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08040176I I& CITY OF CUPERTINO ��a ks«'T�i� BUILDING DIVISION PERNUT C©;Sol RX -TOW1 , <QS MATION ('&v"t BUIIDIN ADDRESS: PERMIT NO. 199 S DE ANZA BLVD TBD - TO BE DETERMINED 08040176 VER'S NAME: PERMIT ISSUE DATE 10/16/2008 PHONE SANITARY NO, CONTROL NO. ARCHm3CT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Chsptor 9 Job Description 1 launch, Mr.. that 1 w licensed under pmvisim r of (comm use ng with Section 70MB of Division 3ofthe Buvn,ssad Professimu Code. and my licutx is T.I.—FOOD MART,AUTO SERVICE,NEW CANOPY, REMODEL l�eB�uc�.Class Lle 0 SERVICE BAYS AND SNACK SHOP, REMODEL EXTERIOR Denc_ Contractor ARCHItECISDECLARATION FACADE,TRASH ENL,ACCESSIBLE PRK STALL,LANDSCAPING I undeemnd my plans shall bo it as public records Licensed Pmfestione OWNER -BUILDER DECLARATION 1 henchy aRnn that I am ucmpt from the Conuamots License Law far the following mason. (Section 7(5 I.S. Becomes and Pmfessiom Code: Any city or county . which requires a Permit to construct, aimr. improve. dcmulish, or repair any structure prior at its issuance. also requires the applicant for such remit W file a signed statement that he is [lectured to tis of the, Convector's Ucenre Law (chapter 9 Sq. Ft. Floor Area Valuation putmant provisions 15 0 0 0 p (commencing with Section 70th) of Division 3 of the Business and Profiteers Code) or that he is exempt therefrom and the baso for the alleged exemption Any violation of 3 6 61012 0 Aff Number Occupancy P Y Type SeNon 70313 by arty applicant fora permit subjects the sppliant to a dAl penalty of nor mc dun five hmWrd dollars (S5M 1, as awn,r of th Property, or my ervPlayeca with wages v thevsole campewtim, e Required Inspections wiRdathewmf_and Neswctuteunoti me dmaffemdforsak(Sec.7W.Bu mss and Professions Cade: The Contractor's Liana Law don net apply to an owner of q P property who builds orimpm ms thereon, andwho deessuchworkhimself arthrough his own employees, provided that such improvements arc not intended moffemd for sale. if. however. the building or improvement is sold within arc year of completion, the. builder will have tho WWet of proving that K did not Wild or improve for purpox of ' 1, u awns of the property,m aexclusively contracting with licensed contractors m z de pmjea (Sec. 7016, Business and Professiam Code:) Tfie Contractor's U, cense Law does not apply to an ownsr of proporty, who Wtiias or Improves themon, and who contracts for such projects with a conuac or(s) licensed pursuant he f Contractor's Lleeme Law. ❑tom evempt and a B&PC for this u D. b / Z- WORKER'S COMPENSATION DECLARATION I hemby affum under penalty of perjury on, u( due following declandom: rl I ham and will maintain •Cenifieam of Consent to self -issue far Worker'sCompen- sadon, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this Permit is laved. 1 have and will maintain Worker's Compensation Insursnec, as mquird by Section 3700of the ichor Codes. for the perfimmumeofthe work for which this permit is issued ' My Worker's Compenution Iwrance artier ad Policy number ere: " Carrier. Policy No.: CERTIFICATE OF EKEMP ION FROM WORKERS' COMPENSATION INSURANCE (ITU section need not bo compleed lithe permit is forces, hundred dollars (SIM) or las) 1 certify that in the p rformana of the wart for which this permit u horsed. 1 she not employ anyperson inmDatemy con,rm as� I to to Wafers' Consummation' ' Laws of Califomia. � r7� Appliant NOTICE TO APPLICANT:If. eller making Nu Certificate of Exemption, you should become subject in the Warknr'V Corn amselon provisions of the labor Code, you mut foMwith comply with such provisions or this Permit shall M deco ed rcvakcd. CONSTRUCTION LENDING AGENCY 1 hereby affirm the Vert is a construction lending agency for da performance, ed the work for which this permit u house (Sec. 309'1, Civ. C.) lenders Name Lender's Address I sonify Nat I Mve red this application and Veto that th= above Wmenation u correct 1 agree In comply with all city and county ordina ems and imus, laws misting to building concoction, and hereby authanse representatives of this city W enter upon the above-mentioned property for inspection puryores (We) agree m save, indemnify and keep harmless tis City of Cupertino ageren liabiliues,jdgmenu, casts and espermu which may In any way amus against said City in consequence of the granting of thisperrnil J APPLICA Re -roofs Type of Roof D /� Sienuumo Appian/Con Dam HAZARDOUS HUS MATE RIALS DISCLOSURE Will sex applicant in future building oecupml or handle Mnrdoanmamrid core Ne Cupertino Municipal Cade. Chapter 9.12 and the Health and Safety de.GrandSec io ' Section ss53z(') j II;'N, All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or Tawe building «apant a= equipment or deviceswhim emit hamnious air comeminmu as dcfincd by the Bay Area Air Quality Management all new materials for inspection. DIi ne,T QYa � F`n 1 have mail the Isco semcries requiromcnts untkr Cimper 6.95 of the Cashion. nix Hcalth&Safety Cabo,Secdmu M5.M533ou125531.ImWrsaerdthniDh= Wilding Signature of Applicant Date 'rod - All roof coverings to be Class'» a' or better g wncror'u esom as,' f"f CITY OF CUPER Y INO BUILDING PERMIT BUILDING ADDRESS: 1699 S DE ANZA BLVD OWNER'S NAME: W1 License Class Contractor LICENSED CONTRACTOR'S DECLARATION Lic Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this pen -nit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date LJ OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save (:cmnify and keep harmless the City of Cupertino against liabilities, judgments, ,,sts, and expenses which may accrue against said City in consequence of the grunting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date '" ACTOR: BAINS DEVELOPMNT PO BOX 1575 FREMONT, CA 94538 NO: 08040176 DATE ISSUED: 10/16/2008 PHONE NO: (510)445-0227 BLDG ELECT PLUMB MECH RESIDENTIAI. F I COMMERCIAL JOB DESCRIPTION: T.I.