of
sale.).
I. es owner of Ne property, am exclusively contracting with littnsed conmcton, m
onmm� the projen (Sec. 7044. Business and Professions Code:) Tec Conuazmri Li.
cane Isw dues not apply m an owner of property who builds or improves Hereon,. lad,
who conlractsfor sac projero with ac.=t.r(s) licensed pursuant to Use Contodemes
/
Licenu Law.
I. axe ndcrSm. .BKPG for Nis season
O Dam 14 Ivi
WORKERS COMPENSATION DEC TION
I hereby affirm under penalty of perjury ane of Ne al ng declanaions:
I have and will mainuln a CCnifiQUtaf COMeaI to selbiuune for WorkeM1Compmm
ration, u provided for by Section 37M of the Labor Cade. for the Performance of the
V
work for which Nis permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, ss required by Section
1]00 of the lsI., Code. for the performance of dm work for which this permit is issued.
My Worker's Compensation Insurance "crier end Policy number em:
Cartier: Policy Na,: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
f ri s action need nos Int rompleted tube permh a front hundmd dollars ($]Q))
or leas.)
ccnify shy in the p of the work fnr which ahia permit is irvucd, I shell not
employ any mann
my perml. in any manner sat M In become subject m Be Workers' Cnmpcmatinn
LawsO
Laws Of GB lfarnl0. Date
Applicant
NOTIC
NOTICE TO APPLICANT: IL after making this Centfictionof Exemption, you should
become mompto it Workers ro Compensation previsions Code, YOU m s
reedLabor
' forthwith comply with such previsions or this form it shall4 ticcmcd revoked.
he
CONSTRUCTIONLENOINGAGENCY
- -
1 hereby affirm that there its construction lending egenry I'nr the perfurmanm of
' the work fur which this permit it issued (Sec. 3110 97, Civ. C.)
lender's Nam.
Leader's Address
I ccnify too I haw mad this application and sum that the above information is
'
' correct.) agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorize representatives of this city to enter Upon We
abovcmentiuned property for inspection purposes.
(We) ague In cove, indemnify and kith hay the City
Cupertino againstflabfl
/J
j ents,malsand ofin m e
in smitch may in any way accrue against mid City
to consequence of the of this Permit.
RS..granting
' APPLICA UNDERETANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOU GULATIO
Re -roofs
Type of Roof
11�1 Z_`� I
i6 rear' Appli"nb nuazmr
HAZARDOUS MATERIALS DISCLOSURE
Will the apercon. Idiom building Occupant stow or hand lch Bus maunel
as defined by the Cupeninn Municipal Coda Chapmr 9.12, and the Health and Safety
Code, Section
All roofs shall be inspected prior to any roofing material being Installed.
[3 Y" �
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment or devices which
it hocardous air contaminant ar defined by the Bay Arca Air Quality Management
all new materials for inspection.
iaulat7
El YC' Nu
I have mad Ne humrdnm materials requirommir under Chnpmr6.95 of the Calif r,
.is Health & Sufmy Cock, Seen.. 25515,25533 and 25534.1 uow.und Nm if the building
dues oat vurte dy haw a tenant, Not it is my responsibility w notlfy the occupant of thu
regmre icbMost on ypdfnrtaruananr ccmE.am ocupaney.
�
Signature of Applicant Date
All roof coverings to be Class "Bt' or better �/
o
n a mixcJ ag t Da