01080086 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMITNO.
10118 BANDLEY DR # H 01080086
OWNER'S NAME, APPLICATION SUB DATE
OKRA INC & CAFE OPHELIA 08/16/2001
?HONE: SANITARY NO. CONTROL NO,
SHONE:
z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
GO BLDG ELECT PLUMB MECH
m= LICENSED CONTRACTOR'S DECLARATION Job Description
DZ—p I hereby uf0nn that l am licensed under provisions of Chapter (commencing
:t; with section]WU)afDivisiun3nl the BusinessnndProfessi°nsCde,andmylicenu INSTALL 3 SIGNS .
m I d is in full force and effect.
¢ a License Class Lic.p
3 u.L' Data Contractor
ARCHITECT'S DECLARATION
�=-O Q 1 undersmnd my plans snvll he used es puhlic records
f
3 i O O Professional
Profesxion
z OWNER-BUILDER DECLARATION
vat "2 1 hereby affum that 1 vat uusin from the Contractors License Law co the
t Z< which re reason.permit
t 7031.5.Business and Professions Code:Any city or county $5800
I F O which requires permit re<°nstmei"Imo improve,demolish, fi repair any structure
C _.p t t ,ssuenc P6r tt9 theapplreamfor.mch tW micenu w(ChnNe9 SO F ..-_,.
d 3- Nat h<f I d<niea pat reap to the pmJi4ons of the,he 4tomea amd Pr law IChager9
s
or
that
he is exeiitI Sdienre omian fDi basis of theA9ItYptsss and pth.AnymCde - V3 �34te)F��°. ��a� pp y s Valuation
or that hers exempt therefrom vnd the baso for the aileged uempdoh Any violation I'4 x s i r. ,4,,'L t t t l-
S —of Section T031.E by any it liam for v permit subjects the a,licvm to a civil penalty
tnf.nmmarc than It.hundred dollars ts50B). 101 F
APN ��.11❑❑Ummtb�fer irr'r:'.''• : ' Occupancy Type
- UNllATION
❑I,al dodo, of the an far,Snrmycmployees viddeadedth wages e Neir mile for.1 (lens.....
Burne;s"a'work:and tee ode:The is not'mwndd ene Lawred for appy TM4? ' 1 O4 - REBAR Required Inspections
'Buiines.andProfexsions Code:The Commctor's License Low does not apply to en "� PI"'�^'
' o rte f p
r° m gh his
two
ar phluy c pT impa amint<rcporm eanpd ho edonesnvcnhonot
endedeplfr
j _.. .,_.. _105 - ANCHOR BOLTS
nfferddf I If. --,h buildingI _
.urd env la 'Nin do, Yar of LI': .._ _. .,.. .. . . _..
compkuon the owner butte.). l have the burden of prov,ng vee he did no,build or 304 - ROUGH E LE CTR I CAli" '
imP rnrpnrpoaearmR.) _505 FINAL ELECTRICAL _
— -
,es owner ofthe proper,am escluswely commp"ngwth licensed contract rs to' 514 FINAL PUBLIC WORKS
_i corswet the pmlect(See 7(94 Business and Professions CoaeJ The Contestant's 1 %, y i,y„
:''`-'-; Liccnu law Jas nm°pp1Y m an owner of pmpeny who boilda or improves
andwf thereon
h concu fsuch.P c b_wnh c rs)I sd p uant t th !
-...
Contractor,License
❑l
-
B&P C fon his rcmoni si,IJ iin.;Cf(:U' O
WORKER' MPENSATION DECLARATfON F'��`
I herehy affirm under pcnahy of pc`jury Rorie of the following declarations: �(ls N ED
O 1 haveand'will me nem o Cenifcme of C' aero-m selfnvnure for Worker's SEP 13
C mpen aeon, as provided far by Section 3700 of`me Labor Care, for the: 200,
performance of the work for which this permit is issued.-
❑I haft d B m Worker
m -o n I m ce as wrd b Swat U1L
'37Miaou f the Lemur mkrr'Cd f the oort. i of the work le Im ch thisDI•,�
ry
P g Y
" cd My Wo ker 9 C mpensut 1 um cc c d Pol y u bcr
U.
