08050132 CITY OF CUPERTINO
BUILDING DIVISION PERMIT C, INFORMATION
BUR.gltd('y A0TEIs TEVENS CREEK BLVD GIDEL AND KOCAL 0805U132
L sNNASME: PERNM ISSUE DAIS
'INN BROTHERS CONSTRUCTION 574 DIVISION ST 06/12/2008
PHONE: (408) 370-0287 SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u00 LICENSED CONnRACMR
under
DECLARATION Job Description
4 e thereby affirm Net 13 ftheBu under provisions of Chapter 9(commencing P
wiNSmrcendcffcf)iviilon3of the BuumssaM Professions Code,and mylittrtmu T. I . —EXAM ROOMS, RESTROOM,RECEPTION AREA. NO
in fun torte and erten
Dam cissa�ry. Llea s�('y 3�/b�/'> SANITARY INSPECTION REQUIRED.
F Dau Con
ARCHITERSDECLDECLARATION
I understand my Plans shall a uad ss WElie rtcorde
pyU
g1 Licensed Professional0
u D 3 OWNER BUILDER DECLARATION
rn
.0 O E I hereby alarm Nal 1 1. exempt s an the Contracto oa License taw for the
COO O following moon.Permit
703 1.5.Business and Pmfde o demolish.
Code:Any city s county
129 9 which rtquiruv a issuance,sle re cors Usei slur.Improm,h Permit i nr mash any anucum
31 i y prior b ion ensed palso requires the applicant me Cm sennet m file s,Lawd staumcm
31 < Nelhcirtingwdpulction7lM provisicns 3 of too
nuaess aiccvclaw(Chapltt9 Sq.Ft. Floor Area Valuation
ea § (cot M is ro min therefrom and
theOf basis for the al B ed exemption.
Proon.Any vi Cods)of $42000
_ Nal Section
u exempt therefrom and the beer for the alleged acliomt t.Any violation of
.1. 70113 iby naryapplicantforapermitsubjccuNeapplicantmacivilpwltyof Number Occupancy Type
not mom Nan five hundred dollar(5300). 3 6 9 0 3 0 01 !�,� P Y -
0 1.u owtmr of the property.a my employees with wagon ss dmir"to compensation,
will do the work and Neslrucmm is not intended or offered forsate(Sec.1044,Business
aM Professions Code:rte Conustwa License law don not apply to an owmr of Required Inspections
property who bu ilds a i m proves thereon,aM who docs such work himself or through his
Own employm,provided thatruch improvemenu are not intended moRered imitate.B,
hoverer.the Wilding Or improvement is sold MNin mu year of ccmpl.don.Ne owncr-
Wildm will have the burden of proving that he did Inst Wild or improve for purpose of
sale.).
0 1.as owner of the property,am onclumnly conuaning with licensed cenuxtm to
construct the pmjcn(Sec 9044,Bouriess and Professions Code:)TM Convenor's Li-
cense Law does not apply b an owner of property who Wilds or unpmves thermn,and,
won limusc s for men projects with a tormorcuut.)licensed pummmt in the CnnVMtoYs
License law.
Clem mmpl under Set ,B h P C for this mason
Date
WORKER'S COMPENSATION DECLARATION
I hereby at.under penalty of perjury tae of the following decimations:
01hawaMwillmainwnaca rl eof Consentmself-imumfmwmke sc=Nn,
stolon,at provided for by Sncuon 3700 of the uWr,Code,for the performance of the
went for which this permit is issued.
0 1 have and will maintain Woukefs Compensation Insurance,as oupdo l by Section
370oof Ne Labor Code,for the performance ofthe work for which lhu permit is ismM '
My Worlmes Compensation Insurance c 'v anrip oliry number are:
Gtrier. Poliry No.:
C TIFICA & (b PION FB OM WORKERS'
COMPENSATION INSURANCE Tab/ Cj
(ThE orn rued lotet be,completed if the,peomil is for one hundred dollars(S )
or ltu)
1 cerufY Nat in the performance of the work for which this potmit Is issued,l ileal not
employ any person in any mannerm as in become subject On the Women'Compensation
Iowa of Ca ifmoL Dau
Applicant
NOnCE TO APPLICANT.If,after making this Certrmau of Exemption,you Amid
biome Subject in the Wortcr's Compensation prorumns of the La1wr Cod,you must
.J O forthwith comply with such previsions m this permit shall 4 deew
deemed mked.
