06090025 (2) CITY OF CUPERTINO ��,g� rsgs'.ssp�.�v� -•gip �}+�r"a ' t� € .
BUILDING DIVISION PERMIT V�L\:L16t'A4��l� Yr.�01 `
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BUILDINGADORESS: B &„ SPECIALTIES PERM"o-06090025
19949 STEVENS CREEK BLVD
OWNER'S NAME: PERMIT MITE DATE
PINN BROTHERS 903 AZALEA CT 09/05/2006
E: SANITARY NO, CONTROL NO.
(408) 225-9992
ARCXITECT/ENGINEER: BLDG ELECT BUILDING PERMIT INFO
O O PLUMB ly MECH
tn
imp LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm Nut am Iiaesed unit,provisions of Chapter 9(rommencing
'•' with S"hon`7OIIU)af Div' Jartho Busi and Prof oes Cade,and mylkcnmb
,a Ifam ionleffem. Q'rf' 3 TI- CONSTRUCT TEMPORARY SHOWROOM AT COMMERCIAL
{ Z License Lo.N
Dem cono-acwr n 9 y OFFICE SPACE INCLUDES ELECTRICAL.
qQ ARCHITECTS DECLARATION
i 2 I undenund my plain shall heated as public mcorda
igu
'G G Licensed Prufestianal
O�
OWNER-BUILDER DECLARATION
p 1 Wrehy atom that 1am 1. .amps from the Csaitme o :A License taw for IW
following myon.permit
t RD 1.5, t,III .
and he.dem as Cade:Any city or county
S$ whorl requires issuance,
re enreslnhe alley,hnpron,deermiti or repair ane one,um
-iy triotus Removed pursuant
requires;the no,ismnste tar Connector'to tilts Law Clement Valuation
QNu�c�littnwJnuravantmlhcpfDisbion3of seBuazmr'andPnolaJw(Chapmr9 Sq.Ft. Floor Area
L�13 (commencing with Satimn 7000)of Division ant Nc Business and Rofessiom Code)a $10000
Na'in u tramp'thenfro s and She basis for She alleged rumpdm.Any violation of
Section 7031.5 by airy applicant fa a permit Cbjacts the applicant So a civil Family of APN Number Occupancy Type
not mart than fin hundred dollus(55001. -
❑I.n ownor of 1n pmpmy,m my cmplayeas wW wage o deo mo canpewdon.
will do Newark.and the sctum u mUnanda ed Offered Russia(Sm.7044,But=
Required Inspections
and ProfesdoM Code:The Confiscates Lime law does net apply at an owner of q P
property who builds or improves thereon,and who does such work himmlf or thmugh his
awn employees,provided dal Such improvements arc nmtintended,offered for We.If.
however,She building or Improvement laaold within am:year of completion.the owner-
builder will have the burden of proving that he did lot Wild or improve for purpose of
ask.).
❑1,as Owner of the property am sacluaively contracting wide licensed ronuacom m
construct to pmkn(See.7o44.Business and pormalau Code:)The Conmctur's Li.
case law dao Out apply to an owner of property who builds at improve thereon,and,
who conmets for such projects with a conuator(s)licensed"moan,m the contractors
Lice.law.
❑Iommemp'under Sae .B&PCrardaurcama
rer One
WORKER'S COMPENSATION DECLARATION
I hereby afllm under partially of perjury,am of the following dalarWou
union,
u and will vfair by Se tion 37m of Cmuem oCode.furefaWotkehCumpen-
Ction,as which
this
for by Section 3`700 ar de Labor Code,for de Performance of tW
work far which Nis pmmit is issued.
❑1 have and will mainuin Warkoes Compensation Thrown,at required by Section
3`700 of the,tuba Code,for the performance of Ne wort for which this permit is Issued.
My Wurkees Compensation Iesaana carrier and Policy number are:
Cartier. Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Mis section need Out bueompleted If IW perms Is forms:hundred dollars(SIM)
or It.)
I certify that in to performance of rthe wobrqk mfoormwhich Nis permit is Ismod,I&hell nm'
m rr
employanypersoninanyS in subject to the Workers'Compe"Aam,
Laws of CalVaml m
Applicant
NOTICE TO APPLICANT:If,after making this Cea rtmic of Exempdan.you should
become subject in dee Worker's Compensation provisions of de labor Cade,you must
O 2,' forthwith comply with such Provisions or this permit anal W datmed revoked.
„zO CONSTRUCTION LENDING AGENCY
[-' Ihereby affum that Nem is a coruuvetion lending agency for In performance of
p:> Ne work fa which this permit U issued(Ser.3(19`7.Civ,C.)
G4Q Lender's Namc
0 z Undoes Address _
U O 1 certify that I have toed Nis application and sum that de aero information I-
r
comet.l&Sme to comply with all city and county ordinance,and Nm laws miming in
OU building construction,and hereby authorim mpresenutins or Nis city to enter upon the
�G2J Move-mentioned property for inspection purposes.
C (We)agree to save,indemnify and keep harmless to City of Cupertino agaiml
iHy to liabilities,judgments,costs and expenses which may in any way acme against Cid City
U Z in cumegeence of the grenting of this permit. _SKdC
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURQl0.E('LULATION �/O�
J/ 't�/yy Re-roofs
Signature of ApplicantlConuacter Data
HAZARDOUS MATERIALS DISCLOSURE Trypsof Roof
Will the applicant a future building amupanlatom or handle hvardaw material
as dc0ned by the Cupertim Municipal Code,Chapter 9.12.and the Health and Safety
Ole.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yin Nu
Will the applicant or future building Ocupam um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ami'hazardous air comamimna as defined by the Bay Arta Air Quality Management all new materials for inspection.
DisWct`7
❑Yes go
I have,mad to heralloua maorialsmquiretncntsumkrChaper G95 mfde Califon
nu HralN&Safety Cmde,Secdau25J05.25533md25534.luMeraunddmif0e Wilding
does not currently ban a knane that II u my rapamibuily o ratify Ne occupant or the
rets cntswchm met roissuanceofaCertificae a Signature of Applicant
ql ,yg _pp ]� 3 o6 ate
Ownerorratrmariinddage%tt ` Dam All roof coverings to be Class"B"or better