06010105CITY OF CUPERTINO
DIVISION PERMIT
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BUILDING
ING ADDRESS:
1626 STEVENS CPX RTA
9TH ST CONSTRUCTION INC
PERMITNO. 06010105
R'S NAME:
jAR'1HITECr/FNGINEER:
PERMIT ISSUE DATE
WAHOO'S FISH TACO
1726 W 9TH ST
02/07/2006
E:
SANITARY NO. CONTROL N0.
(909)949-7334
BUILDING PERMIT INFO
I
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that I am hearted under provisions of Chapter 9 (commencing
wits Scction 7") of Division 3 of Ne Business end Professions Codc, end my licenx is
`ni`Cnlu�undeffeer.
-7111Q.REVISION-STRUCTURAL.
CLARIFICATION OF ROOF
Lle.g
Dam a — 2 - �Contractor
PLATFORMS FOR EQUIP & INT TRANSFORMER
R�crsDlspu TDds
NO NEW PERMIT ISSUED/ORIG. #05090144
� I undcraunJ my plans shall he used u public records
U
Licensed Professional
DECLARATION
I hereby affirm 0.11 mo License.,c Law for the
11. exempt from thin Contracfinal
0
O following mason. ]0nstr Business and nn(dc uw Cale: Any city of county
reaso on Co:
whim alts isu a permit construct, hnprom, m pair any structure
Permit
aalter.pplicant h fern t
re e
y four to incensed aalso rc int he pro inion of rorsucthe Corr perm's Lice se Lawdautemcm
CNmhcinciatwJpuntion70)ofDroionsnftscCom.muhaicenxLame,Coumr9
Sq. Ft. Floor Area
Valuation
ncingwim of Dtesist n3 of the Bet!cammpt Professiovi Cnde) or
$
$0
refrumnn0)
that he Ihcrtlrom and burs for alleged Any of
that u )x1.5
Y
APN Number
Occupancy e
P Y TYP
be
pplk.oa
it penalty
fore permit subjects the epplkanuo a merit penalty of
et or
Suntan b
by eery
thato
not more man nm hundred amlma (gsoo).
red dollars
t] I,uownm of the propmy, Lir my rmployw with wage. Inev.Ic compewuon,
Required Inspections
will dO the work end me shumurt is not intended or offered foraale(Sm. 7W. Business
arta Professions Code: The Conmctofs License Law doe not apply to an Owner or
propeny who builds or impmvumereon,and who dmf such work himselforRuough his
avmemployms, provided thatsmh imprommenu art amt mumbled orofferW for Sala B.
however, me building or impmvemem is sold within one year of completion, me owner -
builder will have me burden of paving that he did not build or imptom Ile Purpose: of
.Ie,.).
SS
❑ 1, a owner or este Sect . Business sinandnly conte i n s Cod;) Do Contrae<wn .
me pmiota (S)c. Toga. arta Pretensions Code:) The Contractor's
come
La
cense Taw coca not m an owner ofpropeny.who Wilds or improve thexon, .d
werof, and
who contracts licensed
fm amu projects with aconuactor(s) limnsed punwnt to the Conhactofs
Lke La
law.
m
❑ 1 am exempt unser See. , B d: P C for this r)uon,
Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury oro of the following declarations:
I ham and will maintain a Certi0wu of Co.., to xlf-insure for Workers Compen.
.lion, u provided for by Section 3]00 of me labor Code, fm tM performanm of the
work for which this Permit is issued.
❑ 1 hale and will maintain Walked Compensation barman, u required by Section
3700 of the Labor Code, for the performame of the weals for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:L f
Cartier. t'lC�eL C�<aYJ Policy No.: (9L<('0 l/0
GEMICATE OF PTION FROM WORKERS'
COMPENSATION INSURANCE
rlTuxctim recd our becmnplce,d lithe Permit u forme, hundred dollars (SIM)
of less.)
I certify that in the performance of the work for which this Permit u issued. I shall not
employ any person in any month, x u to become subjecun the Wmkeri Compeesation
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you most
comply who . ch provisions m the permit ahall 4 dmmel tmokca.
CONSTRUCTION LENDING AGENCY
I hereby ammr that there is a conso cfion lending agency for the perfufmance of
me wools for which role permit is issued (S«. 309]. Ch, C.)
Lena a's Name
Lenders Addle.
I certify that I Nue read this application and sure that Inc sham information u
I agree to comply with all city .d county ordinances and sum laws relating b
building construction, and hereby authorize aprcxmativu Of this city m enter upon the
abovrmentioned c
for instated..
(we) agom to... indemnify and keep ham;us the City of Cupertino against
nes
oral,propertyre sili which may
and eapenrrtmi,. they in any wayammc against said City
ue
inconseqes
consequence ofine gran
of the permit.
A
APPLICANT RSTAN Sthis
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOUR LATIONS — Q O
Re -roofs
Stgnuurt of ApplicanUConlractor Date
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant m future, building occupant a. or handle h.�ow motorial
defm)d by the Cumnino Municipal Code. Chapter 9.13, and the Health and Safety
. Section 35532(x)?
❑YueNa
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building mcupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
it haaardoua air to u dchnc l by the Bay Arta Air Quality Management
all new materials for inspection.
District? .d
❑Yes �I Nu
1 have rcaJ de, hvaNeus materials myuimmcnu under Chape,r QYS of tM Glifor-
'
niaH 1" Safety Code. Sections 25505, n533 and 25531.1 unhrsuM thatifthe Wilding
dam nm currently bac a mmmL tsat it a my repewibuny to notify ti¢ occupant nr the
require= he met pd issuance of acenifiwmofOccupamy.
Signature of Applicant Date
/
All roof coverings to be Class "B" or better
Owner or authormed agent Dam