E( CONSMUCr10N LENDING AGENCY
(—t IhembyafRtm Na Nero iso construction lomingageney for the perfumtan¢of
E
> the work fen which this permit is issued(Sec 3097,Civ,C.)
G(] Leni Name
z Isnlelm Address
U O I citify W I I have mad NS applica me and rum thin the aWve information is
Ly `-` torten.l agree to comply with all city and county ordinances and sate laws rclating Io
C) Wilding consrtction,and hereby auNmirs mpommuselives of Nu city in coos upon the
above-mentioned property for inspection purposes.
F„W (We)agree to un.indemnify and keep harmless the City of Cupertino against
fag IiNiliva,JMgmcnu.co xpesa which may in any way amen against said City
acq
^�
SOURCE
APPLICANT E0.5T SAND WILL COMP LTH ALL N-PoINT Issued by: Date
SOURCE /
Re-roofs
Sign um of ApplicanUCanlrxtor Dau
HA DOUS MA DISCLOSURE Type of Roof
Will Ncapplicant car forum bull ng nccupanutorcorhuMld hauNous mamriil
fined by the Cupertino Municipal Cede.Chapmr 9.12,and the Health red Safety
.section zsslz(e)t All roofs shall be inspected prior to any roofing material being❑res � g installed.
Will Ila applicant or future building occupant us. If a roof is installed without first obtainingan inspection,I agree to remove
pP g p equipment car Marta Mich P
emit haurdnm air contaminant;ss defined by the Bay Area Air Quality Management all new materials for inspection.
Dirtrin7
Oyer
the mad Nchv maurialsmqubcmcmun&rOupmr6.95ofthcCSlifor-
nir1b:ilNhSafny ,Sec' 23505.25533and25534.Iundetsund NaifNe Wilding
does not coven caw a L Out is u my resporm".tY neufy Um avvyant of Nc
require c hic de t prior m i antt of imam of Occupancy.
/2 Signature of Applicant Date
wnm nr and wuM igen Dam All roof coverings to be Class"n"or better
CITY OF CUPERTINO
BUILDING DIVISION PERMIT C, INFORMATION
BUR.gltd('y A0TEIs TEVENS CREEK BLVD GIDEL AND KOCAL 0805U132
L sNNASME: PERNM ISSUE DAIS
'INN BROTHERS CONSTRUCTION 574 DIVISION ST 06/12/2008
PHONE: (408) 370-0287 SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u00 LICENSED CONnRACMR
under
DECLARATION Job Description
4 e thereby affirm Net 13 ftheBu under provisions of Chapter 9(commencing P
wiNSmrcendcffcf)iviilon3of the BuumssaM Professions Code,and mylittrtmu T. I . —EXAM ROOMS, RESTROOM,RECEPTION AREA. NO
in fun torte and erten
Dam cissa�ry. Llea s�('y 3�/b�/'> SANITARY INSPECTION REQUIRED.
F Dau Con
ARCHITERSDECLDECLARATION
I understand my Plans shall a uad ss WElie rtcorde
pyU
g1 Licensed Professional0
u D 3 OWNER BUILDER DECLARATION
rn
.0 O E I hereby alarm Nal 1 1. exempt s an the Contracto oa License taw for the
COO O following moon.Permit
703 1.5.Business and Pmfde o demolish.
Code:Any city s county
129 9 which rtquiruv a issuance,sle re cors Usei slur.Improm,h Permit i nr mash any anucum
31 i y prior b ion ensed palso requires the applicant me Cm sennet m file s,Lawd staumcm
31 < Nelhcirtingwdpulction7lM provisicns 3 of too
nuaess aiccvclaw(Chapltt9 Sq.Ft. Floor Area Valuation
ea § (cot M is ro min therefrom and
theOf basis for the al B ed exemption.
