06080205'ITY OF CUPERTINO
+v•+ �5 x " "'' �",
'OTOR4I?ZMATION ,,.
BUILDING DIVISION PERMIT
kCONTR
BUILDING ADDRESS:
PERMIT N0 0 6 0 8 0 2 0 5
19805 STEVENS CREEK BLVD
WNER'S NAME:
PER.Mrf ISSUE DATE
CEC ENTERTAINMENT
08/24/2006
ONE:
SANITARY NO. CONTROL NO.
ARCHI2ECf/ENGINELR:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONIRACIOWS DECLARATION
Job De$Ci1pllOn
1 bertby option that 1 am licensed under provisions of CWpur 9 (commencing
with Section Ill(()) of Divialon 3 of 0v Businevand Professions Code, and my license is
in full fare, and effect
INSTALL SEWER LINE CLEAN OUT
License Class lJuN
Da¢ Contraaor,
ARCHITECTS DECLARATION
I understand my plans shall W used as public meorda
Liccnud Professional
OWNER -BUILDER DECLARATION
I hereby mina that I am exempt fuse the Communes License Law far the
fallowing return. (Section 703 L3, Business and Profusion; Code: Any tip or county
which rcqui. a permit w cmnua¢I, sltu. impuvc. dcmnlish. or repair any no.
$100
He, W its issuance, ala. requires BM appinCNl per such pcmlll W file a SigMd statement
the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that W is licensed pursuant to lW previsions of
(commencing with Section ]000)of Division Sof the Business and Profusions Crum) or
1 b
Nat he u exempt therefrom and the,asis for the alleged exemption. Any violation of
zt APM Mffiber
Occupancy Type
Scefion 7031A by airy applicant for a permit ubjecu the applicant u a civil penalty of
mat more Nan fist hundred dollars (5500).
1, u owns of the pmpmy, or my employcu with wages u them wle compensadon,
Required Inspections
et
will de the wank. and the swmum is notimmnded or offered fonak(Sec. 2004, Business
ioru Cade: The Canmcme, License Law dors se
and Profeuns apply W in owner of
q P
property who Wilds or imProva thereon, and wW dnessuchwarkhimvJforlMugh his
own cmployeu, prodded that such imptummenta m nm intended or offered forsak. If.
however, the building or improvement is sold within one year of wupledon. the owner.
builder will have she Worker, of proving that he did not Wild or improve for purpose of
ukJ.
❑ 1, as owner of the property, am exclwivdy contracting with licensed contractors n
construct rte project (Sec. 2044, Business and Pwfessians Cade:) The Convector's Li-
ccae Law docs not apply m an owner of property who Wilds or improves dtemon, and.
who con.acu for such projects with a conlraCmr(s) licensed pursuant to da, Communes
Lfc". Law.
❑ I am uemps under See ,B&PC for this reason
er Date
WORKERS COMPENSATION DECLARATION
I hereby o iml under pendty of perjury one of the following dMamGons:
❑ I have and will maintain a Coo ficom of Comu
eno self -insure fm Worker's Compen-
SAN
sation u Provided far by Senfon 3200 of the Labor Com, for We pofoomanm of thework
IJARY
for which this perreft is issued.
Worker's Compensation urmcc, required by Section
F1 1 have and will maintain WorkMu
m
32W of the labor Co, for Ne performance of the work for which this pemtit u issued.
My Workers Compensation Insurance, curter and Policy number m:
Cartier. Polity No.:
-
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
-
mus secure need An, W completed if the permit is for one hundred dollen ($IM)
or )
1 cenify that in the performance or the work for which this permit is issued, 1 shall not
employ any manner soum become subject to the Worker;Compensation
Law,
laws of California. Dov
Applicant
NQITCE0j APPLICANT: If, ager making this of Exemption, you should
become a ,isimua I
w Inc Wahm's Compensation provisions of the labor Com. you must
' forthwith comply with such provivansm Nu Permit Oat] Wdamed n:vmkcrk.
Comply
j CONSTRUCTION
I horwhich thi that there iso c.nN edmi leGAGENCY
agenry for the perlomuna.f
ed IS.. 3097. Cing
' the work for which this permit k ;sued (Su:. JM2, Civ, C.)
Lenmr's Name
`
Lender's Address
'
1 cenify that 1 have read this application and sum that the aWve information is
' toren. 1 agme to comply with all city and county ordinances and sure laws relating m
building construction, and hereby authome mpracnutims of this city to enter upon the
Wye -mentioned pmpeny for inspection purposes.
