02020034 CITY
DVSONO
IiiNPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: APPLICATION SUB DATE
HIPOTTE RESTAURANT 2420 PRUNE AVE 02Z08/2002'
PHONE: SANITARY NO. CONTROL NO.
(510) 438-9000
ARCHFI EC iENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i l ..l 1.1 LJLICENSEU
ARATION
Ihmcbyamrootha lDam�cesed under pmiisons of Chapter 9(commencing Job Description
isim Section](g0)ofDirision3ofthe Busine and Prfessions Coae.a d nylicense
=ys= ix i.ml � � 7 REPAIR SEWER LINE.
r ne e a Liceme Li X
O a�' DIt Commmp((r
v 3 a v ARCHITECT'S GIVLARAT O
_LL O Q 1 umlecaand m 1 hall h used as blit retards
.� y P an..a pu
T
o o Linnsd Prnfcsxional
OWNER-BUILDER DECLARATION
so 1 hereby affirm,hid 1 am exempt from the Commit Co License Law for the
CMM fallowing mason.(Section]onsum Business improve,
vet de io demolish,
Cada Any tiny or county
ws a xhich requires a pem,it m cnnvmn,alter,improve,demolish,or repair any swnuro o*2 5 0 0
to C pn to Is' ant also q ire th< ppl cam for such pemmn fl 'gnWstaadnend. ...__.. . . -
m3'`Wmhe Ineedpaisamtothep ins err me theBromrLcenseie onsCoer) S -Ft„Floor-,, ea T';, Valuation
(commencing with Safo 2810) f he Division o t the B jib r,t and pion A Code t.F t` 3 G; { i `.T 3J Z' si;I F(�
or he 7lexampl mercfrdli and the hasis for the subjects the applicant
to Any v aemion 3 5'917 0'19 . d'0
of Section]than
iv any applicant fora petrosa-uM1jecn the applicum m a civil pcnnlq
'of no,moiemanEvehundred dollars tssoot APN Number 1, Nr Occupancy Type
o 1,as owner ohne pmpeny.or my employers with wages as their sole compensation, 106 - SEWER & WATE
will do the'%ink.and,ne'swctom is non intender or'offered for sale'(Sec 70",- - - - _ m�Wa -
Bud.c,,and Professions Csde:The Contractor's License Law does not apply to an %1,.s '_
owner of prepeny who builds or improves thereon,and who does such work himself 3 01 — ROUGH P
or through his own employee,.provided that such improvements art not intended or
",-arrcraaforxlemp
nowcvcn,thebuildingofiraaemm
e :a.oldw;thm a< -
yearor "---507 - -FINAL'-PLUMBING
complet ale
ion,the toner-budder will have the bode.of proving man he did not build or •;.,: :.. ,:.j .._ )I.—. ____
improve for impose of sale.).
❑I;aserowner of the pmyeny,am N.Businessacommaingwith licensed c Cmdoonto _ -'-- --
cnnawa,he pmjec,(Sec.]to Business and Professions Code:)The Co theme..
License Law does no(apply man owner of property who builds se improves thereon.
,. dna wad c,License
L such projects.with.a.commmorts).licensed.puaoant.w.d,e. ..
_ Cnnuac,or's License law.. YtlP� -----'------- -
❑1 em exempt mr er sea ";B'&P C for,his mason t. ,• ,
OwnerDaie FEB 2 8 2002
" • wORKEH'S COMPENSATION DECLARATION
1 hereby am.under penalty of Perjury,one of the following declarations:
a O I haSe'md will mainmin a CeniBc-;c W Consent to self-insure for Worker's BUILDING
:2 Compensation, as provided for by Section 310' of the Labor Code;for the
piAormarce of thi work fo'x hich this'comm is issued. .
❑I have and will niiint;m Worker's Compensaion Insurance,as required by Section
3700 of he Lahti,Cod for h Iii1fornmotie of which d; penrli,"is
:scud My keraC.rrpsiomdmn Immormeac d P licy her
mer mw s . Pub y1aQ9 �s,xr..
,'CERTIFICATION OF EX E, ION FROM,WORKERS" r t�y"4 S^;�*, '� '4, ii6r $�i 1't*�slvf.a..if�.ti: '
„_ti-_.r„_,•,..,,__ _,_COMPENSAt'IONINSURANCE m I'
' 5'rrhu' .ion.ccd nus he complaiE if the permit is for otic hundred dollen
(SI00)or less. ,
( 1 nfy th,inth,pe f. '.fthe work for which nh 'cunt"'ss dl _ . .,-
shall not employ any pe son in any manner so as to become subject to the Wmiscrs
Compensation laws of California:Date' -
1 NOPICETOAPPLICg this Certificate f E ptio yso
Wopalf,h LvhorCod;you mustZ my , be t he Cs
'
cc forthwith comply with such provisions or ths Permit shall h deterred rooked.
ti •sCONSTRUCTION
ruGAGENCY
I h ieny firm,hid nhcrc I,o wcti
on o f ding agency for,he performance
ofth work for ix h:chth pc .t, sued rs 309] Ci.CI
Lim
6i'A -Lde Name- .It _..
s . _ .._.c_
:7 Z
V I certify that 1 have read this application and state than the above info
nnauon s '
W_I:. c'o@eco.I-gree,o comply with all city and c...ty.erdinanecs and state laws relining
rebuilding com,mc,ion and hereby ammonite moresentativesof this city to enter upon
tl:e above-mentioned pmpcny for impemion purposes.
- �,Cli tWc)egrce to toir.indemnify and keep harmlessthe Ciiy of Cuperiino against
W Iiehili,ies,judgp¢m i.cons and expenses which may in any wayiaccme against said
f.> i City n'co f G me of II g-ming of,hi,'smut
'APPL'IC U S 'D 'ILL COMPLY WITH ALL NOV-POI I
S s .. "{• Issued by: Da e
e,f A'Plic
, HAZAR,DDU$-MATRIALS.DISCLOSURE
Re-roofs
w l pf ant future bile g Pan , handle hams 'a mam
as ddit edy the Cupertino Municipal Code,GdPl 9 12 ❑m Health d Safety Type of.R
oof
CodeSection 2551
)P ..
r�i ; �8
ra+d'o'ir t t.t' All roofs shall be inspected prior to any roofingmaterialbeing installed,
na t I wn dieapplicant fun buildingdi pa,use .Ai devices whh If a roof is insialled'without first obtaining an inspection,Itagree'to remove
c t h mrd - mourn,- defined b th Ba-Ama'A n,
p,xm n _. __. . .._ , . P -,, _ ., _ - ds and will tom I with
Y Y ny MvmBed,rc
all new materials for inspection. Applicant understan
P,Y_..
°Yu' °' all non-point source regulations.,..
I ha d the h d s mmedals requirements, nder Chapter 6 95 of die '
Califomia He N&Safcry econ
Code:Stis25505;25533 end 25534-1 understand,ha,
if
the build' cu .fly have a mnam:that it is my.,visibility mimify,he
Deco' hich mull he it prior,o issoance 6f a Cenifwm of'. .
Si nature of Applicant _
Date
All 1 roof coverings to be Class "B" or better
� ate g
OFFICE . .. -