08020058 CITY OF CUPERTINO .7 ••s�-,-✓ .�,..f:�'� �� `" �
BUILDING DIVISION PERMITCONTR'ACT(?RIN'FO,RMATION,
BUILDADDRESS: PERMIT NO.
2N 90 HOMESTEAD RD TBD — TO BE DETERMINED 08020058
W NER'S NAME:
PERMIT ISSUE DATE
NOBEL, GROUP 06/26/2008
HONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGEIP<IT PLUMB MECH
L� 0 0
�0, LICENSED CONTRACTOR'S DECLARATION m hmJob Description
1 cby affirm Nal I am flocan a under previsions of of Chapter 9(mmmc,sing
�
with Section and e)eel- alon 3ofthc Business and Professions Coda.and mylkcnse is T. I . —SNACK BAR UPGRADE—DEMO (E) INTERIOR WALLS,
in full forte acts ettaL
E;: ueanma� Comm INCLUDES E/M/P NON STRUCTURAL. CONTR,HOMESTEAD
SF
Ig- Date ARCHITECTS must
FAMILY FUN CTR, HAS BUS LIC #28618 & IS CURRENT
Wu 1 understand my plaru shut W mea as public records
g an Licensed Professional
aN3 OWNER-BUILDER DECLARATION
i 1 heathy of im that I am exempt from the Canlraaars License Law for the
D O following moron.(Section 7031.5,Business and Professions Code:Any city or county
$ which acquires a permit to convect,alter,improve,demolish,or repair any stmcmre
i< prior 0 its ismance.also requher the applicant forsuch permit to file a signed statement
that M is licensed pursuant to the provisions.(the CmurectofeUcame law tchapw 9 Sq.Ft. Floor Area 1800Valuation
x�S (commencing with tt
Suon 7000).(Division Sof dm Prolats
Business and ions Code)or 0
Nat W le exempt rhea from and she Won for she alleged examptim.Any vi.ladfon of
Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty or Number O
not more than five hundred dollars(3500). 32609060 . Occupancy p y Type
oworsk.Ifie pmpuly.re is employees wild wrens r the'tr tele cornpe access
wail do the wortim"and the he Com uctsel Li Law ed dos.1 apply as s o Success f
and Prywind,m cmc:The csthassmra license!Ave aaa Inst apply m rt as lb is Required Inspections
man enrwho warmanimpeatsdimon,arm wed arensanaddedhwork roffealMugn Ma
man employees,t1w building
Nn eachimprovements ticm catrndedoro@in,for sate It.
builder thearveshgorimprovematu Vsaid ediinot year of cprove far
owe r.
of
builder will haw she Worm of poring Ws K did not;did or improve for pugore of
sok.).
S 1,•s.war of The property am exclusively contracting with Ilcemad can=to.to
mnstmct the project(Sec 1014.Business and Professions Cmc:)The Conmctoes Li-
cents Law does not apply as in Owner of prepeny who Wilda or Improves dem.n.and,
who conuacrs for such projects with a mnuactogt)licensed pursuant m the Contractor's
License Law.
1 am ex/empt under sea. B&/P/C far this
te
boner ( �. Da
WORKER' COOMP y �[$�
WORKSATION DECLARATION7_D( //
affirm
I hereby aunder perWty of perjury east of the following declaradmts:
❑Ihsve and will muntein•Certificate of Consentmself-insurtfarWmkehCompen-
sation,as Provided for by Sedan 3700 of the Labor Code.for the performance of the
work far which this petit is issued.
❑1 have and will maimun Warks,Compenvtion Insurance,as required by Schon
37W of tho Labor Cme,for me performance ofthe wort f.rwhich his permit is its=& '
My Wallace,Compensation Wee.carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rus sena need wt W eomplemd irrW Permit is forone hundred dollars($100)
or lass)
I certify that in the performance of the wank for which this permit u issued,I shall not
Lam.any person in y cmc mbjmtt.she Workers'Compenuum
Isws.f Ga peers t� P„Y' p
NOTICE TO APPLICANT:IL after JimIcingbis Certificate of Exemption,you about;
become subject It,the Wall Gpnp atedon provlalom of de Labor Code you most.,Q foMwih comply with such provisiorw or mu pewit Nall bo dcemm mwkd.
'y CONSTRUCTION LENDING AGENCY
F 1 Wmby Nim that mere u a consmwtiml lending agency for he performance of
a .moi
the,work for which his permit is iatwm(Sm.3097,Civ.G)
Q Landces Namc
z Lenders Address
J 0 1 cenify that 1 have read this application and sum that the above informNun is
tL` comet.I agree to comply wish all city and county oNlnsnces and awe laws relating to
0
. building convection,am hereby authorie mpresmudves of this city or enter upon the
above-mcnti.ned property fm impassion.whichma
(We)agree to save,indemnify and kcep harmless she City of Cupertino against
h incimsea,jnuceO is.the trading
ex pens pe which they in any way attmc adun56uid City n
()z in
UNDERSTANDS AIND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO CEREGULATIOys--�
,�(.,o"Applic^�J/ �o�BUb6p, Re-roofs
Sognmurt of Appiscan✓Contrac r Date
US MA IAIP DISCLOSURE Type of Roof
Will tie applicant a Futuro Municipal
Cd occupant ante or and O halardon materiai
as defined o the Cupertino Municipal Code.Chapter 9.12,and the Health and Sefcry
me.Scm.n 25533(a)7
❑ter 'gNa All roofs shall be inspected prior to any roofing material being installed.
Will she applicant or future Wilding occupant use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
cmil ha coal..sur cmrsminarts a germed by the Bay Area Air Quality Martel;..at all new materials for inspection.
District?
❑Yes
I haw read she ha srdousmarcrialsmquiremau unrkr Chapterb.95oflhc Califor.
ma Health&Safety Cade.Sceuom2 M.15533 and 25534.1 undcrsund hurif he Wilding
dors not cumndy have a emeAL hat It is my respmuihility m notify the�upent of IW
acrid, nsseladmaaWmct m. aec.raeertifteateorOccupanq. Signature of Applicant Date
neroratift ;loge,, Date- All roof coverings to be Class'R."or better