07050029BUILDING DIVISION PERMIT
PERMIT NO.
S CREEK BLVD TBD — TO BE DETERMINED 07050029
OWNER'S NAME: PERMIT ISSUE DATE
06/18/2007
PHONE: SANITARY NO. CONTROL NO.
ARCHIIEC (ENGINEER: BUILDING PERM1rINPO
BLDG ELECT PLUMB MECH
LICENSED CON7RACMWS DECLARATION
I hereby affirm that 1 am licensed under previsions of Chapter 9 (commencing
vith Section 7000) of Division 3 of the Business and Professions Code, and my licerlsc is
n full forte and effort
License Class Lie. a
)ate Contractor
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
Iollowing mason. (Section 703 1.5, Business and Professions Code: Any city or county
which requires a permit to construct. alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to rile a signed slairm em
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption Any violation of
Section 7031 S by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (5500}.
❑ L as owner of the property, or my employers with wages as their sok compensation,
will do the work. and the structure is not intended or offered for ask (See. 7044, Business
and Professions Code: TLe Contractors License Law does trot apply to an owner of
property who builds orimpto thereon, and who does such work himself or thmagh his
am employees, provided that such improvements are not intended or offered for sale If,
however, the building or improvement is sold within am year of completion, the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
ETT'asowner of the property. am exclusively contracting with licensed contractors to
construct the project (Sec 7044, Business and Professions Code:) The Contraemrs Li-
ecase Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License law.
❑ 1 am ex pt See. B & P CC f this reason
Owner Date Y 0
MPENSATIONDECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the perform&= of the
work for which this permit is issued.
❑ 1 have and will maintain Workefs Compensation Insurance, as required by Section
3700 of die Labor Code, for the performance of the work for which this permit is issued.
My Workers Compensation Insurance artier and Policy number am:
Carrier. Policy No.:
CERTIFICATE of E(EMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need riot be completed if the permit is for one hundred dollars ($100)
or less.)
1 certify that in the performance of the work for which this permit is issued, l shall not
employ any person in any manner so om�c �syubb)e�tQQ the Workers' Compensation
Laws of California Dam
ti,-rte—T
Applicant
NOTICE TO APPLICANT: If, atter making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a comaruction lending agency for the performance of
the work for which this permit is 'issued (Sec. 3097, Civ. C)
Lender's Name
Lenders Address
1 certify that 1 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 or this city to enter upon the
ahove-mentioned property for inspection purposes.
(We) agree Lo save, indemnify and keep harmless the City of Cupertino against
liabilities, judgmcnLs, costs and expenses which may in any way accrue against said City
in consequence of die granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE
Signature ofSignature of Appliant/Ci5rhact Darer f/ Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant arae or handle hazardous material
as defined by die Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Corte, Section 25532(a)?
[3 Yes C] No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
❑ Yes ❑ No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & SaretyCodc, Sessions 25505, 25533 and 25534.1 undcrsu ind that if the building
docs not currently have a tenant, that it is my responsibility in notify the occupant or the
requirements whO most be metpoor of a Certificate ofCc�y.
n...-..... _.. u T/
Job Description
T.I—INTERIOR/EXTERIOR ALTERATIONS TO TWO
(E)RETAIL
SPACES TO FACILITATE(E)PASHA'S MARKET. SANITARY
IS
SUNNYVALE'S JURISDICTION. DINING MUST BE PART OF
Ft. Floor
$30000
37507046.1W Number
Required Inspections
Issued by:
Re -roofs
Type of Roof
Occupancy Type
Date
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
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better