06020116 BUILDING DIVISION PERMIT CONTRACTnRCINFORMATION ;
BUILDING ADORESS: s PERMITND.O 6 020116
20520 STEVENS CREEK BLVD
'ER'S NAME: PERMIT I550E DATE
STARBUCKB 08/17/2006
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Op LICENSED CONTRACTOR'S DECLARATION Job Description
w F I hereby arcrm that 1 am licensed under provisions of Chapter 9(commencing P
zw with Semon 7"1 afDivision 3 of NC Business and Profession,Code.and mylinnxu
I.full Co.anderc«t 12 TI--STARBUCKS
i Liccwc Class Lt.N
:Fp Dale Cmumetef
' wARCHITECT'S DECLARATI
ge
i W I understand my plans shall W used at,public rtenrdv
i V
°oty Littnud Pmfcssional
g OWNER-BUILDER DECORATION
1 Wrtby.(Tian m 1 1. exempts a the Contractor's License Law for Ne
p o following mase..(Section 703 nest,.Business and ere.de Tow Cade:Any city or county
m which mquirw a pumit m convruct all,.improve,dcmolW,or repair any stnxtun
$162872
?< prior w its issuance,also sequins the applicant for such permit he Ne a signed statement
that he is licensed pursuant othe,provisions ofthe Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
ss-$ (commencing with Section 7")of Division 3 of the Business and Pro@wiaw Code)or
_ Nat he is exempt therefrom and the basis for the alleged axempfion.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Occupancy Type
net mon than five hundred dollars(S500h
1,as owns of the pmpwy,or my employee with wages w their sole eomP=don,
wiR de the we.and dte he Cmit rs no,intended ar Law
does
W an,Bwiws
and property
wh rota Cade:The convenor, .naso Law dew sat apply if an owner is Required Insp
property who iota ilds m improves thereon,and who does such work himself or through his
own employees,provided that such improvements as nut intended oroRerel fors.la If. g@
however.the building or improvement is mid within one year of cmnplction.the owns- A�ITR 7f(.a
builder will have the burden of proving Nat he did not build or improve for purpose of
sate.). 4/ .1J.
❑1.w ewKr of BG property,am exclusively ConwCting wide licensed C9nVKmna in
construct the project(Sec.7000.Business and Professions Code:)The Contractor's Li-
cents Law does oat apply to an owner of property who builds or improv,thereon.end �l
who contracts foa such projects with.ron,acter(s)licensed purnwnt an dee Cen,xtors
Litt.Law.
❑lameaemptundcrSee ,B&PCforthismason Bill,
_
mr
r Data
WORKER'S COMPENSATION DECLARATION b
1 hereby affirm under pestalty of perjury on of the following declinations
❑1 have and will maintain a Certificate of Consent he self-insum for Workers Compcn-
nation,an provided for by Section 7700 of the labor Cade,ror dte Performance of the
work for which this Permit is issued
❑1 have and will maintain Wo lees Compewation Iwurann,as required by Secdon
3700 of do Labor Code.for tW pciformroa clubs work for which this Permit is issa&
My Worker
CCiar ssub n Iwu .artier and Policy numbc are:�/�
Cartier.1111 � �IV� Policy N., 60 00
CERTIFICATE OF EXEMPTION FRO ORKERS'
COMPENSATION INSURANCE
(Thuxction reed not W completed lint,permit is for on hundred finnan($100)
ar less)
I ccni(V that in the Performance of the work for which this permit is Lund,1 shall not
Cori person in any mann,ro u to Wceme subject,.tW WorkersCimermaden
laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,yen should
become subjm an the Warner's Compensation provisions of the Lahr Cods,you must
.JO forthwith comply with such provisinw or this Permit shall be deemed rewired.
.Z.t'M CONSTRUCTION LENDING AGENCY
[—tom 1Wnby aBhm thattmit itscil Sac.30 ten ding agency for Use per(umnence of
FL the work fur which this permit u ivnd(Sec.J097,Ci,C.)
GQ Landers Nem.
M z Leader's Address
U C 1 ccnify that I have rad this application and state that the above information Is -
IL conte.I agree to Comply with all city and county ordinances and sure laws misting 10
0V building Construction,and hemby authorise nprescmatives of this city m enter upon the
r m anove-mentioned property for inspcctin purpose..
(We)agree to save,indemnify/red keep harmless de City of Cupcnino against
h liabilida,judg Is Oxm.dexec a which may in any way accrue against said City
rpos
f the Starting
V z this pernnit.
APPLICA n NDERSTANDf' No WILL COMPLY WITH ALL N N-P01 Issued by:S4(V� ,
Date 4 6—UL
SOUL ULA NS. / Q
Re-roofs
Sigwtum OfA,pIiVConus0br 0Dare
HAZARDOUS MA RIALS DISCLOSURE Type of Roof
Will the applicant or future building occupanutom or Worth,hazvdous material
defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Section.0Yes 35513(,)? 1/J/J{"No All roofs shall be inspected prior to any roofing material being installed.
Will mea applicant re Nturt Wilding occupant use If a roof is installed without first obtaining an inspection,I agree to remove
pP B P ea Air Quality
or Mann which g
emit haxardnus air contaminants w defined by me Bay Area Air Quality Managcmcnt all new materials for inspection.
District?
❑Y �j
I ere n:aJ me hvallousma�i alsmquimmentsunder ,CMpwt6.95oftheCalifor-
maHealm&Safetycodc.Seniwq �505,25573rod255Ja.1 undcrsund lhatiftW Wilding
docs ran cumnaly h ro a tenant ar it is 5,respowihility to nouI me cupror f the
nqu' m tswmm� wt / pnertuissuamoofac.rdficate , Signature of Applicant Date
Owner or authonvcd agent �D,te All roof coverings to be Class "B"or better