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021000641.11 x Vr L-UrrIMIUNV BUILDING DIVISION PEh IIT CONTRACTOR INF0R:AT10Nt BUlfpplg4aEs19ANDLEY DR RYON COMMERCIAL INC PERMITNO2100064 1330 ORCHARD DR. APPLICATITVY"TY 2 0 0 2 // PHONE: 4 0 8 5 9 0— 8 8 9 4 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 o a O 0 m t= Z LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencingCCl tlOn TENANT I M PRO V E p ;N with Section 7000) Division 3 of the Bus `nes�s nd Pro essions Code, and my licenses in full force a e e 3 /122 y� SHOWER RM/LOBBY REMODEL � Z Lica)"' License Class �7 O Z'^ O t"' ^ ^; Da Contract " 9 o4 X, < ARCHfTECTS A A understand my plans shall be used as public records dO�U m 3 u. t-' O < Licensed Professional F" = OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the i00 % P following reason. (Section 703 1.5, Business and Professions Code: Any city or county requires a to alter, improve, demolish, any y� which permit construct, or repair structure $25000 F Z < prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed to the of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation FE O pursuant provisions Section cc t- to (commencing with 7000) ofivision 3 of the Business and Professions Code) or that he s exempt therefrom and the', for the alleged exemption. Any violation of 32633 0 7 9 . 0 0 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy p y Type not more man five hundred dollars (x500). 101 - FOUNDATION E] 1, 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 and Professions Code: The Contractor's License Law does to an - Required Inspections not apply owner of 10 3 — UFER 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, 10 4 - RE BAR however, the building or improvement is sold within one year of completion, the owner - 105 - ANCHOR BOLTS builder will have the burden of proving that he did not build or improve for purpose of builder sale.). 106 - SEWER & WATER ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to 202 — UNDERFLOOR PLUMBING construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon, and 203 - UNDERFLOOR MECHANICAL who contracts for such projects with a contractor(s) licensed pursuant to the Contractors 204 — UNDERFLOOR FRAME License law. ❑Iamexempt under Sec. ,B&PC for this reason 205 — UNDERFLOOR INSULATION Owner Date 301 — ROUGH PLUMBING WORKER'S COMPENSATION DECLARATION 302 — TUB & OR SHOWER I hereby affirm under penalty of perjury one of the following declarations: 303 - ROUGH MECHANICAL ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the 304 — ROUGH ELECTRICAL work for which this permit is issued. 305 - FRAME ❑ 1 have and will maintain Workers Compensation Insurance, as required by Section 306 — HOEDOWNS 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers Compensation Insurance carrier and Poli number are: 307 - INSULATION ca er:E!/EXJIAl/ok'Aj /NS Polic 0�40/67''9Q9 308 — SHEETROCK CERTIFICATE OF EX �PCION FROM WORKERS' COMPENSATION INSURANCE 309 — EXTERIOR LATH (This section need notbecompletedifthepermit isforonehundreddollars($100) 310 — INTERIOR LATH °`less.) 311 — SCRATCH COAT I certify that in the performance of the work for which this permit is issued, I shall not 313 — ROOF NAIL employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Dale 501 - FINAL ELECTRICAL ENERGY Applicant 502 - F I NAL PLUMBING ENERGY NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should Z become subject to the Worker's Compensation provisions of the Labor Code, you most forthwith comply with such provisions or this permit shall be deemed revoked. 503 - FINAL MECHANICAL ENERGY O Z O 504 - FINAL BUILDING ENERGY F1 CONSTRUCTION LENDING AGENCY hereby affirm that there is a construction lending agency for the performance of 505 - F I NAL ELECTRICAL a > the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name 506 - GAS TEST W Q a 507 - F I NAL PLUMBING Lender's Address U O 1 certify that I have read this application and state that the above information is 508 - F I NAL MECHANICAL V�431�� E correct. I agree to comply with all city and county ordinances and state laws relating to hereby 5 F I NAL GRADE building construction, and authorize representatives of this city to enter upon the Wabove-mentioned >"0. property for inspec oses. 10 — FIN N I G I;n U ,Z (We) agree to save, indemnify keep harmless the City of Cupertino against liabilities, judgments, costs a�t5%pe es which may in anyway accrue against said City in conscqucnce of the gra ngo ispermit. 5 WORKS APPLICANT UNDE A AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGU 10 Re -roofs & Si Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will 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 Code. Section 25532(a)? .,CCCC��i�'''' o E] Yes 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 future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑ YesIo I have read the hazardou rials requirements under Chapter 6.95 of the Califor- niaHcalth&Saf.'yCodc'Sec' ns 505, 25533 and25534.1un fthebut lfmg does not currently haw a ant, at it is my responsibility to no the cupant of the reqytremems which mu in prior to issuance of a Certificate of aney. Signature of Applicant Date 2 �1L All roof coverings to be Class "$" or better Owner or au `zed agent Date CITY OF CUPERTINO ^- •' BUILDING DIVISION PERMIT 'CONTRACTOR INFORMATION: - BUIT0144allsBANDLEY DR RYON COMMERCIAL INC PERM]rN02100064 P@tE2IdAN 1330 ORCHARD DR. APPLICATI!1rbS//IdUTY2002 PHONE: 408 590-8894 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 oo LICENSED CONTRACTOR'S DECLARATION m❑ I herebyahem that 1 am licensed under provisions of Chapter 9(commencingCrl �Oab withSenion7lMns Division31ff the Bun nee ed Pro ca+ions Cole.and my lieenxTENANT IMPROVEh N'1' p Lifull mucClon e, ` -C3 ,t t/( SHOWER RM/LOBBY REMODEL°�� ►� Li cense Class 3 Lie.au / 72 S9 G 4'p Date Cnnuue /I,� � teiy ARCHITECTS re a/U 'r unJcrsmnd my plans shall beused epublic rcanrJs 1 1 20p3 60 V 3u. Licensed Professional I OWNER-BUILDER DECLARATION 1 hcrcby affirm on 11. exempt from the Cssions Co :License Lew for the o.apO followingream..