Proon.Any vi Cods)of $42000
_ Nal Section
u exempt therefrom and the beer for the alleged acliomt t.Any violation of
.1. 70113 iby naryapplicantforapermitsubjccuNeapplicantmacivilpwltyof Number Occupancy Type
not mom Nan five hundred dollar(5300). 3 6 9 0 3 0 01 !�,� P Y -
0 1.u owtmr of the property.a my employees with wagon ss dmir"to compensation,
will do the work and Neslrucmm is not intended or offered forsate(Sec.1044,Business
aM Professions Code:rte Conustwa License law don not apply to an owmr of Required Inspections
property who bu ilds a i m proves thereon,aM who docs such work himself or through his
Own employm,provided thatruch improvemenu are not intended moRered imitate.B,
hoverer.the Wilding Or improvement is sold MNin mu year of ccmpl.don.Ne owncr-
Wildm will have the burden of proving that he did Inst Wild or improve for purpose of
sale.).
0 1.as owner of the property,am onclumnly conuaning with licensed cenuxtm to
construct the pmjcn(Sec 9044,Bouriess and Professions Code:)TM Convenor's Li-
cense Law does not apply b an owner of property who Wilds or unpmves thermn,and,
won limusc s for men projects with a tormorcuut.)licensed pummmt in the CnnVMtoYs
License law.
Clem mmpl under Set ,B h P C for this mason
Date
WORKER'S COMPENSATION DECLARATION
I hereby at.under penalty of perjury tae of the following decimations:
01hawaMwillmainwnaca rl eof Consentmself-imumfmwmke sc=Nn,
stolon,at provided for by Sncuon 3700 of the uWr,Code,for the performance of the
went for which this permit is issued.
0 1 have and will maintain Woukefs Compensation Insurance,as oupdo l by Section
370oof Ne Labor Code,for the performance ofthe work for which lhu permit is ismM '
My Worlmes Compensation Insurance c 'v anrip oliry number are:
Gtrier. Poliry No.:
C TIFICA & (b PION FB OM WORKERS'
COMPENSATION INSURANCE Tab/ Cj
(ThE orn rued lotet be,completed if the,peomil is for one hundred dollars(S )
or ltu)
1 cerufY Nat in the performance of the work for which this potmit Is issued,l ileal not
employ any person in any mannerm as in become subject On the Women'Compensation
Iowa of Ca ifmoL Dau
Applicant
NOnCE TO APPLICANT.If,after making this Certrmau of Exemption,you Amid
biome Subject in the Wortcr's Compensation prorumns of the La1wr Cod,you must
.J O forthwith comply with such previsions m this permit shall 4 deew
deemed mked.
E( CONSMUCr10N LENDING AGENCY
(—t IhembyafRtm Na Nero iso construction lomingageney for the perfumtan¢of
E
> the work fen which this permit is issued(Sec 3097,Civ,C.)
G(] Leni Name
z Isnlelm Address
U O I citify W I I have mad NS applica me and rum thin the aWve information is
Ly `-` torten.l agree to comply with all city and county ordinances and sate laws rclating Io
C) Wilding consrtction,and hereby auNmirs mpommuselives of Nu city in coos upon the
above-mentioned property for inspection purposes.
F„W (We)agree to un.indemnify and keep harmless the City of Cupertino against
fag IiNiliva,JMgmcnu.co xpesa which may in any way amen against said City
acq
^�
SOURCE
APPLICANT E0.5T SAND WILL COMP LTH ALL N-PoINT Issued by: Date
SOURCE /
Re-roofs
Sign um of ApplicanUCanlrxtor Dau
HA DOUS MA DISCLOSURE Type of Roof
Will Ncapplicant car forum bull ng nccupanutorcorhuMld hauNous mamriil
fined by the Cupertino Municipal Cede.Chapmr 9.12,and the Health red Safety
.section zsslz(e)t All roofs shall be inspected prior to any roofing material being❑res � g installed.
Will Ila applicant or future building occupant us. If a roof is installed without first obtainingan inspection,I agree to remove
pP g p equipment car Marta Mich P
emit haurdnm air contaminant;ss defined by the Bay Area Air Quality Management all new materials for inspection.
Dirtrin7
Oyer
the mad Nchv maurialsmqubcmcmun&rOupmr6.95ofthcCSlifor-
nir1b:ilNhSafny ,Sec' 23505.25533and25534.Iundetsund NaifNe Wilding
does not coven caw a L Out is u my resporm".tY neufy Um avvyant of Nc
require c hic de t prior m i antt of imam of Occupancy.
/2 Signature of Applicant Date
wnm nr and wuM igen Dam All roof coverings to be Class"n"or better