-FOOD MART,AUTO SERVICE,NEW CANOPY-REMODEI, SERVICE BAYS AND SNACK SHOP,REMODEL EXTERIOR FACADE, TRASH SNCL ACCESSIBLE PARKING STALL, LANDSCAPING -INCLUDES STRUCTURAL. 8/27/09 REVISION #I -REMOVE OUTSIDE ENCLOSURES -EXTEND THE CASHIER COUNTER, REVISE STORAGE & OFFICE AREA AT THE REAR OF THE BUILDING. Sq. Ft Floor Area: I Valuation: $150000 APN Number: 36610120.01 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. Signature of Applicant Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should 1 store or handle hazardous material, Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: CONSTRUCTION LENDING AGENCY Date: 1 hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C. ) Lender's Name --- Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. t ;ocnse(' TY OF CUPERTINO BUILDING PERMIT BUILDING'ADD&ESS: 1699 S DE ANZA BLVD CONTRACTOR: BAINS DEVELOPMENTS PERMIT NO: 08040176 OWNER'S NAME: ATAM SANDHU PO BOX 1575 DATE ISSUED: 10/16/2008 OWNER'S PHONE: 4084063158 FREMONT, CA 94538 PHONE NO: (510)445-0227 ❑ LICENSED CONTRACTOR'S DECLARATIONr r BU_ ILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # I r r MECII RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: T.I.-FOOD MART,AUTO SERVICE,NEW CANOPY, (commencing with Section 7000) of Division 3 of the Business & Professions REMODEL SERVICE BAYS AND SNACK SHOP,REMODEL EXTERIOR Code and that my license is in full force and effect. FACADE,TRASH ENL,ACCESSIBLE PRK STALL,LANDSCAPING I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's " Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $150000 permit is issued. APPLICANT CERTIFICATION APN Number: 36610120.01 Occupancy Type: I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non -point source regulations per the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. Signature Issued by::' Date: OWNER -BUILDER DECLARATION r I hereby affirm that I am exempt from the Contractor's License Law for one of RE -ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is I, as owner of the property, or my employees with wages as their sole compensation, installed without first obtaining an inspection, I agree to remove all new materials for will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection. Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain Section 3700 of the Labor Code, for the performance of the work for which this compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. permit is issued. Additionally, should I use equipment or devices which emit hazardous air 1 certify that in the performance of the work for which this permit is issued, I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after making this certificate of exemption, I Health & Safety Code, Sections 25505, 25533, and 25534. become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or autho a t: i Date: 41, APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's to building construction, and hereby authorize representatives of this city to enter for which this permit is issued (Sec. 3097, Civ C.) upon the above mentioned property for inspection purposes. (We) agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9.18. R / �'j Signature Date / 1 understand my plans shall be used as public records. Licensed Professional REVISION IF R-2 CITY OF CUPERTINO BUILDING PERMIT _ BUILDING AibDRESS: 1699 S DE ANZA BLVD `" �-r;'RACTOR: BArNS DEVELOPMNT PERMIT NO: 08040176 OWNER'S NAME: ATAM SANDHU PO BOX 1575 DATE ISSUED: 10/16/2008 OWNER'S PHONE: 4084063158 FREMONT, CA 94538 PHONE NO: (510)445-0227 ❑ LICENSED CONTRACTOR'S DECLARATION I— F I— F BLDG ELECT PLUMB MECH RESIDENTIAL. License Class Lic. # I— COMMERCIAL Contractor Date JOB DESCRIPTION: T.I.-FOOD MART,AUTO SERVICE,NEW CANOPY-REMODEL 1 hereby affirm that I am licensed under the provisions of Chapter 9 SERVICE BAYS AND SNACK SHOP,REMODEL EXTERIOR FACADE, TRASH ENCL (commencing with Section 7000) of Division 3 of the Business & Professions ACCESSIBLE PARKING STALL,LANDSCAPING –INCLUDES STRUCTURAL. Code and that my license is in full force and effect. 8/27/09 REVISION #I-REMOVE OUTSIDE ENCLOSURES-EXTEND THE 1 hereby affirm under penalty of perjury one of the following two declarations: CASHIER COUNTER, REVISE STORAGE & OFFICE AREA AT THE REAR OF I have and will maintain a certificate of consent to self-insure for Worker's THE BUILDING. Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $150000 performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 36610120.01 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and. state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code, Section 9.18, RE-ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous 1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work. for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: Date: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, i must I hereby affirm that there is a constriction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date