07010168OC
:UP
:zu
Tac
7 p�G e
U. v
�a7
o�
uz:
>=C
'r~CCa
i5•
CITY OF CUPERTINO
PERMIT
C�1'TtI2AC�'iR IQRMATIi�N•
BUILDING DIVISION
BUIL INGADDRESS:
0128 STEVENS CREEK BLVD
PINN BFOTHERS CONSTRUCTIONS
PERMIT NO.
07010168
'ER'S NAME:
PERMIT ISSUE DATE
?INN BROTHERS
1475 SF.RATOGA AVE
02/12/2007
SANITARY NO. CONTROL NO.
ONE:
r
(408)2-r2-9131
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division3oftheBusinessandProfessionsCode,andmylicenseis
FOUNDATION AND STRUCTURAL DETAIL FOR PRE -APPROVED
in full force and effect.
License Class Lic. #
TRELLIS
Date Contractor
ARCHITECTS DECLARATION
ORIGINZ,L PERMIT #05080165
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt Crom the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
Sq. Ft. Floor Area
Valuation
! prior at its issuance, also requires the applicant for such permit to file a signed statement
License Law 9
that he is licensed pursuant to the provisions of the Contractor's (Chapter
Code)
$ 0
(commencing with Section 7000) of Division 3 of the Business and Professions or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofNumber
Occupancy Type
not more than five hundred dollars ($500).
3 6 9 0 3 0 01 .
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
q p
will do the work and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does Trot apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
44. as auvrrer of the properly, am ex sively contracting with licensed contractors to
the project (Sec. 7044, B in and Processions Code) The Contractors Li-
cense Law docs lux apply to an o mer o properly who builds or improves thereon, and
who contracts f Juch projects th a co tractors) li rased pursuant to the Contractor's
License Law.
Q 1 am eC, B& P C for this reason
er Dare
rWORKER'SCOMPE miTON DECLARATION
I hereby affirm under penalty o 'ury one of the following declarations:
C3 have and will maintain a Certificate Consent to self -insure for WorkeesCompen-
sation, as provided for by Section 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 Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Polity number arc:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
`
or less.)
I certify that in the pert ante of thew gfo[ hick thi �rmit is issued, 1 shall not
employ anypersonin y ao tet qelite Woticcrs' Compensation
Laws o(California.
Applicant
NOTICE TO APPLI A ,-after g CcniCicate of Exemption, you should
become subject to W kis Com do provisions of the Labor Code, you must
forthwith comply w th s ch provisions or this permit shall be deemed revoked.
5
01 CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency rot the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
~ Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is
correct. 1 agree to comply with all . and county ordinances and state laws relating to
building consupction, and here auth rize representatives of this city to enter upon the
above-mentioned property for nspccd n purposes.
>w (Wc),egree to save, i emnify d k harmless the City of Cupertino against
yi liabilities, jupgracros, costs nd expcn s w ' h may in anyway accrue against said City
in conxqu oe f the g Ing of thi r t.
APP LiC ER ANDS D ILL COMPLY WITH ALL NON -POINT
Issued by: Date -(2
SOUR LA S.
` Z rl �n
SignaiA A IicanDare
r
DISCLOSURE
Re -roof:
Type of Roof
HAZARDOUSUCon
MATERIALS
ill the applicant or future building occupant store or handle hazardous material
As defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
:c, Section 25532(a)?
All roof; shall be inspected prior to any roofing material being installed.
❑ Yes Q No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the app)JJ'��ant or future building occupant use equipment or devices which
emit hazardous air t�ntaminants as defined by the Bay Arca Air Quality Management
all new materials for inspection.
District? J /
❑ Yes t �` ❑
1 have Wad'the hazardo mater' Is requirements under Chapter 6.95 of the Califor-
nia Hcalth & S&4y Coc, Sec ' ns 25 5, 25533 and 25534.1 understand that if the building
does not cu ndy ve a to nt, tha it is my nsibility to notify the occupant or the
'
Date
rcyuircmen 0 1 ust ei p r to iss ce of a Certificate of Occupant
v .�
Signatul a of Applicant
All roof coverings to be Class "B" or better
Owner 4 cd agen _ Datc
T—T--- v