02050186Id
{
CC c
t
CITY OF CUPERTINO -' "' '
BUILDING DIVISION PE - CONTRACTOR INFO R MW ONi
BUILDING ADDRESS: PERMIT NO.
10123 N WOLFE RD OMEGA CONSTRUCTION 02050186
OWNER'S NAME: APPLICATION SUB DATE
BENIHANA TOKYO SUITE 246 05/30/2002
PHONE: SANITARY NO. CONTROL NO.
(408)243-0404
Z ARCHITECTIENGINEER: BUILDING PERMIT INFO
O
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that 1 am licensed and r provisions of Chapter
9 (commencing
j4=Zh�Bm,erebyctfired sandProfessionsCode, (oddromircure CFi 2 HEATPUMPS�mry �p�!�pL' p r 1 r+ o"^i B.v (r-qy /tieINAL.liiL:.�/Commit
n YJ '�w. n n L!'SD a RATIO OCT 2 2002 OCT 2 5 ?.9'�2
1 undersmntl my plans shall be used a chic records
OLicensed Professional
OWNER -BUILDER DECLARATION
m 1 hereby affirm that 1 exempt f theContractor's License Law for the BUILDINGIQ g,
a
following (Section 703 1 S Business d Professions Code Any city arc ubly' 6yy2 YY
D wh h q permit t contract, Ir p demolish, or repair any stra t r< '0 0 0
1....P tot B 9 thet' hp mit m file a signed thaement-
- that be slice s,dpurs ant to thep lsi s of the Contractors License (ChapterLaw9 "r ❑ O+q]QD /��'E$ V' ' Valuation
(c mmepungg w th Sect on 9000) 'f Division 3 o[the Business and QrofGssion Code)
��;lsb'2��V",3ISYL`ki�,i
or that burns exempt therefrom and the basis fnr me alleged a%emplioa. Any solation
of Section 703 1-.5 by any applicant for a permit subjects the applicant m a civil penalty n�'m1,� OccupancyType
.Of not. more man Ilse hundred dollars ($50)(1) 10 1"-N V15VNbAT ION :,'.,..."..
° I, as owner of me property, or my employees with wages as their sole compensation,
- w ll do the OR: add the structure is nor intended or'offered for sale (Sec. 704q-' -
1-02 PiERS
'Business and Professions Cole The Convactor's License Law does not apply to an 103 - UFER Required Inspections
owner of property Who builds or improvesthereon, and whod h work himself
or through h. employees provded that such improvements t tndd__._._._-......_104___-.._REBAR. ___..____ ...... _.___... ....
-':Offered fol sale If however the budding o proi ' Id thin one year of 10 5 - ANCHOR BOLTS `' "' '' `'
completion, the owner bo Ider will have the burden of proving that he did not build or f
improve for purpose of sale.'.
-- - -WATER,.-
Of. _ - ...
as wne -fthe proprty exclusively m t g thl' edcatantrs1
eons-met he pmI«r (See 70", Basins and Professions Cods:) The CaOtmetor s 2 0 2 UNDERFLOOR PLUMBING
- LccwhLwdoesnot-stich an ownwthacertywho buddsormpursuatto.th 203 - UNDERFLOOR MECHANICAL `
convecmr(s) imanxd t to the-
:. .an w o convects o c projects w t pursuant
DTwid s"Ou erns` a 204 _ -UNDERFLOOR-,FRAME-----
DT
.._
❑1 pt -Dile S '; "' B&PCf-r this icnsan i" U
205 - UNDERFLOOR"INSUliATION
° °t 301 - ROUGH PLUMBING
WORKERS COMPENSATION DECLARATION
302 - TUB & OR SHOWER
I hereb,rdirnud peoaltyofpe3ryoe of mefollowing eeelarauonc 303 - ROUGH MECHANICAL
-, ° 1 hA a andwill maintain d'Certificme of Consent to self insure for Worker's
Compensation, as, provided for -by Section 3700 of the labor Cade for me 304 - ROUGH ELECTRICAL
performnnce'af mew k In r hien this pe r sailed. 3 0 5 - FRAME
°In eand'wHlma t w kr'sCompensation-immo e, is required by Section 306 - HOLDOWNS
3700'of theLabor Cd f' the ficiorm of the work for which His Permit
issued. M` WCERTI 'CERTIFICATION F n ra c era J Pol cy mbe :_
307 INSULATION
cm � SIley 70- �.:.; 308. f rSHEETROCK, ,,r t i
COMPENSATION GRrceasl �' F'309 3- 'EXTERIOR `LATH
_ ..,31�", 7-2NTERIOR` LATH.
