07050100 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:
10122 BANDLEY DRIVE TBD — TO BE DETERMINED 07050100
PERMIT ISSUE DATE
OWNER'S NAME:
MARINA FOODS 07/13/2007
SANITARY NO. CONTROL NO.
JE:
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
p j LICENSED CONTRACTOR'S DECLARATION - Job Description
m F, I hereby affirm that I am licensed under provisions of Chapter 9(commencing
':ZW withScction70(l0)ofDivision 3ofthe Business and Professions Code,and mylicense is INSTALL TYRE I HOOD(E) KITCHEN IN MARKET REPL
=y in full force and effect.
;yZ License Class Lic.# FLOOR DEAN,CEILING PANEL & LIGHT/ADD STORAGE RM.
y❑ Date Contractor
ARCHITECTS DECLARATION (PER HEALTH DEPT)
i a< l understand my plans shall be used as public records
iyU
'u-y Licensed Professional
OWNER-BUILDER DECLARATION
r I hereby affirm that 1 am exempt from the Contractor's License Law for the
p0 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
i H prior to its issuance,also requires the applicant for such permit to rile a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q.Ft.Floor Area Valuation
4- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $25000
`3 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 of A��,1 Number Occupancy Type
not more than five hundred dollars(5500). 32634066 .
V V
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not 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 be did not build or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon.and
who contracts rot such projects with a contractor(s)licensed pursuant to the Convectors
01:
Law.
L J n:exempt undo Sec B&P C for this rcuon
Owner Date
WOIMERSrNA0tNSAy0N DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I hsve and will maintain a Certificate of Consent to self-insure for WorkeesCwnpen-
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 Workers Compensation Insurance carrier and Policy number arc:
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the ormance of the work for which this permit is issued.I shall not
employ any person in y manner so as become subjec to the Workers'Compensation
Laws of California Da
Applicant
NOTICE TO APO LICA .If,a akin this rtificate of Exemption,you should
become subject to the Workers Comoctisation proCsions of the Labor Code,you must
O forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
(~rA I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued(Sec.3097.Civ.C.)
W Q Lenders Name
Lenders Address
U 0 t certify that I have read this application and state that the above information is
[I.•^
Cc CL I agree to comply with all city and county ordinances and state laws relating a
rJ U building construction,and hereby authorize representatives of this city to enter upon the
LZWi shove-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
HCo) liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence4ERS-TANDS
this permit. Date
►'� APPLICANT AND WILL C MPLY WITH ALL NON-POINT Issued by:
SOURCE REGRe-roofs
Signature ofADaeof Roof
US MA ALS DISCLOSURE Type
Will the applicant or future building upant store or handle hazardous material
as defined by the Cupertino Muni pal Code,Chapter 9.12,and the Health and Safety
Code.Section 25532(a)? All roofs ;hall be inspected prior to any roofing material being installed.
[-]Yes
V o
If a roof i;installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
,.mit hazardous air contaminants as*ftncd by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes o
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs not currently haN a tenant,that it is my responsibili to notify the occupant of the
requirements which m t be et prior t,issuance of a rtifrcate or Pay- Signature of Applicant Date
tiP All roof coverings to be Class"B"or better
Owner or authorized agent Date