03080065 CITY Or CUPERTIINO
BUILDING DIVISION PERMIT CONTRACTOR INFOMATION :,
BQ ILCIINGADDRESS: PINEWAVE CONSTRUCTION, INC.PE"MIT"°03080065
01
EM'S NAME: 3515 RYDER ST. PERMIT ISSUE DATE
ALAN WONG
"E (408) 245-3836 SANITARY NO. CONTROL NO.
ARCHITECrIENGINEER: BUILDING PERMIT INFO
HLDG ELECT PLUMB MF.CH
0 0 0
±op LICENSED CONTRACTOR'S DECLARATION
I hereby Affairs Nn 1 am licensed under provisions of Chapter 9(commencing Job Description
?P2 with Section] qnf Division Jof the Busincs and Profession C0 c.and myliccnxis
to .recon err 1. DEMO--RETAIL INTERIOR PARTITIONS
tcenxGlaaa
COS DEC
ARCHITECTS DECLARATION
w<
].a estand my plant shall W uxJ u public Menrds
.dD
ii Licensed Prnlcssianal
Oat NEDER DECLARATION
s I 1 heresy.Item that I orem exempt from the Camrna Club:
License Lew for the .
repo followWhich
flar.Amason (Smut i ID3 L0.Business and improve.
d.ions Cmle:And,ed,at looumy
u$ which requires a pcmtit to renewer,allecimrmc,dcmolsR m repair any mmolurt
prior to its issuance,slsu requires the applicant for such permitto file a signed statement
Nal he is licensed pursuant m the provisions of the Contractors License lew(Charter 9 Sq. Ft. Floor Area Valuation
F (commencing with Section IINM)nfDivision 3of the BusinesaAnd ProfessionACnde)or 31620037 . 00
$ Nat he is aempt ftmfrom and the bass for the alleged exemption.Any vinlation of
Section 7031.5 by any applicant fors permit mbjem the applicant to a civil penalty of APN Number Occupancy Type
not mom Nan five hundred della.(5500).
D 1,AS owner of the pommy,or my employees with wages AS their sale compensation,
will do the work,and the soucmm is not intended or offered fanalc(Sec.7144.Business — DEM
and Prafea Bina Code:The Canonical Liecnx Law does not apply to an owner or Required Inspections
property who builds or improm Herron.and who does such work himselfor Nmugh his
own employees,provided that inch improvements are not intended or offered for sale.It.
however,she building or improvement is sold within one year of completion,the owner.
builder will have the burden or moving Nat he did not Wild or On for purpose of PI IlI/ALsE®
Sale.).
p I,as owner of Ne property,am exclusively contracting with licensed conoartors to
convect the project(Sec.7044,Business and profession Code:)The Contrxmrs Li. SEP - 5 2003
cone eny Law does not apply to an owner or pmpwho Wilds or improm Nemon,and
who contracts for such pojects with A comt.mor(H licensed pursuant o the Contractor's
Licemx Law.
I Am exempt under See, ,B&P C for this reason te BUILDINGI Da
WORKER'S COMPENSATION DECLARATION
1 hereby affan under penally or perjury one of the following declarations:
I have and will maintain a Cenificam of Consent to self-inum fes Worker,Campen-
Aatun,as pmvided for by Section 37W of She Labor Code.for the performance of the
work for which this permit is issued.
❑1 have and will maintain Warmer Compensation Insurance,as required by Scotian
3700 of the Labor Code.for On performance of the work for which this permit is Wind.
M arkcri mpensetioa lm a carrier and Policy nu em:
artier: /�'g�yt�Paliry No.:
A 'DF EXEMPTION FROM WO
COMPENSATION INSURANCE
(This section need not W completed little permit is Nation hundred thus.(SIM)
in less.)
1 cesufy in.,in the performance of On work for which On permit is issued.I shall at
employ any person in any manner x AS to become subject m the Wriftfs Compensation .
Laws of Celifomia.DAM
Applicant -
NOTICE TO APPLICANT:If,otter making this CenifcaM a(Exemption,you should
Weome subject to the Worker's Compe nution provisions of the Labor Cram.you must
Jz forthwith comply with such provision no this mesmttahau l W de...d invoked.
Z� CONSTRUCTION LENDING AGENCY
t—i Ihereby AMrm Nu Nem is a construction lending agency for the performance of
ai the work fur which this permit is issued(Sec.3097,Civ,C.)
QLeader'Name
a z Underi Address
V O 1 Maify Nat 1 have read this application and Nie that the above information is
11. F Corton.l agree to comply with all city and county oNinanca and slate laws misting to
0 U building eonStoedon,and hereby oothorim representatives of this city to enter Oran the
W ahovcmentioned prorerty for inspection purposes.
F
G. (We)agree to Save,indemnify and keep harmless the City of Cupertino Against' V3 Iiabilides,judgments,costs and expenses which may in Any way see=against said City
!)z in consequence 011e
ft cgnmd3
Issued by: Date
Of of this permit. /]
'—' APPLICANT UN ERSTANDS AND WILL COMPLY WITH AL NO POINT t�
S E R GU TIONS. RAd0
Re-roofs
MIMI..of All
=
aH 11=1 US MATERIALS DISCLOSUR are Type of Roof
Will ap licam lar future building Occupant store nr handle hanrdous Binomial
der, by upenimo Municipal Code,Chapter 9.13,and the Health and Safety
.semmm z(a)r All roofs shall be inspected prior to any roofing material being installed.
❑Yes AN.
Will the applicant of future building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
tit hammdnus air musammants as defined by the Bay Area Air Quality Management all new materials for inspection.
wort? ��`//,
Dyes LT,[yn
1 have Mad the hanNhusnama ials hddimamndunder Chapter G95ofthe Califar
Ads H Safct oM,SccuarsZM5.35533 And 25534.1 undc.uad thatifthcilding
d of curten0y .sc a toner that it a my responibility to noul' On scup t n(the
m4acracuts whof must Wmet four toissuance ofaccrdfc o cu enc Signature of Applicant Date .
Ow ermau@or sdagcN one All roof coverings to be Class "B" or better