06080243A
CITY OF CUPERTINO
k °�`' •'*
I1V''ORMATION
BUILDING DIVISION PERMIT r
�ONTRt1.CT7,R
BUILDING ADDRESS:
PAKWAY CONSTRUCTION &
PERMIT NO. 06080243,
19805 STEVENS CREEK BLVD
OWNER'S NAME:
PERMrC ISEUEDATE
nk CHUCK E CHEESE
1000 CIVIC CIRCLE
06
NE:
SANITARY NO. CONTROL NO.
(972)221-1979
wRCNT1ECVENGINEEA:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� � I�
LICENSED CONTRACTOR'S DECLARATION
Job Description
Me' 1 r licensed order Provisions of chapter 9 (commmming
Mines, affirm m ns
Divi on Sof NCB nc and row item eoe. my Rcena ix
sulll
in forte adeffec
GENERATOR FOR TEMPORARY POWER TO BUILDING
License Clam Lr. p
Dau O--So-o! court
ARCHffELTS DEC RATION
I understand my plans shall the used as public records
( Licensed Professional
OWNER -BUILDER DECLARATION
I hereby arum that 11. ucmpt from Ne conuaaars Law for nc
e: Any c
t following mason. (Section 9fon LS, Business and ons Code: Any city at county
Improve, de
which requires a permit m construct, slue W pmve, dcmol6h, or repair any swesurt
$100
prior or its Lssvamc. also inquires dm a,iment for such permit as file a signed stsumcm
Sq. FC Floor Area
Valuation
deal W is liccmcd pursuant in the provisions of the Common's Lice= Law(CTapia 9
a(commencing wine 7W) of Division J of duce Business and Professions Coon)or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
r U U
Occupancy Type
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of
not ream cum love hundred dollars (IM
❑ 1, an owner of the Property, at my employees with wage as their sole compensation,
Required Inspections
will do the work. and the structure is not intended or oReted fint(Sec. 7ra4, Busiws
and Professions Code: The Committers License Law dues ret apply an an owner or
q P
propery who Wilds m urnpmses thmcam,and wMdo,sauchwork lorpos ter through his
own csnpluyms, provided nm such improameau art trot intended crpnered finale. If.
however, the Wilding or improvement is sold within one year of completion. the owner.
builder will have the Widen of priming that bo did wt build ter improve far purpose of
Ai
❑ L az owner of the property, am exclusively... among with licensed cmmmctms in
ss
B
construct the nea (Sec. orad, Business and Code:) Th Condolences ors
who nd
an owner of property who Wilds or impmvex thereon. and
es property
cense law coos not apply
°IL■tan
who contracts for such projects with a conmaemr(s) licenced pursuant b the Conmaetors
a
Liana Law.A'—
❑ 1 am exempt under See , B d P C far this reason
e-'1
Owner Dau
a n as
WORKER'S COMPENSATION DECLARATION
lk I hereby affirm order penalty of perjury m of the following declarations:
IY ®QM. fxf/raa,�l1 (QL .
1 have and will maintain a CeWRau of Conant o self -insure for Wmkcri Compen.
bYR'j�{NF#{rf]
anon, az provided for by Section 3700 of the Labor Code, for the performanm of the
work ler which this permit is issued.
❑ 1 have ard will maintain Workers cooperation. Ivunarm, as required by Section
3700 of dee labor Code, for the performeme of the work for which this permit is issued.
My Wool Compensation Inanmic artier and Policy number am:
Carrier. fgr.aluSr r Policy
CERTIFICATE OFEX PTIONPROM ERS'
COMPENSA ON INSURANCEANCE
-
(Nu section med notWcomplemsl if the permit is fortune hundred dollars (SIM)
or less)
1 minty that in the performance of the work rot which this permit is issued, l shall not
croploy any person in any manner in as At become subject to the Workers' Compensation
Laws of California. Dau
Applicant
'
NOTICE TO APPLICANT: If, after making this CeNfiau of Exemption, you should
become subject m the Wor er's Compensation provisions of the labor, Code, you must
forthwith comply with such previsions m thia permit shall he decreed nookcd.
