07120258 CITY OF CUPERTINO x •3tt+. ..as €" �" ^«'�' ''fi=r a
BUILDING DIVISION PERVIiT J CONT=RACTRI.iVERMATION
BUILDING ADDRESS: PERMR 440.
10050 S DE ANZA BLVD HOWARD WRIGHT CONSTRUCTION 07120258
OWNER'S NAME: - PERMIT ISSUE DATE
SCS ADVISORS, SEMI SALMI P.0 BOX 3764 05/06/2008
V NE: SANITARY NO. CONTROL NO.
(206) 447-7654
ARCHI'fECT/ENGINEER: BUILDING PERMIT INFO
-BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION O O O O
m I hereby atrm that 1 em licensed motor provisions Job Description
of Chapter 9(eamteiny P
wititSectis70far)ofDivisim3drumRusinenWPmfcssiomCode.analmyli¢nneu T. I .REMODEL RESTAURAMT,ADD MTG RMS,ADD OVEN,ADD
m ria full farce and e
�qz Licertse c
Li,.Is NEW FIRE PIT & TRELLIS ON EXTERIOR-PARK PLACE
ny,q Dale !Z:-, —Cmurwmr QI.`.Alt1�L.�XLS h
7th ARCHITECTS DECLARATION RESTAURANT
U 1 undersand my plans dW I be used n Public meards
Ic Licensed Professional
10 3 OWNER-BUILDER DECLARATION
s� f 1 hereby affirm Wel 1 am exempt from Ue Centnners License Law for the
i an 0 following reason.(Section 7131.5.Business and Pmfesumis Code:Any city or county
S$ which requires a Permit to cansuuc4 slier,improve,dcmniish.or ropair any suuctum
Z i Poor m its isUrrom.also requires the applicant forauch Permit to file a signed settlement
Es`e that he is licensed pursuant to deprovisloneofthe Can� ='&Li¢vclaw(Chapter 9 Sq.Ft.Floor Area Valuation
xI- (commenci.gwithSecus7000).fDivuion3.fftBudnnsadff.i..Cade)or $830000
E R.- that he"exempt therefrom da
and the basis far ,alleged exemption.Any violation of
Section 70313 by any,appllcmt ror a permit subject/the appliesm m a coil pointy ofNumber e
trot more Wan frw hundred dollais(5500). 3 6901064 .W Occupancy T P Y yP
❑I.as.of the property,m my wployees with wages u their sole compewtion,
will do the wore and the structure is notintended or offered for W,(Sec.7044,Business
and Pmtessiom Code:This Communes License law don rot apply in an owner of Required Inspections
pr speny who beildaorimpmves shvmn,aha whod¢susehwerk himulf or thmugh his
awn employs,provided that such improwmenLL are not intended ora@red rmsale IL
haacvn,the building or improvisation is said within am year of completion,the owner,
builder will new the burden of proving Wal he did not build or improv for purpose of
sal W.
Q I.as owner of the property,am exelusivcly contracting with Iicewd commetors is
consort We project(Sec.7044.interests am Profession Cade:)The Cstracmrs LL
env law don not appy in a earner of property who builds or improv.Neon.and,
who contracts for such pmjecu with a eommerar(s)licensed Pursuant in the Conbano's
Lime law.
C]I am exempt under Sec ,B&P C far this reason
Owner Data
01 WORKER'S COMPENSATION DECLARATION
I hereby elfin under penaiy of perjury ane of tie fallowing declarations..
Mw am will m timain aCsu6eate of Covent as self-inure far Worker's Compen-
sation,a provided for by Section 3700 of We labor Code.far the performance of Ne
work far which this permit is isued.
❑I have ad will maintain Worker's Campemation Insurance,as teyuhad by Snow
3700of the labor Code.for the performance oftle work for which this permit is issued '
My WorkeYs Compensation Insurance cutler and Policy number aa:
Cartier it-RLI L 0, No.:1,,)u4277 IOU
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
frbisa alm,..deal be camplewd 111h,permit is Iranian hundred doBus($100)
or bass)
1 cmufv shot in use performance of the work for which thio permit u issued.I shell nm
employ my person in any msner so as at become subject to the Wooten Compewtion
Laws of Califomia.Data
Applicant
NOTICE TO APPLICANT:If,after making Nu Certificate of Eamptied.you should
become subject in the Workers Compensation pwinum of the labor Code you mus
.J O forthwith comply with such pmvisiam w this permit shall be deemed msked.
Z N CONSTRUCTION LENDING AGENCY
[-r 1 hereby alrmn that then is a crnsmetim lending agency for the performs¢of
(Y.> the wank for which this permit ee issued(Scc.3(197.Civ.C.)
Landse,Name
D Z lander.Address
U C) 1 certify that 1 haw road this applicsion and sum ths the above informed..is
0.F cortect.I mgr¢to comply with all city and cosy ardinamxa and seem laws relating to
CC) building cnnsutrction,and hereby anthmis rtpmunuuvss of this city to enter upon thc
�1 strove-misjudge Property for inspection purposes
F qW, (We)agree in saw.IMcmnify and luxe hermins the City of Capetian against
I.anaan,judgmenLL.emur,npenses which may in ay way aecrue against said City
Z of de of this
V APPPLICCANTeUN ERSTANDS ANO WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULAl70N5.
C�:.� I_�\ 6•�s Re-roofs
argrwurt of AppleaHHduComaicum AZARDOUS MATERIALS DISCLOSURE Data Type of Roof
Will the applicant or future building eccopanl mom in handle harallon material
as definod by the Cupertino Municipal Code.Chapter 9.13.and We Health and Safely
Code,Section 25572(x)? Ha
❑Yn All roofs shall be inspected prior to any roofing material being installed.
Will thea list or future building acen as use arbitration If a roof is installed without first obtainingan inspection,I agree to remove
Pp d p a Ailment or dM ata which
DUNctt Nam air communities s defined by the Bay Area Air Quaky Management all new materials for inspection.
❑Yat '--@ NO
I haw mal the luxation ma M,r.requimmenn.Mer Chapter 6.95 of the Califor-
tieHcuth&Batty Cadc.Scnions25505,255JJ ad 35534.Isdenrantl thnifthc building
can ret monody haw a trust dict it u my maponsiNlity an maty tie aceuW,of de
requiremenLL whieh`m.tr\ee met prior m isma.¢of.cmi6nw of Occupancy. Signature of Applicant Date
Cs..�le��7Li.._ S•�d•.�v
o........th.n.d agadi Daw All roof coverings to be Class'A!'or better
G