(We) .,me Io se.e, indemnify and kap harmlca the City of Cupertino against
j Habililie judgmcnu. toss anticxpcnxu which may in any way accrne against said City
in con —ce of the granting of this permis
' APP A NDERSTA S AND WILL COMPLY WITH ALL NON -POINT
Issued by: 2�(� Date �-'Z 4—G G
SOU CE ULATLONS
Re -roofs ��—
Type of Roof
b
gnature of Applic�t�US MATERIALS DISCLOSURE Date
Will the applicant or room Wilding.ccupmtstommhandleha ommaterial
Asrefined by the Cupertino Municipal Com, Chapter 9.12. and the Health and Safety
25532(a)?
Code,yes ❑Ne
OYu
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 to applicant or future Wildingmcupanwse Cquipmcmordevices which
remove
cmil hazardous air contaminant As defined by the Bay Arca Air Quality Management
all new materials for inspection.
Diarist?
O Ya ❑ N.
1 have read the W ardous matermisrequimmcns under Chapter6.95 of the Califon
lm afcp Cade,SCCYOM 25505.25533 am125534. 1 understand thuirme Wilding
t trend, have a that it u my pouibility, m notify the occupant of the
n wNcnm.z mW aracen;rtegr«apanry.
2wor
Signature of Applicant Date
a
All roof coverings to be Class "B" or better
a. rued agent Dame
Oem 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub:
Blk: Lot:
APN ........:
31620083.00
DATE ISSUED.......:
08/24/2006
RECEIPT #.........:
35759
REFERENCE ID # ...:
06080205
SITE ADDRESS .....: 19805 STEVENS CREEK BLVD
SUBDIVISION ......
CITY .............: CUPERTINO
IMPACT AREA ......
OWNER ............: CEC ENTERTAINMENT
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM ....: JOHNNY STEWART
CONTRACTOR .......: LIC #
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
• TELEPHONE ........:
OPERATOR: amyw
COPY # : 2
FEE ID UNIT
-----------------------
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
BPSEWER SEWER SYSTEM
----------
1.00
--------------------
21.58
0.00
--------------------
21.58
0.00
PPERMITFEE FLAT RATE
1.00
38.37
0.00
38.37
0.00
TOTAL PERMIT
---------- ----------
59.95
0.00
---------- ----------
59.95
0.00
METHOD OF PAYMENT
-----------------
AMOUNT
NUMBER
------------
OTHER
59.95
------------------
VISA
TOTAL RECEIPT
59.95
VOICE ID DESCRIPTION
VOICE
ID
DESCRIPTION
106 SEWER & WATER
202
UNDERFLOOR
PLUMBING
301 ROUGH PLUMBING
507
FINAL
PLUMBING
•
r
CITY Of
*UPEkTINO
•
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building De artment
JOB ADDRESS:
PERMIT #
06/,0 zo S'
OWNER'S NAME:
PHONE # - 22 (—/yam
GENERAL CONTRACTOR
FAX #
r-
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
Date
er/Contractor Signature
�OxY--t G
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring. Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
T•
er/Contractor Signature
�OxY--t G
Date
CITY of
•CUPEkTINO
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
PERMIT APPLICATION FORM
APN #� -n o�
3 ICJ
Bldg. Permit Fees
Dat
6
Building Address:
5 s �
Gas Piping System Fee
PLUMBING
(% cven s c -e
�
vc/
PLUMBING
Owner's Name:
Re i e of Fixtures
Phone #:
BPFIXTURE
Pbl . Fixture
PLUMBING
Contract Phone:
Main Water Service
License #:
BPSEWER
Sewers
PLUMBING
Contact:/' Phone:
TWr
Sewage Disposal
Cupertino Business License #:
& v C2 /A/- 9
x=5-3 9
Building Pe rt Info:r� ll C11-11 01��
Business License
BUILDING
Bldg ❑ Elect ❑ Plumb
Job Description:
7/-
Residential ❑ Commercial
Cost of Project:
X
Qty. if
Applicable Fee ID
Fee Description
Fee Groun
BPERMFEE
Bldg. Permit Fees
BUILDING
BPGAS
Gas Piping System Fee
PLUMBING
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BPREPIPE
Re i e of Fixtures
PLUMBING
BPFIXTURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BUSLIC
Business License
BUILDING
0