CONSTRUCTION LENDING AGENCY
I hereby thi that there is lending agency for the performance of
which sed(S.construction0
the work fur which nu permit is issued (Sea J09], Co. CJ
jLenders Name
`
� Lendeh Address
J I certify that I ltsve read Ws application and sou deal the above lot ..do. is
correct. l agree ro comply with all city and county ominemes and state laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
aboveicajudmed property.rt for inspection
y (We) agree to arc, indemnify and kmp harmless the City of Cupertino against
q liabilities.judgments. whichpurposes.
and ea penscermit. may in anyway accrue against aid City
////\�d�
intoe" mote ciranti of Nis permit.
S.
' APPLI ANT NDERST DS AND WILL COMPLY WITH ALL NON -POINT
1 L
Issued by: Dale Q
SOUR E R CATION
V " ^C/
Re -roofs
Type of Roof
morefAP VCtuntractor Dau
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant sore or handle haaardpns material
az defstud by the Cupenin s Municipal Code. Chapter 9.11. and dee Health and Safety
code. Scmlen 35532(,)7
Oyes ON.
All roofs shall be inspected prior to any roofing material being installed.
10 will
If a roof is installed without first obtaining an inspection, I agree to remove
the applicant m future building occupant ua equipment or devices which
emit hvardnns air comaminanu As defimd by dee Bay Am Air Quality Management
all new materials for inspection.
District?
❑Yes 0 N
1 have read the hna dous materials require== under Chapter 6.95 tufne Caliror.
nix FkaiN&S tyCade,SmvarunM5.M33a 25534.IwWcrsundnuifde WiWng
ve a moa Net it is my rc pomibilitY m notify the ottupant of dee
im mustW tpdmru issSignature
AlMoo-106--scm
of Applicant Date
All roof coverings to be Class "B" or better
om 1 of 2
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31620083.00
DATE ISSUED.......: 08/30/2006
RECEIPT #......... 35826
REFERENCE ID # ...: 06080243
SITE ADDRESS .....: 19805 STEVENS CREEK BLVD
SUBDIVISION ......
CITY .............: CUPERTINO
IMPACT AREA ......
OWNER ............: CHUCK E CHEESE
ADDRESS ..........: 19805 STEVENS CREEK BLVD
CITY/STATE/ZIP ...: CUPERTINO,
RECEIVED FROM ....: LARRY EASTMAN
CONTRACTOR .......: JOE ELMER LIC # 27689
COMPANY ..........: PARKWAY CONSTRUCTION &
ADDRESS 1000 CIVIC CIRCLE
CITY/STATE/ZIP ...: LEWISVILLE, TX 75067
TELEPHONE ........: (972)221-1979
•FEE ID UNIT QUANTITY . AMOUNT
-------------------------------------------
BTEMP FLAT RATE 1.00 62.10
EPERMI:TFEE FLAT RATE 1.00 38.37
TOTAL PERMIT : 100.47
VOICE ID DESCRIPTION
103 UFER
•
OPERATOR: amyw
COPY # : 5
PD -TO -DT THIS REC NEW BAL
------------------------------
0.00 62.10 0.00
0.00 38.37 0.00
---------- ---------- ----------
0.00 100.47 0.00
VOICE ID DESCRIPTION
304 ROUGH ELECTRICAL
C(
CITY OF
OFUPERTINO
CITY OF CUPERTINO
TEMP POWER
PERMIT APPLICATION FORM
wm3
APN# 311.0-20 ^8s
EPERMITFEE
Date:
Building Address:
Cr--e-4-
BUSLIC
0 )t e v ,,.eS
ieOwner's
BUILDING
Owner'sName: C
!
Phone #:
Contrac r: Phone:
License #:
w ",51, 97 1-1979
Con ll.aac�c1�: Phone:
&0, 4
Cupertino Business License #:
n c.w - 4 3 8— FS39
0
Building Pe it Info: G
GN G/y{_-�ar or Tin��Q�y
o Na
tow rto 6L :
Elect LY
Job Description:
Residential ❑ Commercial Q
Cost of Project: �.
•
Qty. if
Applicable Fee ID
Fee Descrintion
Fee Groun
BTEMP Temporary Power ELECTRICAL
EPERMITFEE
Elect. Permit Issuance
ELECTRICAL
BUSLIC
Business License
BUILDING
•