06010095 CITY OF CUPERTINO �
BUILDING DIVISION PERMIT ON-TAXCTI0 INFORMATION.
�teF 'rA,w;&Rn:�b 3r fib"BUILDING ADDRESS: RON PARIS CONSTRUCTION CO jNtTN0.06010095
10255
OWNER'S NAME: PERMIT ISSUE DATE
KUMUD GROCERIES 3575 STEVENS CREEK BLVD 02/02/2006
E: SANITARY NO. CONTROL NO.
(408) 296-5926
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
1� o
30 j LICENSED CONTRACTOR'S DECLARATION Job Description
rd(} 1 hereby M.tial I em licensed under prevision of Chapter 9(commencing
with Section 70010)afovidon 3 of the Bud.sd Professions Code.and my license la
In full tone ad affect REVISION--STRUCTURAL WORK FOR
aqz
Licensing
�• CONDENSORS ON ROOF/ORIG. #05110065
- Date ARCHITELTSDPL TI NO NEW PERMIT ISSUED
I undimmed my plans Nall W used u public eenrds
777
y Licensed Professional
Oat I am
DECLARATION
1 wreso .(Sect that 1 I.S.exempt from me Cesdara o e:My c law for tw
o o whichfalliniFU mason.wool
7117 1. t, hers and r Re.diouu Code:My city m county, r
$w which mqulrcs a pans t le cnnsWcl,altec,Improve,do Permit
t or repair any ahu neat
�y that W i u Luwma,also requires to pre inions of tar meh peemit m Rkse Law ataument
<
(commencing
is withSmuam on700 ofDivioion3of icBConuiness UccmfsionC apter 9Code)or
Sq.Ft. Floor Area Valuation
9 tcomeisexe exempt
Moorman
ndthebasisfrafthcBedassuptonsAn violadnof $84
— mel he u emmpt themlrom and the bum for the alleged exemption.Any violation a(
Section 7031.5 by any applicant for a permit objects the applicant in it civil penally of APN Number Occupancy Type
not mare Nan five hundred dollars ISM
❑Las ownerofdm propmy.armyemployces with wagesudxkmlecompewlion,
will Eo the work,and tise s=lue ins utendedaranamd tmade(Sm.7044,Busmen Required Inspections
and Professions Code:The Conuscon r's Liam law donot apply o e ns an owner of q p
property who buildaar b pro elude mon,aMwM daaauch wart himself orthrough his
own employees,ping ori povourimprovemwtts am not year
ofamaffeed forme owner \
however.the wildingorden ovemantlamid withinone)ensofcompvfortheawmr-
w0aee will mw the burden or proving vel w ala not was m improve for wmam of - (�
caul.
❑1,u owner of the property am neluively contracting with licensed common.la \ -`
construct me pmject(sec.70th.Business avec Pofeadons Code:)The Conuttor'a U- �v\
esuslawdorsr such
in an with
arofumurr(property wawWilds orimprov daemon,and
who canvacu far poJecu vice a canuulm(s)licensed pursuant in me ConvanaA
Li
c.
0 ..lam exempt antler see. ,BAPCmor this moon
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby afllml under penalty of perjury one of the following declarations:
1 Nus end will mdnein aCeNficau of Conserv omlf-insure fm Workcta Compcn•
selion,as provided for by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued.
❑1 haw and will maimain Worker's Compensation Insurance,u required by Section
3700 of the labor Code,for me performance of the work for which mu permit is Issued.
My Workets Compensation Iuunn c carrier and Policy number am: '
amlm:C 7M?- F re ,a d Policy Na.:S7 t o o r�J43(.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissectiem reed not bocompleted if the permit is foram hundmAdollan($]W)
or leu)
I cemfy mol in his pulotmauce of the work for which this permit is issued.I dull not
employ any person In my mmmr an as on becomeobjecl in the Wo eri Cmopensauan
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,efmr making this Ceniftease of Exemption.you should
become object m the Worker's Compensation provisions of me labor Cade.you mot
.JO forthwith comply with such provisions m this permit Nall w dcemed evoked.
Z tiCONSTRUCTION LENDING AGENCY
[r I hereby affirm sen them lis construction kndinpgency for the performance of
Iii> the wart fur which this permit U Issued(Sec 3097,Civ.C.)
aQ Lcdces Name ,
7 Z lender'sAddmas
U Q I cendfy that 1 haw mad this application rod amu that the above information is
D. comma.I agree to comply with all city and county oNlnancu and sum law missing to
Q buildingconstructionsproana hereby aumodmepettnmiws of this city to enter upon the r')
f2l shove-mentioned properly for inspection Inkeen,purposes.
(we)ages to on,indemnify and trop0. the City Cupenadmit
f/ liabilitiu,jud{menu.ttN and which may In my wyacone against said
City
fJ 7 I ton
P ICA UNDERSfrngDS AIND WILL COMPLY WITH ALL NON-POINT Issued by: Date
�•r s U ERE CATIONS.
E Re-roofs
Si roof AfplicanuCanuseor se
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or room wilding oceupanutou or handle limcdon material
as aa0md by tic Cuperlim Municipal Cade,Chapter 9.12,and the Healm and Safely
Code.Section 255330)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yrs —BNo
Will me applicant or future building=11Pem ave wurpnmat ar do ices which If a roof is installed without first obtaining an inspection,I agree to remove
colt huaNnus air conuminanu as deRmoi by his Bay Ansa Air Quality Management all new materials for inspection.
Duvict7
❑Yu �j9,No
I the mussel materials reyiirenanu under Chepter6.95afdeCalifar-
Nenldg:Salely .Sectiau 25505.25533 ad25534.I understand matifthe Wilding
set c maty hew tenant.that It is my responsibility o noul'y the=pan,of the
u men whkhm EemetpdorkuuunmofaCauOcauofOccumty. .Signature ofApplicant Date
0 r uraUlhamcd agent ons All roof coverings to be Class°B°or better