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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
�14CONTRAC`TOR INFORMATION
BUILDING ADDRESS:
PERMIT NO.
OWNER'S NAME:
A fE
RSHINE GROUP
595 MONTAGUE AVE
12/22/2006
E:
SANITARY NO. CONTROL NO.
(510)351-3288
ARCHItECT/ENGINEER:
BUILDING PERMIT INFO
BLDC ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
hemby Afford Oat 1 am licensed under provi.4oms of Chapter 9 (commencing
with Sec6on7")of Division 3 older, Rowan and Pruressions Code. and my licensee
T. I .-TATSUMI RESTAURANT 1,087'
in full farce arcd effect. - `l
Li==m4.a I.a.g
PERMIT APPL EXTENDED TILL 12/22/06 SUEW 10/12/06
Dade L Contrader.
ARCHITECTS DECLARA ON
understand my plans shall W used As public records
Licensed Pmfossi... I
OWNER -BUILDER DECLARATION
I hereby alarm Nat I am exempt from the Con unions License Law for the
following mason. (Section 70 31.5, Business and Professium Code: My city ar county
which .quina A permit in eonatac4 alar, import d,mulksh, in repair any stmeam
! prior w its issuance. also requires On, applicant for such permit to file a signed sediment
he is licensed b of On Contractor's Licouni LAW (Chapter 9
Sq. Ft. Floor Area
Valuation
that pursuant the provisions
(eommerarig with Section 7") of Division 3 of due Buri. and Prefessiom Coca) or
$100000
Nat he is exempt therefrom and don basis for the alleged exemption. Any violation of
3 6 9 0 6 0 0 9
Occupancy Type
Section 7031.5 by any Applicant for a permit subjects the Applicant to a civil penalty ofNumber
nut more man five hundred dollars (s5Dm.
0 1, as owner of the property, or my employees with wages v their sale compensation,
Required Inspections
will do the Am& and mestructureis not intended of onesed to, &.to(Sec.]044. Bion .
and Pmfesuons Code: The Conuxmrs Li«dse law does Act apply An an owner of
Property who Wilds or improves thereon, and who dues such wark hisosel f m through his
Own empluyrrs, provided mat such improvements are tmtimended oroRertd for die. U.
however, the Wilding at improvement In sold within one year of mmpl,tim. the ouded,
builder will have the Widen of proving mat W did not WiW or improve for purpose of
sale.).
0 1, As owner of the property, an exclusively contracting with licensed comuactors b
construct the project (See 7P . Business and Professions Code:) The Communities Li.
ere Law does not apply in an owner of property who Wilds or improves thereon, and.
who contracts for such projects with a eontractar(s) licensed pmaant no the Contractors
License law.
❑ 1 me exempt under Sec , B & P C nor this mason
wren Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury One of the following d„lamtioos:
❑ I have and will maintain a Certificate of Consent to self -insure for Workers Compere
sation, as provided for by Sentient 3700 of the War Code. for the peAomame of me
woe for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance, an required by Section
37W of On labor Code for On N60Mame oftW wark for which this permit is issued.
My Workers1Compens�tion Insuaaa arts nd Policy number are'
Canis�/. /�!�I[1��[J,,.f.{�!!' alicyNo.: 17�i2o--
_
' CERfIFICA O ON FROM WORKERS'
COMPENSATION INSURANCE
(This scrum reed not W completed if tle permit is foram, hundreddo0ars (SIM)
or less.)
1 «rifer mat in the performance of On wark for which this Permit is issued, l shall not
employ any Nixon in my manner se as in become mbject to the Worker' Comp in ndcan
laws of California. Date
Applicent
NOTICE TO APPLICANT: If, After making this Cenifica , of Exemption, you should
become suhjcct a the Workers Compensation provisions of me Labor Conic. you most
foMwith comply with such provisi.m or this permit shall be deemed rerokcd.
i CONSTRUCTION LENDING AGENCY
I hereby that mire is construction 30 lending agency for the perfurtnamm of
wheRthi
s
' the work for which this permit is issued (Sec. 309], Civ. C.1
lender's Nam.
lenders Aaamas
) I certify mat 1 have read mss application Aral state that the above information is
' comes I agree to comply with city and county ordinan es and suite laws relating to
building cimsurvcdm.and h byaunorimnepresctativsofthis Cityacnarupnnthc
I ahuvcmentioned property peedan purposes.
(Wc) agmc b sen ndd dify and liecp harmless me City of Cupertino against
j liabilities.judgmenuse ts expenses which may in any way seem against said City
incessant.. of a of anis tannic
' APPLICA U STANDS DML Y WITH ALL NON -POINT
SOURCE
Issued by: Date
G ONS,
Re -roofs
' Z
Sign mor Appli Ucon r Dam
H OUS MATERIALS DISCLOSURE
Type of Roof
Will On appliexm o future building occuPamtame o handle hva ilos material
As derived by the Cupertino Municipal Cade. Chapter 9.12, dna m, Halm and Safety
0Y�y 25532(x)? Na
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to
Will the applicam m tum building Occupant use equipment or devices which
remove
,mit Intensities air contaminants As dcfdnr,d by ted Bay AM. Air Quality Man, ...t
all new materials for inspection.
District?
O Yoau
Ihaw: real dm ardcrosmaarixls requimmcns umkr Chapter6.95 oftW Califon
.is 25505.25533 and 25534.1 undersand thatifthe Wilding
sr,. n thanit mymspeosihilityarafythco«upntofthe
misthe t issavd«ar.c,rtirmaaarOccu
Signa[ureofApplicant Date
2
All roof coverings to be Class "B" or better
aegent
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