06030079 CITY OF CUPERTINO 7 ""m «, t
7 77U7
BUILDING DIVISION PERMIT S-''� � R1ii T • RMI NN� ORMAT'10
BUILDING ADDRESS: BEI CONSTRUCTION INC PERRh(IT"°'06030079
22390 HOMESTEAD RD
ER'S NAME: PERMITLSUEDATE
t7AYNE HAM 1429 CLEMENT AVE 04/24/2006
PHONE: SANITARY NO. CONTROL NO.
(510) 521-3792
ARCHITECT(ENOINEER: BUILDING PERMIT INFO
BLDG If PLO 0
j0o LICENSED CONTRACTOR'S DECLARATION "X— Job Description
i 1 hemby a0em But I am Ikanwd under pmvtsians of Chapaf 9(commencing /�
with Sadon7 )of Division Sof Nc Busimasand Profcuimu Cole,atmmylicence: 11>
+� krnliroaande0 s STARBUCKS-INSTALL N AMP SERVICE-ELECT ROO
p�nsecm' cnuvtor / CONVERT (E) 800 AMP FOR 22390 AND
'qQ ARCHITECTS DECLARATION 23000 HOMESTEAD M
p yy77 1 understood my plane shall he used u public record 1
9b
Licensed Professional
M
OWNER-BUILDER DECLARATION Corm ON A�� � r
a f I hereby meso .(Titre(Section n1 11. exempt from Ne Canamelart License Law for 1W 1006
O fallowing meson. ermii703 1.5,Buallter.and sae.domn=Cade:Any dry m county Y
132 which requires issuance,pmmit re cnnurueL titer.WPmw,do ermit i ore a sig eY twcturo
-is^ pat heoor atir nded paluanttso o ma the applicant of far Cosucon'aiceme Law ned
p5 8 that he is handed putanem to the provielo=orf the,ConRxlors License(new(Ch+pm9 Sq.Ft.Floor Area Valuation
(commencing with Section 7000)at Division 3ofUse Business and ProfcsionsCode)or $3000
C that he ls attempt therefrom and the baso for the alleged exemption.Any violation of -
Section 7031.5 by atry applicant for a permit subjects the applicant to a civil penalty of APN Number eupancy Type
mat mom than ow hundred dollen($500).
❑Luaswmromd Paptny,mmyemplo5'eeawlthvngavt (S=.co .Buudon,
aid dadmwark,Nde:Th.Conscience,
awdoront apply 70 N,omorOfsiness Required Inspections
00
and property
who
Code:The hent ernon.License Law doe not apply lf at owner is q P
propertywoobuildsorImprove himp and whodoes tinwork himsafsir aisle es
awn a however.
the Wilding
p ing or thuavebma my id within
t toe not hnundd mplaniod fm We If.
buildCr Neaveda, mWPmvemmtts ft,he
Wild afcomove forn.the
builder will Mw the Wrdm of Proving dist lee atl oat build or improve far purpose of
ant.).
❑L as awed,of the property am nxeludvely connecting aids licensed anuxtors lo
commuct Ne project(Sec.7044.Business and Profession;Cade)76e Contractors U-
cense law do=eat apply to an comm of property who Wilds or improves therein,and,
who comment for such Projects MN a contracums)lianxd P rsuen to the CQnmwme3
License Law.
❑1 un asempt under Sec. .B k P C far this mason
Data
WORKERS COMPENSATION DECLARATION -
1 hereby dErm under penalty of perjury sue of the following dats,mione:
❑1 have and will maintain aCer eliato of Cement to self-insure for Wohces Compen.
cation.u provided fee by Section 3700 of the Inbar Code,for the performuare of the
wait for which Nis permit is isamd.
❑1 Mw and will maintain Worker's Compensation insurmce,as required by Section
3700 of Nc labm Code,(Or the performance ofthe work for which this permit is Issued '
Mywo gCamPe=edom Warm amimand Policytom�r� 5S ry
Curler. Eley No.: J
CERTIFlG7E OF (EMPTIONFROMWORKERS'
COMPENSATION INSURANCE
I'@ts secdon need oat W completed IHW Permit is for ane hundred Waves(SIM) v
or hest)
I sadly dist in the performance of the wart for which this permit is issued 1 deal not
employ any person in my matter an as to become subject to the Worleri Compensation
Laws of California,Dow
APpucant
NOTICE TO APPLICANT:IL after making this CeniRate of Fs mor den,you alt OW
Wcome subject to Ne Wmku'!Compensation provisions of the Leaw Cade you most
,J O forthwith Comply with such provisions or Nu permit shall W domed mocked.
d.51
CONSTRUCTION LENDING AGENCY
bY ernes NU Nu
F I hemem aeonsmKtim lending agency for tiro performance of
Cv> the wart for which this permit Is issued(Sue.3097.Civ.C)
W Q landau Name '
tz Landau Add^••
V Q 1 cenify that I ban mad this application and Cuts that the soon,Informdun Is
W cotmcl 1 agree to comply with all city and county ordinarces and cote laws mladng to
0 Wilding construction,and hereby authorire reprexnaniw of this city to enter upon ted
W shwa-mentruedd property for inspection purposes.
(We)agree to save,indemnify and keep homeleas tiro City or Cupertino against
,dry liabilities,judgmens,cors and expenses which may In my my accrue 411=1 said City
U z I.consequence of the Lmndng of this PennlL
APPLICANT UNDERSTANDS ANO WILL COMPLY WITH ALL NON-POINT Issued by: Date f
SOURCE REGULATION
-r �� ^
Re-roofs
Saamem Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applic ntm future Wilding occupmt more or handle hasado=materia
u defined by 0m Cupenka Municipal Code,Chapter 9.13,sad the Heath and Saety
Secllon 35533(a)7 All roofs shall be inspected prior to any roofing material being installed.
0Ya ggNa
Will dm applicml or futum Wilding occupam use equipment or devise which If a roof is installed without first obtaining an inspection,I agree to remove
emit hamosco,sir conuminmu as dc0edd by dse Bay Ams Air costly Management all new materials for inspection.
DiNicO
❑yes
I haw and the hvardtus materials requhcmcnu under Chapter 6.95 or lite Califor.
nurlalth&Samycah. nJ3am37I5Wi.ywdcmmd Nulfe building
p =hdatanotcunenayhawaws3mip
to or,ds aaupect of Ne
myul nkn mus be_met rioraati«dik�arac _ar.G Signature of Applicant Date
olwnerOr authorized agentL9— Date All roof coverings to be Class"B"or better