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CITY OF CUPERTINO
BUILDING DIVISION PERMIT�t?l.r�c�'l�c
7
BUILDING ADDRESS:
PERMrr NO.
20130 STEVENS CREEK BLVD
B & J SPECIALTIES
08010039
OWNER'S NAME:
PERMIT ISSUE DATE
:
SANITARY NO, CONTROL NO.
(408)225-9992
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
-BLOC ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 7000) ofDivision 3 ofthc Businese; and Professions Code, and my license's
T.I. NEW SHELL INCLUDES MECH/PLMB/ELECT NON —
in full fora and efrep,C
License Class U.•N
STRUCTURAL. NO SANITARY REQUIREMENT'S.
Date I Contractor G It.. 4,
AACHI'iECi'S DECLA ON
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Conlra tors License Law for the
following mason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alto, improve, demolish or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the previsions of the Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Profrssfons Code) or
$ 8 0 0 0 0
that he is exempt tberefrorn and the basis for the alleged =WptlorL Any violation of
YY I NurLiber
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollar, (S500).
3 6 9 0 3 0 01
❑ 1, as owner of the property. or my employees with wages as their sole compensation,
Required Inspections
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Conuictor's License Law does not apply to an owner of
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,
-
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not hand or improve for purpose of
sale.).
❑ L as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contraemis U.
sense Law does not apply to an owner of property who builds or improves thereon, snd ,
who contracts for such projects with a contractor(s) licensed pursuant to i e Contractors
License Law,
❑ I am exempt under Sec , B & P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
E] 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
work for which this permit is issued.
❑ I have and will maintain Workm's Compensation Insurance, as mquimd by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
.
My Workers Co)mpe/gs�ad Insurance exrticr1gnd Policy number are:
Carrier. �—TZZtC-`'—oTvIDLwSt�4Mflj�No.: �O�z��O
CERTIFICATE OF EXEMPTION FROM WO CERS'
COMPENSATION INSURANCE
(Ibis fiction freed not be completed if the permit Is for one hundred dollars ($I00)
or lest)
I certify that in the performance of the work for which this permit is Issued, 1 shall not
employ arty person In any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPIJCANT: If, after 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 err this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name
Lender's Address
I 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 corswction, and hereby authorlm representatives orthis city to enter upon the
above-mentiorted property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
nabilities,judgmeota.com and expenses which may in any way accrue against said City
in consequence of the granting of this permit
Type of Roof d�
VAR the applicant or future bu0ding 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)7
❑Yes
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,agree to remove
Will Uhc applicant or future balding occupant use equipment or devirsr which
emit hayisdous air contaminants as defined by the Bay Area Air Quality Managernem
, .I
all new materials for inspection.
District?
[3 Yes
I have mad the hazardous materials requirements under Chapter &95 of the Califor-
nia Health & Safety code, Sections 25505, 25533 and 25534.1 understand that if the building
does not currently have a tenant. that it is my responsibility to notify the yypant of the
requim=
agent