03010023BUILDING DIVISION PERMIT
][gMIT
STEAD RD
EAGLE ' S GENERAL CONST. I
PERMIT NO. 03010023
1 459 ANITA DR. I "1 "OT710/2003
ARCHITECr/ENGINEER:
110's CENSED CONTRACTOR'S DECLARATION
I bomb y Iran that 1 am licensed under provisions of Chapter 9 (commencing
Nwith SOCtio ) of DIvlslon 3 of the Business and Profrsstons Code, and my license is
infullf ears ff��_3y r(v
j ? 'c Class -� L c. g��`I
p ret /1/ n Contractor +�
3 /—:2pRCHITECTS DECLA ATION
1 understand my plans shall be used as public records
O ian Licensed Professional
0 OWNER -BUILDER DECLARATION
< x I hereby affirm that I am exempt from the Contractor's License Law for the
O O following reason. (Section 70315, Business and Professions Code: Any city or county
0 K which requires a permit to construct, alter, improve, demolish, or repair any structure
Z 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 Contractors License Law (Chapter 9
9 $ (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
y .. that he is exempt tihcmGam 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
not mom than five hundred dollars ($500).
❑ 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 not apply to an owner of
property who builds at improves thereon, and who does such work himself or through his
own employees, provided that such improvements am not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner-
huilder will have the burden of proving that he 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 Cade:) The Contractor's LI-
ccnse Law dols not apply to an owner of property who builds or improves thereon, and ,
who contracts for such projects with a contrsctor(s) licensed pursuant to the Contractors
License Law.
❑ 1 am exempt under See. B & P C for this mason
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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 performance of the
work for which this permit is issued.
❑ 1 have and w' aintain Worker's Compensation Insurance, as required by Section
37W of th or code, for the performance of the work for which this permit is issued.
My ces Co pe adon insurance carrier and Policy number arc:
art;«
FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed If the permit is forone hundmd dollars (S 100)
or less)
1 certify that in the performance of the work for which this permit Is issued, l shall nes
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT. If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Tabor Code, you must
z forthwith comply with such provisions or this permit shall be deemed revoked.
„z ,CONSTRUCTION LENDING AGENCY
�-r ry) I hereby affirm that them is a construction lending agency for the performance of
fx 5 the work for which this permit Is issued (See, 3097, Civ. C.)
A Lender's Name
0. .7 Q Lender's Address
U Q 1 certify that 1 have mad this application and slam that the above information is
{Lr r4 correct 1 agree to comply with all city and county ordinances and state laws relating to
O U building construction, and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
a -i y liabilities, judgments, costs and expenses which may in any way accrue against said City
U in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL 0 PLY WITH ALL NON -POINT
G VMATIONS.
C6 a /v-3
SO
ignature of AppliranUCanuactor Dem
HAZARDOU ATERIALS DISCLOSURE
Will the applicant or fur building occupant atom or handle hazardous materiel
as defined by the Cupertino unicipal Code• Chapter 9.12, and the Health and Safety
Code, section 25532(x)?
❑ Yes
Will the applicant or forum building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
❑Yes ONO
1 emadthehazardousmaterialsrequirementsunderChapter6.95oftheCalifor-
nia &Safety Code, Sections 25505,25533and 25534.1understand that ifthcbuilding
ocs of currently have a tenant. that it is my responsibility to notify the occupant of the
tett ofOOcc ancy.
!
(650)697-4990
SANITARY NO.
BUILDING
LDG CT
Job Description
TI --SUBWAY SANDWICH -STORE
CONTROL NO.
INFO
Sq. Ft. Floor Area
$ 3 Y68?6ion
3 AM DT®;5Lv--r 0 0
Occupancy Type
1
- FOUNDF0e4IMd Inspections
102
- PIERS
103
- UFER
104
- REBAR
105
- ANCHOR BOLTS
106
- SEWER & WATER
202
- UNDERFLOOR PLUMBING
203
- UNDERFLOOR MECHANICAL
204
- UNDERFLOOR FRAME
205
- UNDERFLOOR INSULATION
301
- ROUGH PLUMBING
302
- TUB & OR SHOWER
303
- ROUGH MECHANICAL
304
- ROUGH ELECTRICAL
305
- FRAME
306
- HOLDOWNS
307
- INSULATION
308
- SHEETROCK
309
- EXTERIOR LATH
310
- INTERIOR LATH
311
- SCRATCH COAT
313
- ROOF NAIL
501
- FINAL ELECTRICAL ENERGY
502
- FINAL PLUMBING ENERGY
503
- FINAL MECHANICAL ENERGY
504
- FINAL BUILDING ENERGY
505
- FINAL ELECTRICAL
506
- GAS TEST
507
- FINAL PLUMBING
FIN
FI5
WMECCA09
Issued by:5
WORKS Date
Re roofs
Type of Roof
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