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CITY OF CUPERTINO
Rt�CTO',! NIATTaX+%:,
BUILDING DIVISION PERMIT�DNTR
BUILDING ADDRESS:
PERMIT NO.03120084 3120084
OWNER'S NAME:
PERMIT ISSUE DATE
PANri�
2
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SANRARY NO. CONTROL N0.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDGELECf PLUMB MECH
l� o O O
LICENSED CONTRACTOR'S DECLARATION
lob Description
P
I hereby Alfred that 1 am licensed under previsions of Chapter 9 (commencing
with Smile. 70W) a'Divkiem Sof the B same sand Professions Codc.amd my [team. is
nm[Ifred Aeif L7
License CBii
TI --PANDA RESTAURANT
Dam Con rCONTRACTOR:
CUTTING EDGE CONSTRUCTION
ARCHITECPSD C TI f rK
I u�nd m M d public re.
Licensed Pnsfessiena
OWNER-BUI RDECLARATION
1 hcrchy affirm Nal I am axe pt from dee Convenor's License Law for the
following motion. (Section 7031.5, Business and Pmfessime Code: Any city nr county
which requires a permit to convect altar, improve, demolish, or repair any structure
priorm its ksmnce,etre regmres titeapplicantforsuch Norther rile asignedtdetemenl
Sq. Ft. Floor Area
Val
that he is licensed pursuansmthe provisiodinf Ne Contactors License Law(Chader9
gtj96000
(commencing wish SectiW 7000) of Diviikm 3 of Ne Business and Professions Code) or
that he is exempt Ncsefrom and WA basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit Subjects the appBcanl do a civil penalty of
nod mom than Ew hundred dollars ($500k
35907005,00
C] 1, as owner of the property, or my employcm with wages As their sok compensation,
Required Inspections
will do ands: nmmwreisnot intendedorLaw ed th. Business
slum IsContramor'si
Prthework,
he
Lkease Law dam not apply man owner of
and Professions Code: The does not
property who builds ter improws thereon, and who drcs such work himself or through hts
own employees, provided that such improvements are not Intended oroBemd foraale IL
however, the building or improvement is mid within one year of comp[edon, the owner-
/
builder will have the burden of proving that he did not build or improve for purpose of
tele.).
❑ I,constro owner of the property, wmsmtins with licensed cmnuKmrs m
,A. B sines and Professions LIQ
and Py,
it pmjeetpplyto
O�
sdoescon.
who e9 Nd
am apply de an Owner of properry, who
mice a an owner
IJW
land
sed p ra to Conuon,
whoocontracts for ouch projecde with a canlmClAr(s) licensed pumuam m the Contnetoh
who f
Lace
License1. Law.
❑ I em exempt under gee. . B & P C for this on
'
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby Arrest under penalty of perjury one of the following declarations:
1 haw and will maintain a Certificate of Consent w self -insure for WorkerSCompcn-
sation, m provided for by Section 3700 of the Labor Code. for the performance of the
'
work for which this permit is issued.
❑ f how and will maintain Worked Compensation Insurance, as required by Section
370ri Labor Code, for the performance of the work for which this permit is issued.
My Worker's ospemtion lnsumnce grain and Policy numbers
—
F^rrjer. �L EXEMPTION FROMWORKERS'
�/ CERTIFIC
OMPESATIONIFROM
COMPENSATION INSURANCE
(ThB section need not hecemplemd if the permit isforonc hundhAdollses (SIM)
or less.)
I testify that in the performance of the work for which this permit is !wood. I shall not
employ any permit in any manner an az At become subject to the Workcrs' Compensation
Ls" of CdRooda. Data
Applicant.
NOTICE TO APPLICANT: If, AIR, making Nis Certificate of Eaemplion, you should
become subject in the Worker's Compensation provisions of me Labor Code. you most
forthwith comply with such provisions or this permit shall be dccmed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby ear. that them k A memocdinn lending agency for the arfurmane. of
rite work for which this permit is issued (Sec. 3097, Ci, Cd
Lendc's Name
Lender's Addlous
I certify that 1 haw mad this application and sate mu the above information is
'
correct 1 agree to comply with all city and county ordinances and suite laws m[ading to
building construction, and hereby authorisse mpresentativa of this city in enter upon the
above-mentioned property for Inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, casts and expenses which may in anyway seem against mid City
in consequence of the granting of this permit.
/
APPLIC UNDE TA AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURC
Re -roofs
Type of Roof
rcA(Ap Iicaa car a
H DOUS MATERIALS DISCLOSURE
H
Willy lowni building occupant handle ua
Andmaterial
Chaptnareor
Health
az dcOncd by the Cup no Municipal Code. Chapter 9.12, and the Health and Safety
the
otic, Section 355324)?
All roofs shall be inspected prior to any roofing material being installed.
0Ycs
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant w future building occupant use equipment or devices which
tit hazardous air contaminants As defined by the Bay Area Air Quality Management
all new materials for inspection.
!mitt? p _
❑Yes �Nu
Tmamriab
I have mail the hiseent requirements under Chapter 6.95 of the Califory
^iceHealth&Safety Colo,S"dons25505,35533md75534.1undc..dmuifthc building
does not currently an A ren Liston my rcepooslNrily m notify tie occupant of me
require. sew' PH.,onmummer aCcABcawof eep
Signature of Applicant Date
All roof coverings to be Class "B" or better
brauthori.edeg
O r Dam