04090293 (2) CITY OF CUPERTINO 1 ".' gwkb«s a.;:z:„»gym' y �sa;Nl'R..!•' ks „�” _'_ - -,. _. .. -.
BUILDING DIVISION PERMITCOIyTRAC�';OIt=INFOR MATIUN;BUILDING ADDRESS: .__ J. T CONSTRUCTION ....ND04090293
20363 STEVENS rRF.P.T( PTAIn
NER'S NAME: PERMIT ISSUE DATE
LEE ' S SANDWICHES
NE: SANITARY NO. 0 CONTROL NO.
408 - d
ARCHIIECTIENGINEEIII BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 _
op LICENSED CONTRACTOR'S DECLARATION - —
I M y allitm than'
am Ileened der v..a.of Chapter 9 mommcncing Job Description _
4 IXafma than' . MBass Pmfessiaro Code,ad MY Hearst,is
LL and arc
5��, Lme Claes Lm,w " Gy ri SO TI--LEE ' S SANDWICHESr��
n Dam ConUNIN (! r
A CHITE!. SDECLAR ON I. •^I /j ,r�.�
on raved ery plena shall he use I alt
y0 Licensed Professional �L
OWNER-BUILDER DECLARATION
a I hereby affirm that i am attempt from M Conlr elm's UC.e Law for the
i p 0 following mason(Sedan IIB 1.5,Business and Pmfesslam Code:My city or county
$ which requires a permit to commun,altar.improve,demolish,nr apalr.y s1N.lare linea A/
F-�0 prior m its ismance.alw requires the applicant furnish permitw lila a signed summem _ y
gg,Sp C that he!,licensed purtuantto the provislansafthe Conuacmr's Umnso Law(CWpmr9 Sq.Ft. Floor Area /j {,r y \Va uatlon.
ds (commencing with Sectioe7B00)of Divalon3aftha Buslnumand Profwlons Codc)ur
that he is exempt thmerfrose and.the basis for M alleged taamption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant M•civil penalty of 3 I/62MBImetO 0 - Occlipancy'Type - -
am more than five hundred dollen(S500),
❑1.asowner of Me property.or my employes with wages as Mn vele eampensdoa,
wnlldothework.arWwmu.aaisa.t Intended oroBerd for sam(Sm.7044,Business Required Inspections
and PrefeWot Code:The Contexture, Law does ant apply a an awns of q p
paopeny who builds orimproves thereon.and whodocasuch work Mmse forthmugh his
own employees,provided Net such imp ntemanu art not intended maRead for sale.If.
however.ON building or improvement i,sold within ane year of completion,the owner. ---
builder
.,builder will Mw M burden of pmving sus be did nm build or Improve for purpose of .. .
sale.).
❑1,as Owner of the property,am exclusively connecting with licensed commolnrs to
construct M project(Sea 7044,Business and Professions Cade:)The Connector's LI-
cents Law does not apply to an owner of property who Wilds or improves Mmon.and . . _
who conusess for such projects with a conuacter(s)licensed pursuant to MCormwelora
License Law.
❑1 am exempt under Sea .B&PC fm this reason _
Off Dam
WORKERS COMPENSATION DECLARATION
I hereby affmm under penally of perjury one of M following declarations:
❑I ham and will maintain a CWRcate ulcansom to self-imum for Workers Compen- '
saturt..provided for by Schon 3700 of the Labor Code,for the performance of the ,.
work for which this permit is Issued.
❑1 have and will maintain Worker's Compensation IraW.ce,as required by Section - -
37M of M Labor Code.f.M performance of M soak for which this permit is Issued.
My Wor etc tpe anon mount, rtiamd Polmynurat6tt am: -
Cartier. a
67
Policy 0 —
ERTIFI TEOFEXEMPnON 0 WORKER ,
OMPENSATION IN CE
(This action need not beeamplemd if M permit is foronc hundred dollars($100)
or less.)
1 certify that in the perform....f the work for which this permit 4Issued,l shell not [.
employ any person in my meaner on u to NOUN Whoa to M Worame Compensation
Laws of California.Dem
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Eaempdon,you should
become subject w M Worker's Compensation provisions of the Isla.Cade.you most
w,O fOMwithcamPly with such providi or this .it shall N dMod ranked.
y y CONSTRUCTION LENDING AGENCY
(~ Thereby ares that Mrs is a.nsimaskaa lending agency for M Performance of
lYi M work fur which this permit is Issued(Ste.3097,Civ.C.)
W Q Lenders Name
]z Lender'sAddress
U 0 I certify that 1 have sed this application and state that M above Inrormatlea is
I,.E correct agree to comply with all city.d county ordinances and sue laws relating m
0 SV' building construction.and hereby sutharia representatives of this city to cera upon ft
W above-ammiaml progeny for inspection purposes.
ty Wc)agree to asve.indemnify and keep lunnleu M City of Cupertino saga nst
v,w fn Iiabilines.judgmenss,cesu.d expenses which may in my way amue,agents said City
U z in consequence of the treating Of this permit.
PLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
rear SO CE REGULATIONS.
Re-roofs
Signator ApplicaseX nuocmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ill M applimm N funare e building=upset some or handle ha sendom material
as defined by M Nno
CupeMunicipal Code,Chapter 9.12.sod w Health.d Safety
Co., [3yesxss3x(.)7 42Na All roofs shall be inspected prior to any roofing material being installed.
❑Yes
WIII w appiicsot or future Wilding aceupant ase equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hAUMOV,air contaminants as dcaned by M Bay Area Air Quality M.aecmcnt all new materials for inspection.
District?
❑Yes GJ No
I have and the hmardlms mammals requirements underChapmr 6.95 of the Califon
nu Hcalh&Safety Cade,Seedons 25505.25533 and x5534.1 undersand that ifw building i�/ �,p D
does not currently ham a tureen.Nm It is my msponsibility to tifw y Occupant of M /l/
uImmcnu which mu bemetpdortu issummofaceninowaf Occup.cy. Sign eof Appicant Date
venae ter arisd scant Dam All roof coverings to be Class"B"or better