(Sarno]onstr Business mrPe.derram Code:Any city or county a�$ which requires a permit re construct.alter improve,demolish.Fi repair any tatuture $25000 prioress issuance.cosdelmreto the the isimont the suchpermit LGlc.LawJxtammem pg�xx< (col me cing wit amount 70l pro visions of the Cnmmcmr'a License Law(Chapter Sq. F[. Floor Area Valuation (commencing icrefor.and hiDivisinf 3 o the egeBusiness exemptnd ion. visCode)of 32633 0 7 9 . 0 0 Nn he u exempt thertfrom and the bMu for the alleged exempunn.Any violation of Ration 7031.5 by airy applieml for a Profit+objects the applicant o a civil penalty of APN Number Occupancy Type not more than tiro hundred dollars(E500). 101 - FOUNDATION ❑Los owner of the property.or my employee wird wegusstheir cele rompeueron, will do the work,and he structure isnot intended or offered for We(Sm.7044,Bmittess PIERRequired Inspections and Professions Code:The Convectors License Law does not apply m an owner of 103 - OF ER q p property who builds or improve thereon,and whodasaoch work himselfor through his own employee,provided Nat+uch improvements art not intended oro@red for We.If. 104 — REBAR however,the building or improvement is sold within one you ofcompletion,Ne owner- lOS — ANCHOR BOLTS builder will have the burden of proving for he did not build or improve for purpose of We.). 106 - SEWER & WATER ❑ I,as owner of the property,em exclusively contracting with licensed rontrumrs to 202 - UNDERFLOOR PLUMBING construct the project(Sec.7044,Business and Professions Code:)The Convenor's Li- censelswdoesnotapplym annwnerofproperty who Wilds orimprove,Income,and 203 - UNDERFLOOR MECHANICAL LiceconLLaawsfor each pmjecu with econvannt(+piansed Pumuammthe Conlrumr'a' 204 - UNDERFLOOR FRAME ❑ I am exempt under Sm. ,B&PC for this recon 205 - UNDERFLOOR INSULATION er Data 301 - ROUGH PLUMBING WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER I hereby alarm under penally of perjury one of the following decimations: 303 — ROUGH MECHANICAL I have and will maintain a CeniBcae of consent in self mature for Worker's Compen- 304 — ROUGH ELECTRICAL .line.as provided for by Section 3]000(Ne Labor Cak,for the Performance of Ne work for which this permit is issued. 305 — FRAME ❑ 1 have and will maintain Workers Compensation Insurance,es required by Section 3 06 - HOLDOWNS 37M of the IaborCede,for Ne performance of the work for which this permit is issued. My Workers Compensation Insurance cam.crend_Polyp mberam: 307 -' INSULATION ca er�UtXfl7�/cava! /NS Pnhl:D(00/67N�� 308 - SHEETROCK CERTIFICATECOMPENSATION INSURANCE EJOTION FROM 309 309 — EXTERIOR LATH (This section need not be completed life,permit is forone hundred dollars(fill 310 - INTERIOR LATH lean.) 311 - SCRATCH COAT 1 cenify that in the Performance of the work for which this permit is issued,I shall nut 313 - ROOF NAIL employ any person in any manner an as in become subject to the Workers'Compensation LLawiCant of California.Date 501 - FINAL ELECTRICAL ENERGY ApplNOTICE TO APPLICANT:If,after making his Ccniticam of Exemption,you should 502 - FINAL PLUMBING ENERGY becnmcsubject to the Worker's Compensation provisions of the labor Code,you must 503 - FINAL MECHANICAL ENERGY QQ forthwith comply with such provisions or Nis permit shall m deemed revoked. z CONSTRUCTION LENDING AGENCY 504 - FINAL BUILDING ENERGY Ihereby affirm that there is a construction lending agency liv the Performance of 505 - FINAL ELECTRICAL g>: > the work for which this Prom itisissued(See.3097,Civ.C.) 506 - GAS TEST W5 Lenders Namc a Lender'nAdd.. 507 - FINAL PLUMBING Up 1 cenify that 1 have read this application end scate that the above information is 508 - FINAL MECHANI CAL Y.Pcorrect.I Une,to comply with all city and county ordinances and scam laws relating 1^ Wilding construction.and thereby authorim repmsemative+of this city to cnsrupontls 5 FINAL GRADE above-mentioned property for inspcci Pnms. 10 - FIN NI G !F^+ CL, (We)egra m save,indemni( keep harmlcse the City of Cupeninn against sh Iiabilitiea,judgments,costs ar deipe a which may in any way ecene against old City 5 N L WORKS / V s'+ APPLICANin T UNDEof do,gETAFgo is pt AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURC Ill 10 Re-roofs Si a or APPBcandcuntracmr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant of future building acupml slow or handle haamous material as dented by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety <,saran 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes101, Will the applicant or future building mempanl use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it h t nodous air contaminants as dcG ed by the Bay Arca Air Quality Management all new materials for inspection. District? rte" ❑Yes I have mad the haerJnu a rials myuircmcuts under Chapterd 95 of the Califon nix Hcalthdt Sue,Cok,Scc' ns 505,25533mJ25534.lun ,,,and thwifthc building Jasmgmmcndyhavea am, nitismyrcsponsihilitym not no 'cupmt olds m isroen0whichmu m pdofmissumce^ta certificate of mcg Signature Of Applicant Date Z <i,2_ All roof coverings to be Class "B" or better Owner urea red agent Date