06010036 CITY OF CUPERTINO •k'--'> w;+ae, • R ds �5:=> a:K;l:�
BUILDING DIVISION PERMIT ;CONTRACTQ16 MORMATION
BUILDING ADDRESS: RON PARIS CONSTRUCTION CO 3rffe'No'06010036
�.
OWNER'S NAME: PERMIT ISSUE DATE
AIM KUMUD GROCERIES 3575 STEVEN 01/06/2006
E: SANITARY NO, CONTROL NO.
(408) 296-5926
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O D � O
Sop LICENSED CONTRACTOR'S
rproviDECLARATION JobDescri tion
rd bj I ibarely..70 0).f that 1 am Rcensed under d P.f.us of CT . 9(commencing p
with seorce 7dafecDivisionlof ata Businessmd Pro(tainm Coda.and myIicensa ie
n'1 WmOmaameerrec 30-DAY TEMP PERMIT
? License CI f J CLm.ontractor
Date Gomrsma EXPIRE 02/05/06, ORIG. #05110065
;1 RC IIxuse DELLA ATION
1 underara d mY pLLmi Matt W thud u public seenrda
yo Licensed Freiman...I
OWNER-BUILDER DECLARATION
1 hereby&film Net 1 em exempt from the Commmes License Law for the
00
following won.(Section 7031.3,Business and predications Cade:Any city or county
which requires a permit to com tact.alter.Improve,demollah,or repair any structure
—fit,^ prior b its iuvume.elm requires the applicant for permit to file a signed sukment
that he is licensed pursuant t.the pnvlsiou of the Comrseuh License law(Chapter 9 Sq.Ft. Floor Area nation 84
zC$ (commencing with Section 700D)of Division 3 m the Business and Professions Code)or
a— that he u exempt the¢f e m and the buil for tie alleged exemption Any violation of
Section 7031.5 by any applicant for a permit subjects tie applicant b a civil penalty of APN Number Occupancy
not marc than Ow bundred dollars($500). 35917001 . 00
P y TyPe
❑1,u owner of the property,or my employees with wages u their sale compensation,
will do the wort,and tie wucture isnot intended a onnrcd for We(Sec.7044,Brained,
and Profession,Code:The Contacbra Liceme Law does not apply b in owner of Required Inspections
propeny w W builds mlntprowa uercon,mdwhodecusuch work himaelfardm ugh his
one employees,provided that such imprnwments art not intended aaffercE for sake If.
however.the building or improvement Is cold within am year of completion,ata owner.
builder will have the burden of proving that he did not Wild or Improve far purpose of
uk).
❑1,u owner of the property am exclusively contracting with(lamed con=rom to
contrast the project(Sec.7061.Emitted,and Professions Code:)M Comracto's U.
come law does not apply b an owner of property who Wilds or improve,uemon.And,
who contracts for such projects with a tonuuur(q 0anted puruam to the Contractor's
License Law.
❑lamnaemptundersec. ,B@PCfarml. atom
mr Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury am of the following declandiona:
1 Ww and will maintain.Certificate of Comm to self-insum fa Workers Compen.
titian,u provided for by Section 3700 of tie Labor Cade.for the performance of the
work for which this permlt Is issued.
❑1 have and will maintain Worker's Compensation Imuaana,u required by Section
3700 of the Labor Cork,for the performance of the work for which thin permit is issued.
My Workers Compensation l`as-�rum canter and Polity ngCr, ram:
Canter: STA Tfa /"y 1n J Polity No.:J ! 0 0 1 09 (e
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(TTusection mW mtbecompleted if the permit is foram hundred dollars($101)
m kat)
1 cattily that in the performance at to work fm which this permit LL lured,I,hall not
employ any person in any manner an as,to become abject m the Worker'Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become Subject to the Worker's Compensation pm pions of tie labor Code,you muss
OZ foMwiu comply with such provisions or this Permit halt be deemed rooked.
C7 CONSTRUCTION LENDING AGENCY
I W.by affirm that there is.command..knding agency far ue performance of
C tie work for which this permit Is issued(Sec.3097,Ci,C.)
6Wi 0 Lanier.Name
O z Lenders Add.
U O 1 etNfY that 1 Mw read this application and mm dust the aWve information Is
(g.Hcancer.I agree in comply with all city and county estimates and sink laws reading u
OU building communion,and hereby auumien rsp.nmives of this City to enter upon the
shove-mentioned property for iupacdon purposes.
(We)state b naw,indemnify and kap harmless de City of Cupertino against
Ilabilitles?'menu.coluandexpcuaswhlch may In anywayacerm agaimtuid City
U,`� in co ucn IRguuppLLn'of esu Penta.
APP 1 UNDERSTAIf AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU C E CATIONS.
j� Re-roofs
Signuu fApplian RDOU
Dille
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum Wilding oaupmt some or handle Health and
u dented io the Cupertino Municipal Code.Chapter 9.I2.and tiro Health me Safety
Com,Section us32(07
Ya All roofs shall be inspected prior to any roofing material being installed.
hMU
TT If a roof is installed without first obtainingan inspection,I agree to remove -
Will the applicant or future building by the Bt tic equipment m dMana which I� g
it Javier? air contaminants u defined by the Bay Arta Air Quality Management a W eCt10n.
a0in7
❑Yc> �No
I hew mad tiehvamwsmmcriahmquimmcrosunder Chap¢nd.95ofueAuibi t l
'a it
c Oq�Sections u54S.T3sJ3 std 25334.1 undcrsund uuifue Wilding Qa ('
d ret c atly haw a ITlra tat it u mY aespomlhilitY b nodfY the oatryant M the �O
myui men hichmusibemet dormiuuumcof.CcNOcabafoccy�cy Signature of Applicant Date
oownLlarautWme�isent / (Dam�� All roof coverings to be Class"B" or better