03100217 (6) CPERMIT ITY OF CUPERTINO � *�Gy_0.R' �FAMATTON §d
BUILDING DIVISION ,rr.. �
BUB.DINO ADDRESS: ALL BAY CONTRACTORS, INC, PERMRN003100217
2
OWNEWSNAME: PERMIT`LSUEDATE
STARBUCKS
NE: SANITARY O. C NTROL NO.
0
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
iM0z LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that I am licensed under Provisions of Chapter 9(commencing
i with Secd..TOOD)of Division 3 of she Buu.and Pmfeuiom Code.aM my it--is
^<
in full ett TENANT IMPROVEMENT
5 Lteense Class
LIC.N
Dem cumracmr REVISION--#04020047
ARCHITECT'S DECLARATION
3 < 1 mukri and my plans"I W used u Public recerds
U Licensed Professional
j OWNER-BUILDER DECLARATION
> 1 hereby affirm that I am commit,from de Comrectola License law for No
o following reaeon.(Section 71131.5,Busimu and Profession Code:Any city or county
9 which¢quires a permit to construct,elect.improve,dcanMfih,or repair any structure
poor m its issuance.also acqulrn to applicant for such permit o file a signed statement
FF that
W Ts licensed Pmnunt in the Provision of IW Convector'sConvector'sU..law(Chapter 9 Sq.F[. Floor Area V""000
C g (commencing with Section 7000)of Division 3 of Nmfc
e Business and Puion Code)or
3
that he is exempt tie¢from and the bats far the alleged exemption.Any violNun of
Section 7031.5 by any applleml for a penult subjects the applicant la a civil Penalty of APN Number Occupancy Type
oat mon Nu the hundred dollars($500). �"`n
01.as mvmrofNeproperl many employes with wgnuNe'v tole ampennthon 5:907005 . 00
will do the work. ad ft ahucture ie not Intended or cull fcsain(Sm.7014,Businua „ ';j ` �- IHS cellons
and Profession Code:The C.mamr's License law dao not apply m an owner of '� iJ_J,1 j
pmpeny who builds Or impromuhermn.aad he daasuch work himself Or through h
own=Play..provided that such Improvements see notlnmMed m.Rued fm sale.
however,the building or improvement is sold within one)ev of comptedon.Ne own L�
builder will have de burden of proving thathe did oat Wild m Improve(or purpm
sale.).
❑1,as.war of be property am conclusively...hearing with licensed ecntrac'msa to
construct the pmjact(Sec.IDN,Business and Professions Code:)The Commences Li- r. _
caro law don out apply to an owner of property who Wilds or Improves themes,and,
who contracts for such projects with•c.nhactor(s)licensed pursuant an Out Coronation
Licence Law.
O lvnexemptundu Sec. ,B&PCforthsresa.n
Dam
WORKER'S COMPENSATION DECLARATION
1 hereby Eaton under penalty of perjury one of the following declaration:
have and will maintain a Certificate of Content m self-insert for WortCompen-
on,u provided for by Seal..3700 of the labor Code.fm c e performance of the
work for which Ns Permit is Issued.
❑1 haw and will maintain Worker's Compensation Insurance,u required!by Section
3700 of the labor Code,fm the performume,of the work for which Ns permit Is Trued
My Woheh ComPemtion Insurance esrtiu and Polity number are:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Ohs section teed Int W completed If IW Permit is forum hundred dollars(5100)
or lose.)
I certify that in the Performance of dem work for which this Permit is Wood,I"I not
employ,any person in any manner sou of become subject to the Wm1moV Campemda
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.After making this Cenificam of Feemption.you should
become subject m the Wohei s Compensation provisions of thte labor Code,you muse
Ofon iwith comply with such provisions Or this permit shall W deemed revoked.
Z y CONSTRUCTION LENDING AGENCY
[—t 1 hereby affirm des dmrt is a conuucdnn lending agency far rax Performance of
the work for which this Permit is issued(Sue.3097,Civ,C.)
W Q Lenders Name
7 z Lenders Address
U 0 I certify,hast I have read Nis application and sum Nat dem move informmiun s
U.F cormim 1 agree to comply with all city and county ordinances and sum lawn mlating in
C V building construction,and hereby a dhorim representative of this city to enter upon Ne
W mow-mentioned property for Inspection purposes.
(We)agree to save.indemnify and keep harmless the City of Caperton against
n.t y
liabilities,judgments.cats and expenses which may In my way sena against lend City
I.
() APPLICANTOof the UNDERSfANDS ANDof WILLWILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGULATIONS.
Re-roofs
Signature of AppliuHAZA DO Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII theapplicantor forum Wilding occupant more or handle Health ad Safety u defined by de Cupertino Municipal Code.Chapter 9.12.and to Health and Safely
C10wroc,
dcSection 25532NI1 All roofs shall be inspected nor to an roofing material bei. installed.
❑Yrs ❑N. P P Y g 8
Will dm applicant or future building arupant use oquipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
bromomm air contaminants u defined by the Day Area Air Quality Management all new materials for inspection.
tint?
Oyer ONO
1 have rob the buaNnm materials requirements under Chapter 6.95 of the Califon
ealth A Safety Code,Scd.n 25505,25533 and 75534,1 undernsud thv ifde Wilding
am currently have a mnana that It s my respons hillty m mdfy dm cecupant of the
immcrm which must be met Our m instance of a Ccrdficam of Occupancy. Signature of Applicant Date
rorauthorn<dagent D.ec All roof coverings to be Class"B"or better