050901440
Z.
CITY OF CUPERTINO
*
INFORMATION ,a
BUILDING DIVISION PERMIT
pKCONTRACTQR
6 5 pWF Yvl +_u'•
BUILDING ADDRESS:
PERM" N0. 05090144
19626 STEVENS CRK BLVD
OWNER'S NAME:
PERMIT ISSUE DATE
WAHOO'S FISH TACO
12/05/2005
SANITARY NO. CONTROL NO.
ARCHITECrIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
LICENSED CONTRACTOR'S DECLARATION
der rovisions of Chapter 9 (commencing
I hcmby affirm that 1 sm liecmcA unp
Job Descri [ion
p
with Section 70)(r) of Division 3 of the Business and Professions Code, and my license is
.a. orcamdefreely !(1(z
TI --NEW RESTAURANT
License Cla9a �� tic. a
Oa¢ 1JrISICS - _d . ATION
I undcrstenJ my plans shall W uxd as pub is records
/(V
�1�5
Lkcrs.d Professional
DECLARATION
Dat
1 am exempt from Law for IW
I hereby .(Sero Nn 1 em exempt from the
OQ
Business and feWnctafs e: Any l
eVo Cade: Any city m county
following mason. lermit
(((/9
we, i any sVUCmm
In alms, impmsu demfillip,
which requiress. a Permit t0 Co
0
{/ F 2 J O 2 10
es; the, fie. sig
ro inion ofthent for snehpcmdlm Bleas Law(ned haprorl
prlOrmsl lensed pursuanCQWTS provisions
thar, he pursuant Nc pmvisiovo
Sq. F[. Floor Area
n
�MaloallQn,_
of Businessland Professions Coal) or
(commencing with Section T000)nf Division Jof the Businessand Professions Codc)or
Va
Nal he u exempt therefrom and the basis for t1e alleged exemption. Any violation of
B% t Q.
C
OCCU ane -T
P YPe
Section 7031.5 by any applicant for a permit subjects the applicant an a civil penalty Of
not more Nan Esse hundred dollars (M),
employee with..df..1.(isle c
the property,re
Required Inspections
theworof
will doNcwns& and is or 7094, ,Business
gra l mal a(Sec.
e: he Coro m's Licenstendud
Lawowner of
and Professions Code: The Contracmr's License Law dee mat apply lf an Owner of
Pr
property does such work
At.
mofff ulthrough
own a mrlfCrW for sale
Nat such improvements art not ear
r.
ofc
however. thebuilding orimpmwmcnlis Baldwithin att year of completion, the
the building
purpose
builder will have the Wrden of proving Nal he did not build or improve for puryoBe Of
builder
salcJ.
❑ 1. as owner Of ft property. am exclusively contracting with licensed contractors to
corstract the project (Sec. 7094. Business and Professional Code:) The Commutes Li.
come Law docs not apply In an owner of property who Wilda Or improve thereon, and
who contracts for such projects with a conuactor(s) licensed pursuant to the Contractor'.
License L, .
❑ I am exempt under Sec. . B & P C for this matin
Owner Data
'
WORKERS COMPENSATION DECLARATION
1 barely affirm under pershy of perjury, one of the following decluatiors:
I .and will maintains Certificate of Conxnl in Belt -insure for WorkersCompen-
provided for by Section 3700 of the Labor Codc, for the performance Of the
r whim this permit Is raced.
5Rwmtion,
1 have and will maintain Worker's Compensation Irsunnce. as required by Section
37W of the lslor Cade, for the performance of the work for which this permit is issued.
My Workcfs orpypensaJl'pninry1nnacarierand PolirynumMrare:
la
1
curio. s -a Ttswv-tl POliq No.: OOIOH('Y-XC)5
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cnissection need not W completed ifthe permit is fmo rc hundred dollars(SIW)
or let..)
I certify that in Ne performance of the work for which this permit is issued. 1 shall not
employ any peon In any manner an a 0 became subject t0 the Workers Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should
become subject in the Worker's Compensation provisiors of the UWr Code. you most
' forthwith comply with such provisions or this permit shall W deemed mwked.
CONSTRUCTION LENDING AGENCY
I hereby that there u a ding agency for the performance of
1
the rwhich
rk for which this permit u issued (Sec. 709], Civ. C.)
ed (Sill. 3N7,
Lender'. Nam.
de
Lcnder'.Address
I I certify that 1 haw read this application and state that the aWw information is
COMCL 1 agree in comply with all city and county Ordinances and state IBM relating to
building eonslNctian, and hereby amh nee rcprcsentatiscs Of Nis city I. enter upon the
about -m. ts for inspection purposes.
A properJudgments.
(We) agree m saw, indemnify Bud keep wardeas the City of Cupertino against
j liabilities.judgmentsegrantand es
Judd any waY accrue agairsl avid City
this pawhichfuryin
Aeortsequence of IAC granting of this permit.
APP A��ii'' UND R TANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
Sig C pEGI�L 0 g.
17 51
z51 O S
Re -roofs
Type of Roof
Signa o p i Camncor tDDA.
AZARDOUS MATERIALS DISCLOSURE
Will Ne applicant or future Wilding occupant store or handle hanrdous material
az defined by dx Cupenitm Muni 1 Cook. Chand dt
Chapter 9.13, e Health Bud and Safety
oM. Section 255324)?CYe Nu
All roofs shall be inspected prior to any roofing material being installed.
Will thea scant or future building Ora rel use equipment
pp g W y pmcnt or devices which
If a roof is installed without first obtainingan inspection, I agree to remove
P
air conuminmtsas flecd by the Bay Area Air Quality Management
all new materials for inspection.
INn�i7ardnm
❑Yes No
I haw round the huardWsmaterials requirements under Chapter6,95 of t s, Califer.
nia Hca &S ctyccxlc. a 'wen 25505.25533 and 25534.IuMcrstard then ifdte Wilding
Jae of •urtc ly hat e to ant, that it u my respotoibility, u notify th oats ant of the
requi m II, hil t Ib mepnormissu=ccor.ceNOete.fo ant
S 05,-
17F51"" s
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner or Bothria a c
te