07120208 CITY OF CUPERTINO a x*'; �r� �"^ `�'�
BUILDINGDIVISION PERMIT =MCORACT(TRINFORMr�.T.TO '
PERMIT NO.
9u11.OlyQApljR N WOLFE RD #2119B TBD - TO BE DETERMINED 07120208
W3UER'S NAME
: PERMIT ISSUE DATE
GENE LEE 02/11/2008
PHONE: - SANITARY NO. CONTROL NO.
ARCHITELTIENGINEER: BUIMING PERMIT INFO
BLDG ELECT PLUMB MECH
Sop LICENSED CONTRACTORS DECLARATION O O O O
ti 1 Wroby affirm that 1 am licensed under provident,of CMpmr 9(commencing Job Description
with gectkars? U)ofDivi,ion Sofdw Business and Profcsauns Code.andmylicevcis T. I . -NEW FROZEN YOGURT SHOP, 594 SQ FT.
in full forte and effort.
i'M4 Licenuclw sec.• (SEE NOTES)
' Dom 1..1 .t conlncur 1 to f rnk'T
nQ ARCHnECrSDECLARA 10 ��' '
I understand my plans shall bu used as public meomls
2ytJ
g sed Licensed Pmfeastanal
OWNER-BUILDER m Ce ContrON
a1 harohy affirm that 11. exempt from the Contractors :Any c Law for one
y 1 Oyu following maun. enctim constru5.ct.
Baslmu sed Preens,froom Code:Any .ity m county
k$4. Which its iuuancc.
apmrnit In CnnnmC4alter,ntfor such
permit,fifile a sig ed ,Wclum
iy prior mitscensece,dumquiw theapplicanto the Contractor's
ice a,Lacdatatemenl
that(commencing
pursuant be the or Division
of dteCBusiness
usins inimmelaw(Chapter9 Sq.Ft.Floor Area C Valuation
(cemm is exempt
ptheNrom7ODB
and
eassisafref Gal Bvainwmd Profession,viCads)or $15000
that ha 7 exempt Era apple sed the beer for the subjects
the aemam in Any violation of
Section,than by ury applicant for a permit suhjecu the appl¢mt ar s civil penalty of tuber Occupancy Type
net mom than five hundred dollen(5300). 316 2 0 0 9 6 .�I]"��
❑Lot owner of Ne pmpmry,army employees with wags u thc(Sm.
tele 0M,Bus om
will do lhewanr,ande:The omm ice,License
ace do fs sasta(Sec.t oan B nee of Required Inspections
and any who
Cade:The ves tracmrt Liaise face dem larks apply lf an owner of q P
property who buildsorimpmvmch improvements
andwM am cut
hendewarkshimselfor edIluough his
awnwer the
building
that suchimpm.mmtsamnot ouofemoRemtl for salmi If,
however.thebuilding erimProwmmtuhat within etayearamproeforNeowner-
bnde.). will have the burden of proving that he did arks build or improv for puryme of
asley
❑1.as owner of the proper,am exclusively contracting with faced convectors m
construct the project(Sec.7004.Business and Pofesdam Code:)The Contractors Li-
cons,law dors not apply m an owner of property who Wilds or improwa thereon,and
who contracts for such pmjew with aeantneteRO licensed pursmm in fm Contractors
License law.
❑I tun exempt under See ,B&PC for this mason
Date
WORKER'S COMPENSATION DECLARATION
I hereby.Berm under porosity of perjury,one of the following doclamdom:
Lha.andwiculfory eCeni 3700 of Gntmeb r Code.
for Wmkers Compere
moon,r provided for Ferran
Salon 3]00 0(the labor Code.for the performance of the
work far which this permit ie iastmtl.
❑I haw and will maimain Workers Compensation Imuran¢,as required by Section
37W of two labor Code,for Bm performance of the we*for which this permit is issued. '
My Worker,Compensation Imuran carrier and Policy number am:
Curier.�IL11A ^P At aft' Policy Na.: 51729�5�
C InGTE OF EXEMPTION MOM WORKERS'
COMPENSATION INSURANCE
(Thu=it..send cwt bu completed if the permit le finene hundred dollar(SIM)
i or lea:) ,
1 certify that in the perfmmantm of the work for which this permit is Wood.l shall tut
employ any person in any manners,as to Women subject to the Workers'Compenasdon -
Laws of Califounn.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Cedificate of Exemption,you Mmld
become subject In the Workers Compensation provisions of the Iahm Coda you most
.,O forthwith comply with such provide.or this permit shall bu dimmed revoked.
z CONSTRUCTION LENDING AGENCY
t-r ate-+ I hnrehlefiime the them iuccrostma m lending all for the performammof
a
the work for which this permit Is u,md(Sec.3097,Or.C.)
W�Q Lenders Name
7 z Lenders Addoo, _
V I certify that 1 have read this application sed sum that the also.information is
is,r+ correct.I agree to comply with all city and county onfinances mtl scam laws misting to
O IS.'J building construction,and hereby authorise mpreunuuves of this city to enmrupnn the
W aha.-mandoned pmpeny rod inspection purposes.
gy, (We)agree to saw,indemnify and keep hamilw the City of Cupertino al
m liabilities,judgmmca,costs and expense,which may In my way acme agaimtuid City
U,'ZZ in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date L ( v
SOURCE REGULATIONS, //'��
�2eAU :0- � �� 0 Re-roofs
Slgrtumo , tsntiC�ontracwr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will c applicant or future building occupant mom or handle haasNam material
defined by dm Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
.Section 35532(,)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya
Will the applicant or future building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove,
emit ha'rardnm air comeminanu at defined by the Bay Area Air Quality Management all new materials for inspection.
District?
[I Y. Nu
I have mwl the haasrdammemdar requirements under Chapter G95 of the Caller.
ntu Hmlth&SafetyCade,Sctbxnx 0.25533 and 25534.1 underacaM dualithe building -
does cart currently haw a mount,that it is my responsibility to notify not uccupsm of she
rcquimrmou which masa W an. Signature of Applicant Date
G
d gent DmAll roof coverings to be Class"B"or better
Owner ser eta sea � ' '