00120117 CITY OF CUPERTINOt - CT "" "''' '^ '
BUILDING,DtvtstON PERMIT. CONTRAOR INFORMATION:
BUILDING AVD.@I,�SS11fl DAIXIDLEY 'DR. -EAST' RAY. REST SUPPLY PI iV�01010120117
'
OWNER'S NAME: - APPLICATIO sl1H l '('•
CHANG, .SNEENA & JEFF 49 4"flI S'f �'r'/fg/20Q10
5 •I'HONIi: v - SANITARY NO. - - CONTROL NO.
SIU T��6
(510).46374300
ARCHIa EN' [ER:, BUILDINGPERMu'INFO'
m '\ `�a 1 .DC r ELECT ss 'PLIJMB - MI:CH
< C� •1=1 =1 =I
H
LICENSED CONI RACIOR S DECLARATION
z5 Ihereby alr.mman lam rcened under p.,Wim,of chapter 9(aomnem,g Job Descripti .
°�—O wanlectinn]IXlfllofl]s
i3l Ms
r ' td
mnenoo
full mte, onn '
INTERIOR DEIYIOLITION OF RESTAURANT
3 Lveen.wCIxs,_
Date Commerce
-
C Ly 4ARCHI rIiCCS DECLARATION
I up re"od nay plans shell by usee os puAlie recnNs
w,nG -,
u1 6 G Lil Prnesainnul
w a R ri Oat I am eUILDER DBCLARA'I'ION f
— 1 hereby.Sect o that I 1 5 exempt from the Comession,Cos 1:Any c Law far thefollmat "'
C e a which
mason.Section 703 em ilor Business land ver detloos Calc:Any city or county
ochic '
5F� n hremains,_ p.mtn , , h p Jmn 1'.h orrepair >.t cure
w 3� nor on, �I. r 4 :the pi l' r l cl...... t 1 1 g il t n•nu n
tlini ¢with
a d p I n ' n ,j . I L ICI .1c) S Pt. Floor Area Va � o 0 ,
(eo g nhSen 'IOW) fD 3 fah Ie s IP t - .Cato) q'
or that hesempt therefrom and the basis for the alleged exemption.Any violation -
or Section 7031.5 by any applicant for a permit subjects the applicant to a emil Iaanhy
or not more than line nttndrea,,Dort,,(S500). 11 APN Number - Occupancy Type
° nwLomeralim,n,peny.mrtttyen,BoyeeswJ
sell, , 2,1534066., k7O ' .
will do the work,Dna,he smmmre is not i,n abled ,,offered lin ade(Sea 9N4, - .
Business and Professions Code:The Contractor',License Law does aorapply to an Required Inspections'
owner of proper,Who Wilds orhopmeesthereon,and who does rachwork himself NO ASSIGNED INSPECTIONS
or through his own employees.pmvWedthat such improvements arc no,intended or
offered far.ale.It,hmvcver.'the bulldle,nr imprevemcm is sold within one yen of _
eonq,Iodnn,the owncr-hoilde, ,It have the bunlen til'laming thut hell,,not hold et _
mp I p ,p, oI me.). .
L., fah pro,pert,ionnecOmwelycoolowfing withle a tractors to j
sm,non, he a t m (S ]614 Ballot,andcprofessionsCalc 1 Th C , mor x
Lc 1 t o t pply, r w fp pony a build. .........hcra,c
am t ns f ueh PnJutn with uta nor(sl l rW pt rsu ret to Mc - -
Camoexempicense Sec.
❑1 am exempt under Sec. � ,H&P C Ihr this mown
Owner Uma v/
WORKER'S C0MI'IiNSATI0N❑F.CLARATION
I hereby ufirnI under penahy ml perjury ane nl'the following decluratione
.'° I have and will mci,nain v Cenifeme of Catant,o,self-inure for Worker's -
Compaasmicn. vs powided fill by Section 37I0 of the LUMm Cale, for the ,
performance of the work for which ddx permit ix issued. • - y _711 have and will maintain Worker's Compersonon Insmmme,u"required by Section
370K1 of the"Nor Code,for,he performance of,he work for which this permit is
isxu<J.M/�/s�Wor�kels�C,um/p�enm,�,n l/q urance canicr wQ�ul`ll
cty—(y/a-(/a /Gi'1'alicy Ne.
m 4 --I II'C TI( OF XF 11" (N IIiOM "
D`ic1.2D + . GH
rlbi"section,need not be chole ed if the remin 14 for one hundree dollars . .
(8100)nr less.)
I cosily that In the performance of,he week far which this....u(is mind,I
shall nett col any parson in any m:mnea.m as ,,become vani m the Worker' _
Compensation Ines of California.Date. ,
Applicant
-NOTICE TO APPLICANT If, ft king his Cettifi,me of 5scmpimil you should
•
o 2 bac obte,mtheWi k C 1salldtlinp t' f the Lb,r Cade,you lat,l
a O fmtl 'tl comply with h p t'' t:or this punt sh II be decBed evoked.
ti
F rn CONSTRUCTION consomme.
lea AGENCY
1hkI affirm halm mere isvcomunction Ieuding,C.) fnnhc performance _ -
R•7 mf,he work for which,his t i"is ed(Sec.JIM)],Ci¢Cd .
Q odor's Numc_ r
•,� Lendet'"Address _ _ ,
, d .0
U 01 cenify Wm I have read thio xpplicminn and nm,e that the uM,vc informvtinn is
F.
�• col , I acme t ply am all city d tre N n nee J r, I I n ng
Q V mbuilding consamelimi,andhereby authorize representatives offfi,cityt t pm - s
W the M i , pe ty f :pct
r (Q"/] 'liuhftr"jmd i J "i 14, ph J . to Cit, ICp i o, old .
J Jg car.e t d pe ws which may n an) ay Dome a%a nst na J
U z City,intence UND of STANDhe S
ANdNTLLCn.APPI /� f� -- 1 '
SOURJ"NI'UND IONS. SANIQ'ILLCOMI'LY WITH ALL NON-POINT issued CiHN�s..�'\.lJ 7TC/ Date/Z
SOUR RF.0 I13N5��'w ' p y•
n t' phe
.on Toho, Date Re-roofs R .
ITA RD0US MA'I ER1ALS DISCLOSURE ''
Will dteappneam or Gomm Fwldm,oc.,•a� �
nNt Nor, m
or handle banardra. anrim Type of Roof
as defined by the Cupcnino hlunicipul Code.Ch\.]Q'Z.and,he Health and Sae,,
Calc.Section 25532(a)'1 ✓ 1 - -
Cye, f °h All roofs shall be inspected prior to any roofing'material being installed. .-
Wdlth CII , 1 t eh 'ming p ttaecequip t d brh If A roof Is installed without first obtainingan inspection, I agree to remove
mill I � tart ant- Jf by th I ArQ fly hl gmem P 'g
Monetd all new materials for inspection. Applicant understands and will comply with
f(' � ) all non pant source regulations.
h J❑•1 J t r' I: 'k syn 'had CI t 695 ,f the
Calif,rn a Ilealth&Satcty Code,Sen ons 55B 3 and 25531 I ned...bad Ilia,
if the builJin does no,currently ha.camnanL,hat itiuny responsibility to nmify,he
uccop:mt u gmmm Its which mus,be me,pr'. is Dance of Cenifcabe ml
Occ..an
/ Signature of Applicant ; Date
al coverings- 'All roof to be Class `B"or better
OFFICE