02040002 cITY OF cuPERTINO CONTRACTOR INFORMATION:
BUtt.Dmnc DtvtstON PERMIT
Bklhpll dAAI3RESs:WOLFE RD PINEWAVE CONSTRUCTION, INC'[PERMIT
,rj1"MIJCHIES INC. (CANDY BAR) 3515 RYDER ST. APPL'cAifsfjCOTAr2002
PHONE: (408) 245-3836 SANITARY NO. CONTROL NO.
O O ARCIIITECT/ENGINEER: BUILDING PERMIT INFO
W C BLDG ELECT PLUMB MFCH
aiW
u¢�
LICENSED CONTRACTORS DECLARATIONy (hep>wE, In.Ilanne ,wdtulle, "
iz-LL
worCnarvc 9t^olnlncasing TENANT IMPROVEMktpescription
with Scnioo700o)af Divisi 3of,he Busine.yanJ pr lfe si my license
Sty-' in full t'orc .tad efrco, y 1V,1/Y
e License ClyCont, Wl F 0 N /Jd, B-rC®
Contractor !f- II `V'i toil f� L�
73C vA1tCH1'rFCf'SDF.jCe�slsAT-
-`C,� I understand nt plans shall he used aalbhlic rccoNe
�<5 NOV 0 6 2002
z.Epp Lieema114nfelvonnl
x oOWNER BUILDER DECLARATION
W-fir I hemby affirm that 1 am esanpt from the Contractor a License Law for the $30000
F_z Q following rcaum.sionion 703 1 5,Business and Prefession%Code:Any city or county
BUILDINGx
E S hich rcquircmi
s a pert m mimpr
cotruct,alter. ove.Demolish,nr repair any suunure
pnnnoit,,issmnce.almrcquirtuM applicant for such pcamiuo filed slgtmd stamment ..
tbut he is llcens.it pto,uimm,he provisions ofine Contractor's License Lew Chirpier 9 r, a . Valuation
Rodrmencing wwallSection 7001)of Division 3 of the Busineu and Proressiens Cuba) S " 'I s t _, �s r\( '. ,
Or that he is exempr therefrom and the basis for the alleged exemption.Any violation
of Section 70315 by my applicant for a pemJt subjerls the applicant m a civil penally '
of not more than rive hundred dollars 155006 PN A I LUIN Occupancy Type
°Las owner of the t4,.fin my em w with wet Their cola tier, 102 - PIERS
proper, p yenen ansa. pensa
Bur dame wPrk.of Professions
me strCode: is not intended ere Law for axle(per. to 4.an - Required Inspections
Boniness and Professions Cale:The Contractor's License law docs not apply to an
owner of property who builds or impro,,n enaenn,and who doer such work himself
10 4 - REBAR
or through his owa employees.provided that such improvements are not intended or - 105 - ANCHOR BOLTS
'offered for sale.If,however,the building or improvement is sold x i,hin one year or -
inmpletier,tnc owner-builder will have the burden of,eving that he did nut build or 106 - SEWER & WATER
imvrove rim pargnu nr wole.L . . . 202 _- .UNDERFLOOR PLUMBING
_ ❑I,a,,ewoerennepropeatr,:nice.clnninelrrommctingwimheensedcommet^ io 203 - UNDERFLOOR MECHANICAL'
conatma the project(Sec.Tsui.Business and Professions Cmc:)The Contractor's
License Low does not apply to an owner of property who builds or improves thereon, 204 - UNDERFLOOR FRAME
uJ who contracts for such projects with a contructons)licensed pursuant m the .. ..... _
Iso ase Law. . 205 - UNDERFLOOR INSULATION
lam apt nser Sec - B&PC far this meson
about rvk. cr Da / cv 301 - ROUGH PLUMBING
% ORKER'SCON NATION EC RATION 302 - TUB & OR SHOWER
I natchy arnrm ands not,,of Kilo,one or the following declameons: 3 0 3 - ROUGH MECHANICAL
i o I have and win maintain a animate er Coment ,,self-inure lot worker',, 304 - ROUGH ELECTRICAL
U__1 Compensation. as provided for by Section 3700 or the Labor
