04090275 CITY OF C[7PERTINO " ' ➢:k i` v �e�« z1 , r
BUILDIrvc oIVISION. ' - PERMITS CCI `LR1C.'"�QR �Ik'�? Mt�.T,I
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BUILDING ADDRESS: REEVE .KNIGHT CONSTRUCTION PE"MITNO.04090275
20530 51737RUS CRIER-K 5117T)'
OWNER'S NAME: - - PERMIT ISSUE DATE
PICK UP STIX REaTAURANT 12R ARMT DR
_ SANrTARY O. ONTROL N0. '
916 7 -
ARCHITECDENGINEER: - BUILDING PERMIT INFO -
CH
PLUMB M LICENSED CONTRACTOR'S DECLARATI - job Description
BLDG
uOp
-
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+�a ' 1 hereby affirm that 1 am licensed under provisions of Chapt 9(commencing _ p
n� when Section 70(somf Division 3ofthe Busitessand Professi^ns Coda a dmy]loan=is -, - _.._._., .. ..._-
mfall force and ertea - _ REVISION:-DUCT WRAP
Licen��Im,o, L¢.M' '
4=A�—cnnRammr 404050157
iDelo ARCHITECTS DEC RATION _
Y _- _._- ._._..____-___�__.__ -
1 undcamnJ my plana shell M mea as public records
Dku
Licensed pnNcssional
S OWNER-BUILDER DECLARATION
1 herehy affirm that I am exempt form the Canlrachr's Licen=law for the
EVo O following meson.(Section 7031.5,Business and Professions Cade:Any city or county - t
S which requires a permit to constfa:t,aller,improve,demolish.Or repair any atmcwre '-
at�j. Prof.,to its issuance.also requims the applicant for such permit o Ne a signed statement
s< that he is licensed pursuant the provisions of enc Comrutori Liecn=Law(Chapter 9 Sq.Ft.Floor Area Valuation$35
as (commencing with Section 70310)of Division 3 of the Business and Profnssinm Code)or
Nat he is eaampt therefrom and the Isola for the alleged exemption.Any violation of
Section 7031.5 by say applicant farapermll..1,0taline applicant toacivilPenalty of - APN Number Occupancy Type
Out mom than five hundred dollars(1500).
❑L as owner of the property,or my employees with wages a their sole compensation, - - 3590801-8 . 00
_
will do the work and the sWctare is not intended or offered for sale(Sm.7044,Business
and Profesaions Code:The Contmcmrs License Law does not apply to an Owner of - Required Inspections
pro,sa tywha builds.rimproves thereon,and who doessuch work himse f orthrough his
own employees,provided thatsuch improvements arc mminianded aroQercd forsale.If,
however,the building or improvement is sold within one year of mmpleti.n,the owner- C
builder will have Ne burden of proving met he did not build or improve for purpose or
sale.).
❑1,as owner of the pmpas y,am exclusively convecting with lin meed convectors to
construct the project(Sec.7044,Business and Profusions Code:)The Contrac'tor's U. ,-
come Law does not apply to an Owner of property who builds or Improves ruwarn,and - -
-
who contracufor such projects with a conuactor(a)licensed pursuant m me Conuactme, - _
Lken=Law. ' _. ..._. _ _�L- _.._ _—__-
�Iamenter,tnderSec ,B&PC for this moron
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarallawn
I have and will maintain a CeNOeate ofCon=nt 1.=If-insure for Worker's Compen-
,alio.,m provided for by Section 3700 of dte Labor Code,for to performance of the ----- --- '--'- '- - "'- - -
workforwhichthisPermitisissued. -'
❑1 have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code.for me performance of the work for which this permit is issued.
My Worker's Compensation Insurance artier and Policy number am: - - - - -'
Carrier: Policy No.: -
CERTIFICATE OF EXEMPTION FROM WORKERS' '
COMPENSATION INSURANCE _
(This=ctioo nead not becampleted if me permit is for one hundred d.1her(SHal
or less.) - --
1 certify that in We performance of the work for which this permit is tssued.I shall not
employ any person in any manner an as to become subject o the Worlmos Compensation
Lawe of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this CcniOeam of Exemption,you should
become subject to the Worker's Compensation previsions of the Ichor Code,you must
Q O forthwith comply with such provisions or this permit shall M dcemed revnkcd.
Z CONSTRUCTION LENDING AGENCY
F+ I hereby aRrtn that mere to a construction lending agency for the performance of
Ix> the work ser which this permit is issued(Sec.3097,Civ.C.) - - - - - - -
W�Q Lamim's Name
r'7 z tender's Address
U Q I comfy that 1 base read this application and slow that the above Information is
Ig, (~ mutual.Infirm!to comply with all city and county ordinances and sate laws relating m
QU building construction,and hereby authonre mpresentetivea ormis city to enter upon the
LLl above-mcnihmed property for inspection purposes.
(We)agree to an.indemnify and keep harmless the City of Cupertino against
h liabilities,judgments,costs and expenses which may in any way acerae against sold City -
U 7 in consequence of the granting of this permit -
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT _ Issued by: Date,
SOURCE REGULATIONS. _
Re-roofs
Signawrca rcr Data
HAZARDOUS
MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant norc or hanalc heamaterial
az defined by the Cupertino Municipal Code,Chapter 9.11.and the Health
anand Safety
tale,Section 15531(al+ -All roofs shall be inspected prior to any roofing material eing installed.
❑Yeo - �j1e"�
Will the applicant or future building Occupant use equipment or devices which "If a roof is installed without first obtaining an inspection,I agree to remove -
it hmardous air contaminants as dmacd by the Bay Arca Air Quality Management all new materials for inspection.
DistrimR
❑Yes
I have mad the havardous materials requirements under Chapter 6.95 of the Califon pppp
dies Guth&Safetyhe..Sncuonshra iii my res nothila.10notif t emiflonotpon, Itng
Joos trot currently have Code,venom Nat 0 is 55 3 and255 i ty un notify me occupant of ma
tequtrements which must he at prior toitsuanc�egof CC ruftcato oraapeony. Signa a Date
'� — �" R��w All roof coverings to be Class"B" or better
Owner Orthomcda I Dat