Loading...
04070166 CITY OF CUPERTINO ""'n '�+€� ��y° ' ' y �.,� �y BUILDING DIVISION PEF2vM a'Q '-©1lA d1t1YW1W : BUILDING ADDRESS: PERMIT Nb 4 0 7 016 6 '120060 ST OWNER'S NAME: PERMIT ISSUE DATE CHILI ' S RESTRAUNT 11-7 4 ONE: SANITARY N0. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT l� PLUMB MECH O 0 Las LICENSED CONDUCTOR'S DECLARATION IOhDesGn Description I hereby affirm Nu 1 un licensed u provision ofChap=9(cammanc ng p a WSmd n7 ).f Divinon 3 of the Bu and Professions Cod.and my license is " _ 1.f 11fCr I Lkg 22$374 REPLACE SANITARY SEWER (SECTION) g Dam -Gan CONTRACTOR: CIARI PLUMBING ;q Z CHRECI'SD ON u,19 fun dory phuelWl Ec uuAUW kreeords 3 a Licensed Pn(,sai0nl gm OWNER-BUILDERcumptDE Ce Contractors ont(ON 1 Mmby e(tlr on 11. sumps,s ad the Contrm Ch LIcense Low for the O o following moon. emit 1 FD 1.5,Bonircss and Raf.Woes Cad,:Any city .county $ which requires a p.mrl t0 cares the Who.Wpmw,deermitt file ea sig any atrnture Pd.miu imandpurlmat Wham the applicant for such permit to Law ned< lhubeis.awii Sued..tothoprovivioes of theeBand r rod Pnsessio C Code)or Sq.Ft.Floor Area Valuatigo15O0 (conG that he 4 feltwithSr<firma 00)of basis f r the No Band. r. vi latde)or $ Section 7030 by any apppliant fand or a permithjem ft applies t he a civil penalty of APN Number Occupancy Type not mom dun five hundred dollars($500). 36903003 . 00 ❑I,u.wneroftbepmpeny.mmyrmploywwiNmrAudodrmlecwpenudon, will do t1m mk,andthestrumure Isruntended oroffered forsale(Sec.7044.Business Required Inspections and PmfeWmude:CaThe Contractors License law does not apply to an owner or q p property who s,proviimpmwach Imp(andImprovements donnmh work himself orOwugh his howempieyrae,pmvf or Ithatanch esti memmuinnot fear ded ofomoRered fm W.Ir. however.car building n er,ofp ,i.g mid within e, veer of cemove form.the owner. Wilder MB bawds WNan of gcNng the be did nor build or Improve for purpose of / nest.). ❑ 1,as owner of de propmy,am exclusively commaing with licensed cw==to � /aV construct the project(See.7044.Business and professions,Cade:)Man Contractors U- cense Law does not apply to an Owner of property who Wilder improves dammed.and, who contracts forsmh pmjem with.emuan.I,)hearted personal t.the Cr(rml.rn , License Law. ❑l me exempt under See ,B k P C for this wan OwnerDau ATI WORKER'S COMPENSON DECLARATION I hereby affirm under penalty of perjury aro df the fallowing declmadmce IhawandwBlmainuin,Ce an of Co ntioulr-Inumfor Wmk sCompm. - ution.u provided for by Sued..3700 Of de Laber Code,far dm panic...of the work for which this peril Is Issued. ❑1 ban and will maintain Waster's Compensation Insurer¢,as mquimd by Senior 370D.f the LeberCode,for the perf.rara.f de work fmwhich Nis permit is leaned. My WWorker Compe=ad latuan¢artier and Polley number am: G.�r: Policy No Iia�'Zi II CER77FlG •OF E)LT ON FROM WO COM PENSA INSURANCE (This section need rot becompleted if the pemlt is farane hundmddollan(SIM) arm I.SL) 1 certify that in the peri"Ame of the work for which this perp Is issmd,I shall not employ my person in my manner an u m become subject to the Waders'Compensadon Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Geincau of Exemption,you should became=him to the Workers Compensation provision of de labor Cadt you mom .J Q faMwith comply with such Provision or Nu permit shell be drmul rewked. Z CM CONSTRUCTION LENDING AGENCY Fr Thereby amm that them is a mnoucarm lending agency for doped.....f lYi the duh fm which 1Ns peril 4 iatimd(Sec.3097.CIv.C.) v W�Q Lesion Nun, 7 Z landereAadw U O I crdf,that 1 haw hand this application and such that de show infomedon is 1, comes I agree to comply with all city and county collators,and soon laws mlong to 0 Wilding conswcdom.and hereby adadm repmseamuni of this city to enter upm de Wabove-marnhuh l property for inspection purposes. I , (W,)ego.to damnify and kcep hamlets the City of Cupertino agaiest ,�A Ilabilidc%jmi .caw expewawhichmayinany dayw=.gimisaid Oly U^ 'Aat P ICA RSTAN S AND WILL COMPLY WI L NON-POINT d. Issued by: Dat RC EG NS. Re-roofs Sig numc HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will tit applicant a future building me oWnt atom arhandic hazardous material _ u de@vol by to Cupertino Municipal Cade,CWper 9.17,and the Health and Safety Cork,Suueed..75537y. (0] N. All roofs shall be inspected prior to any roofing material being installed. Will the applicant or r Wading occap..t am equipment or dean wnimh If a roof is installed without first obtaining an inspection,I agree to remove colt hazudoes air eenuminanu u dented by the Bay Area Air Quality Management all new materials for inspection. Distrito? vy,(;. ❑Yea a mau mismqumnamus underCldpm6.95.ftbe CAIRO. nmy Code. 'w 8505,25533 aM 25534.l unicumad dnifde Wilding set Y h.w a amt dot it u my ren anoihility notify set of ase n has meopdartoieeaancearaCeanc. Of a Signature of Applicant Date gent Dam All roof coverings to be Class"B"or better Community Development. 10300 Torre Avenue Cupertino CA 95014 l Telephone(408)777-3228 &C, Fax(408)777-3333 �UPERTINO Building Department JOB ADDRESS: PERMIT# -2-0065;0 F- JD OWNER'S NAME: % t_ i PHONE # /p GENERAL CONTRACTOR: FAX# _Z I am not using any subcontractors: --Y-j Signature Date Please check applicable subcontractors and complete the following information 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 ile Z 04- wner/Contractor Signature Date • CITY OF CUPERTINO REPIPE/SEWERS/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM � APN# � /;� � /�� S Date:� Buildin Address: Z �oO ST-F-Jet 4S SW o Owner's Nfme: Phone#: ntractor: Phone: License#: � i `t�L✓mh; £�—ZqL� tv 32-032/c, Contact: Phone: Cupertino Business License#: STEcti /R-2 OSS -Z -(vo Building Permit Info: Bldg Elect ❑ Plumb Job Description: E SEG17 Residential ❑ Commercial Cost of Project: J• �35�°� ESTiell A-rEp Qty:if XpplicabFee ID Fee Description Fee Group a. PPERMITFEE Plumb-ing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPERMFEE Bldg. Permit Fees BUILDING BPFIXTURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING 1 BPSEWER Sewers PLUMBING BPSEWAGE Sewage Dis osal. PLUMBING BUSLIC Business License BUILDING �3 �Y67. i