CemerI4419-il'••(,hPolicy No. .r. I !' I } l sl s ll} Irllt
r;t CERTIFICAnONOF.EXEMMON FFRROOM . . .. 1.
'' I COMPENSATION'INSURdNCE n � I 1
..ht vtwe
(?'his s�cunn nefa out re'cnmpleted d the rennins far one honored anllvrt ( t '1I"a
is (Slllo)or less.) .r,•-• i
.r �I ..._............
.
lcc, it this nthusinin rnww f, ohfor nda'su n'66 No'i ud 1. h.CaU1�(7 :Ha I, 'tSrij'^''P. f•I.
'stall nm employ any ' o n any ma r as ax to become ubl t t the Work,.',,
�•
l. Aompea t t on laws°f Calf D m
pplic
' l"NOTICE APPLY NT:II Oe fhb th C rt f c t m-Emm von �?^'
g p youum Id' :
becowithojm,io,h Workers Compin , i,,.i,voh.il hcl.b .r fed muu'
z O 'fonhwiM comply Bim svchrevisions o-this permitshall be dcemd mvok. :
z .•v Ih rtb aR _ ..._- . .._.__._.-_. - f
wIJ CONSTRUCTION LENDING AGENCY - s 0'I
a s, t xr
y in that th rc . c n, t bn Icnd ag ages y for the perf c
nfth ork( chlhs perm,ls'fud lSm JWT Ci C) _r I
lY 0 endc Adrt s-..
L
-..D ,Z dt
VI cc.ifY that I have red this plicatm.Indicate that the abuse Intimidator.' '
Izt O ;<(rrtct 1 eg to,comply uh all city'and county cb an vad-tate laws rel ting'
�. no budding wet dhenibyvuth rze rep eel tiv fth city to enter upon
the above-mentioned property for inspection borrows.
ll (We)agree td sere,moemntfY and keep haimless'the City of Cupertino ageimt'
Z) labilthis,judgments Cos. tl expenses which y any ay accrue against!aid,
V .zi
City ine nsequence of the, mnII '
t tsp
jAPPLIC/1NtU RS KN DS 1,D WILL COMPLY WITH ALL NONASINT
souace REOL� s a u tl r. Issued by: Date
r ,nature ofA\pplicanVConvactU - 'Date' Re TOOTS
HAZARDOUS ATERIALS DISCLOSURE ��
W 11 ih appl t or f mrc ip Idmg e,Cha t tare h dl hoz lt a s maenal Type Of ROOF. .. tl --'* —r- __ -
',vs d<Rnd by the
Cupertino Mume p I Code,Chvpt r912 d the Health and Svf ty 4r,,.xy fBUi5 4f a rt
Cod ❑Yes 25532fa) }71510 N f- ....... tY, I(Py {�s 'v}
s All roofs shall be inspected prior.to.any roofing.material being installed__
_ ,
; WBlshe applicant fund eb 'ldMuse pant Meaq p nt d p hce, If a roof is installed Without first
( l 1 - obtaining an ins ection;I'a
tee'to'iemove
emit hb sir of t .defined by h BayA p QuItyM dgevn;
mm
I all new materials for inspection. Applicant understands and will complywi
th_ _
all Don-point source regul2hons..e)r
1 hale reod.the harmd0us'mdienals mquircmenm under.Chapter'6.95'ofahe-
nCdliform.Hcahr'&Safety C66.See(mas 25505:25533 and 25534:1 undersomd that
lYiflhe nulldngdoesnot upnl,hove m. hot I,smy apo'bd'ty Innohry the
opcup t ftre�rcy"rcm n( Mc usl be mel pnono_isvn[e of,e;Cenlfivate of -
OccupancY.
_-- _i. ._--
- .-_ Date
_ Si natureof APPlcan
All roof coverin s to be Class"B"or better'
net or i rized ogee II ' .' l .Dow g .
- OFFICE - -
_ ." ••. frit by :.F,.