Code, fee he 305 - FRAME
performancemlworkfarwhichthispermitisissuee. 306 - HOEDOWNS
°Ihave and will maintain workers Compcnamion Insurance.ses required by section 307 - INSULATION
3700 of the Labor Code,for the performance of the work for which this Permit is
sued.My weaker•,,comperwminn lum ante conic,dad Policy rmnber are:
308, - SHEETROCK
Cerricr: Policy No, 309 -„ EXTERIOR .LATH
CERTIFICATION OF EXEMPTION PROM.WORKERS';
COMPENSATION INSURANCE •310 - INTERIOR LATH' _
(The,,section nem oat he completed if the permit is for one hundred dollars 311 `- SCRATCH COAT i - •
313 - ROOF NAIL
I,cariry&Iinthercalirorni�a `ormewor ror�nicnmispermeisis'.ad,1 501 - FINAL ELECTRICAL, ENERGY
x
sChV li nm empmy any person nn err near `��e en ro he weaetr 502 - FINAL PLUMBING ENERGY
m ma
"p°'i`°"' 503 - FINAL MECHANICAL ENERGY
NOTI�ETO akin this Certificate of Exemption.you should
z jr,neeoW{un"' some"
ker',,comp,i,auarp,avianrsonneLahorCods,y.am^at 504 - FINAL BUILDING ENERGY
O fonhxu amply with..M1 provisions or this permit shell be deemed revoked.
. , 505- - FINAL ELECTRICAL
FSI CONS'I'RUC'I'ION LENDING AGENCY ' -
>- I herchy affirm the mem is a ct,mwction Irnding agenq fm the performantt 506 GAS TEST
of the work for which this'pennn is issued(Sec.3(197,Civ.C.)
z. Laade, Nan;a'...• 507 -- FINAL ..PLUMBING -
�' 1,ander's Adaress
v o 508 - FINAL MECHANICAL
I scroll,that I have mad dhow app,aeon and site that the above inraamauoa is 509 - FINAL GRADE
la-tri correct.I agree to comply with all city and count'ordinances and state laws relating
O U to building con.ssmnion,and hereby uumonic,mmicatativesofthis citytoenter upon 510 - FINAL PLANNING
} the absve-mardoneppropanyfor impcanonpufav,, 514 - FINAL PUBLIC WORKS
p, OAS)agree to save.indemnify and keep harmless the City of Cupertino against
0
listed ities,judgmeps,,,costs and expenses which may in any way inside against saidAPPLI ,
U Z City in conscq a of the gnmting nr is it. ” ' ///�/
SOORCE NDERST1ND5AND LCOMPLY WITH, LN I 1 �-
SOURCE sPO R ERS sued by: - Date
t A I n mmaor -' ere
igriu,ao ppica Re-roofs
Hn" RDOUS MATERIALS DISCLOSURE
will inapp team future building Occupant tore fit handle hnsardoas m:rcdal Type of Roof _ ...
as defined by On Cupsmas nfam I Code.Chapter 9.12.and the Health and Safety
Gale,Nation 25532ta 1?,.• `T r(N
.0 °Y"' '' _ All roofs shall.be,inspected prior to any roofing material being installed.-.-
Willthe applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mi bavmdous air contaminants as defined by the Bay Area Air Quality Management
natio all new materials for inspection. Applicant understands and will comply with
'OYes "" I all non-point source regulations.
1 1 have real the houlac ma anaB rcquircmen¢uMae Chapter 6.95 of the
Califeriia Health&safer ode Sections 25505;25533 and 25534,1 understand that
if the building does an,90ronatly have a tenant.thats respnosibilit to unity the
perm of me men enu p which us;be met oo issuance of a C m cam f
o m
`y i 2 ignature of Applicant Date
owneror atimoai=m.gert' Dae All roof coverings to be Class "B" or better
% '- — OFFICE