05010057 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ' cOWAACT6R=INEORMATTON:�'
BUILDING ADDRESS: PERM"N0.0 5 010 0 5 7
10268 BANDLRY DR
OWNER'S NAME: PERMIT ISUB DATE
BANDLEY CENTER INC
SANITARY NO. CONTROL NO.
I PF
ARCHT7ECT/FIiGINEEit: BUILDING PERM"INFO
BLDG ELECT PWMB MEM-1
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app LICENSED CONTRACTORS DECLARATION Job Description
gumI M'by WMM tort 1 w bowed UnI Pov(caaa M Chapicr 9(mmmrxing
MthSatioo 7IXX))af Dlvldon Sof We varcss utl Prof Co@.uM rRcaeia
thrwlra awe a �y INTERIOR TI/PARTITION 1HR CORRIDOR
?� comgDCrr (14/12/5 ADDRESS CHNG FROM 10260 TO 10268
ARCHRECTS(3ECL.RA N- Sj�Kjt CONTRACTOR: ASSOCIATED ENGINEERING & CONSTRUCTI
SC �I un6.israd my pWat"I tIo dss puhk rtcrvdr
SyU
�u6G Liccved PMuioul
O it I ran =plfiILDER DECLARATION
n O I.re'by oHlrm Wat I a1.eatmPt rrurn the Gan4rgdr'.Lions City
o for the
00 Which nC'aan.l5ccvon 7(171.5.Br ior. and AOf enonii Code:Any oily m caw.
5$ Poor 'qvi'..pain m Cmana.X dos. ton ho it i,fi�M,no,la, nt
prior Ns Iivuana,ilm'1.i the W..of fm tachpomil LfkaiLrsdvakniat
dot he 4Ban,Paq�.ntln ll,.gn.i>;on,nrinrc—�nr',ua—Li-(o,.ge9 Sq. F[. Floor Area Valuation
Yl'$ (cornarr ng withSadmi7000)ofDivision 3oftoo Btria andRofudwCrIor $200000
e _ BW K h comp Ibc'f'm aM th Wsh for the dkLW etempda.A"vin4tim or
Sadon 7031.5 by avy,itnix o far.Ph mbjare do,-PPILu u.CMI Pe+ahYN APN Number Occupancy Type
MI mac loan fire huid'd dd4n($500).
El 1..ave of Bic P.P.M.a my Pby.who cargo a thrkmk a Pem .
„nm �.�at.�
uir."ft oranamwdna
dwf.�arnrwn(S .7w,.Bra0— Required Inspections
uW Pmfealmu Cade:The Contrrnon I.lon.e law'doti Mt W ly m an ownry a rly/��/p�ire Ispe
propenp,,, Waarim ia, Wermn,andwW do nor mtcocbimaelfalhyru If. � R ^'�N
boIrW ira,ErdlbrarL imPwememsue rut vueMNaalferWfora. - tttS�tt t BBooff
hvvnen,thebulldlOg nkop'wm is cold did atera of C'mfor pu owner- t
builder cath Wrc ds Eaden of pmnnL Ings h did va htiN a Imprae for papmr.N
01.uavm al We ProWly..rn mia'aely Camrrct4tg www limuN anfluu7orr to 7
ft MjW( MAR r")
V �r3UU
caamuct See 014.Boon*;W Pitman Code:)The Crock—LF .
¢rue Law dou not apply on N wtta of Prop"w Wart,m 4nprorea lhrrra.and
wW..stool.for ouch MI with a conarcmr(.)luxnsd tux.an Oe crrn r on
I.keuc law. B5U I LI
❑lun ezvnq under Ste ,BhPCrad4s'umn
Ow r Dae
W ORRERS COMPENSATION DECLARATION
1 hereby iRrm anger peoiry or Po"Om of the folkwing dechndaae
I om. ana will Minoan•CeNBore of Count IO W11-inwe for WorW'C Canpen.
..tion,ss pmndcd for by Saxon 3700 a ds Labor Code%for dre Puformana or de
wart for�h an,xrnar 4mt
I one and wiii mimin Wurkcr'a Coon porai Inurui¢,u requlred by Salim
3 of de labor Cock.fa tic paromaMo of Be wort forwhkh Wit Permit 4.^'.n
My Worker'/ssC��o�mp,�e�nv�aim Wo�ay}al�io`�,�an;cr rid Policy nruuor� �v,�e�,, /��.�L�
Cunei:�ttSL_S��OmL�Polley RO LLpl_,dl=.LdlSr_'r• .
CCEERR''hh GTTtEi OF IXFlAPf10N FROM 0.'ORKERS
COMPENSATION INSURANCE
(Ihh cation reed not hecwrplctud If the parch 4 for me htn(red dollar.(SIM)
or less.)
I cadry dart In the Po Mrs rce of ds rat for roto Bda Pom;l 4 4.xd,I"I m
cvply'.n,'no.in anY.oast so u to bcmma.ubjat to de Wartrrs'CompcnuB®
U"of CalRomlr.Dae
Appliciunt
NOTICE TO APPLICANT:If.tfw..king W4 Caif"a dEangioe,you QW
become W bj=b Wr Waker'a Compenssam p'vidmw of the Lahr Code.you moa
2 forthwith canPly wla ash pro ivau or this por nit Wil W dmnrd',Nloa
ZO CONMUCITON LENDING AGENCY
pI,, I Try affirm slit de'h a convx nn tiding it a for thr pafar'.aca
04 > ds rat fm which Wit pomit h Lvued(Sa.3097.Civ.C.)
1 London Nux '
7 L
',Z atlrfs Addrns
U C) 1 anlfy dot I Tuve and Wit apPlkaoon rd sae Wu the rWve kfamrdun 4
I, ^ mrtca 1.Pa to comPly with it dly.o i muety otdiru inal sole I..r nL W
O tl�J WOWeL C'on fior..ndwel YruNadrz'p'xalnhra of dos City to rrva upon tm
SIA .b -ramdaooJ pr.,ny for lmpecdm purpoa.
(We)notc 0 ssve,indemnify and Into,kurrn u ax Lily Of Cupmirn.Ling
f^'y 0ab0wm judGMM.cos4 and UP wbinIr may In any wry rose atdmlaW City
U in c000cgt ¢of lis graving of this lam;I ('( j_
^ APPLIQANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date S
S W RJE REGULKnONS.
y ^.� 811 Re-roofs s
Slgnuwe a(Altpl VCCml or Diao
HAZARDOUS MATERWS DISCLOSURE Type of Roof
WE the,lkara or rumor biking oaupmt sort or bandk JoI Munni
u&Anoti by de Cupertino Municipal Codc.clo pw'9.11 inal We Hnith aW Srfay
Com,seedon 15532(11)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu
a) If a roof is installed without first obtaining an inspection,I agree to remove
Will We appl'uaet a Tatum W Ilt ing oc VW L are NodPmnl a III which
it huudan.ir arioarr w4 ss&6MI!by tk Bay Am Air Quaky Manapemrm all new materials for inspection.
iaT
❑Yu �No
I Mot an,hvallousmrsrla4'NuuOns^raunderCLpv6.95ofWeUttar-
MHotilW 6 Slay Cade.Swoon 75505.n533 iNI 5534.I untI thud We browing
don a'ntlY here•sunt Wa It 4 my resporWbiuty m Marr lis acrywnt of We -
rvp,; `N,wh;m uabcmcIpnorWimuecaf.Cailkacar Signature of Applicant Date
l * - All roof coverings to be Class "B"or better
O a ruLM i7Td rLca Dae