Ill I slfon dot he cnmpl redf theQerm, is for one hundreddllary
so i55E< 1 - SCRATCH COAT
..Com moto'beIf rs nkat Chep f 'c fth kfr'nich the pe_� tai AI -- .—,.3:13.., -.-" ROOF ' -NAIL .: 'y, , ,. :: --...:..- -.. ..._..-
sh II n t mplin any person n any mon as m became q t sb the W roar.+• 501 - F I NAL ELECTRI CAL I ENERGY
pe w, of Cal f m D to
' Appl a t -- - '- --' -- ---502 -'-- "FLNAL—PLUMBI'NG"ENERGY"-
NOTICE TO APPLICA im If, ft' 1.k g th C rl f t f Exemption, yoi hold .
haome inbjecl to the wok rs Corons t pm safm Luber coae,y ma -a 503 - FINAL MECHANICAL ENERGY
irnn.
jfirth m r __ - dnpro visions _.__,his tsIa . deemed .. _,_,_.-, 504--.---FINAL..-BUILDING ENERGY
CONSTRUCTION LENDING AGENCY " 505 - FINAL ELECTRICAL,:; „ '
I h rehy ffrm that the co t ct o i le ding ag y for the performance
q LedesH `incl 506. -..-_..GAS .TEST_......
., of thework fowhichthi p rmt i,'ma d(3 309
L a Ase 507 - FINAL PLUMBING-
' 508 - FINAL MECHANICAL
i 1 certify
"a',
h ,Ih dm application n d state that the oboe f ton is
y c rcct t gee ro.Oo nPly m all city and county ordinances d state laws mining 509 - FINAL GRADE
to 1-111.1 co nruaion andh by uumorz `premiv fm tyro em rupon
Q the b t nedp penyf iispst purposes. 510 - FINAL PLANNING
y (W) g em de ify addkap humbl .v theCty fCpnno against
I b l t 1 dg nut a expenseswhich
may ,nay y against said 514 - FINAL UB C WORKS J
Cry eq ofthegg t gOfth p i
APPLICANT UNDERSTANDS AND I ILL COMPLY W TH ALL NON POINT'"'
is, UR Tee 0 Issued by: Date
ig t Applica VC mine[ -, Ua¢ Re -roofs
,HAZARDOUS MATERIALS DISCLOSURE "
W II th' e t f , b al ¢ e, p t tore 2.h die Health an m 1 ..,..Type of Roof........ ...
am 25532(c)"y r ..' :. -
❑Yes �Na ' d Safety
tis ' 4 'hall be inspected pnor5tq j e ei t 3
' iY r- t �' N' ,r, .r
`..`. Pt n t Health 65 n y t Q rt O IQ Yn
.any roofing material being installed
If a roof is
Alro ss
Willthe airc aaminants as defined
ea g p_ t equipment or Quality Mims mon lustall''ed without first obtaining an inspection'; 4�agreetti'remove
emtha rd 'arc contaminants t as den dby the Bay Area Q'ItyManagemem
District" .._,_all new materials for inspection Applicant understands and will comply with,_._
al] non-point'source regulations
,I h ve rcad the hazallous mann Is requirements' under Chapter 6.95W,the
Caidorro Heath & Safety Code. Sections 25505; 25533 and 25534: 1 understand that
tithebuilding foe not w have arena , that t' my responsibility nohfy the
i nts which t III p rto I .ounce of a Certificate of
oaaP temm r TTA ,my\ 05_ kt/ Signature of_- pplic'11 Date_
P 9
All roof coverings to be Class B" or better
Der ar uthonzcd agent
- ... ....OFFICE . ......... ... _.. _ _..._ — — - _.
g
r Date
CC c
t
CITY OF CUPERTINO -' "' '
BUILDING DIVISION PE - CONTRACTOR INFO R MW ONi
BUILDING ADDRESS: PERMIT NO.
10123 N WOLFE RD OMEGA CONSTRUCTION 02050186
OWNER'S NAME: APPLICATION SUB DATE
BENIHANA TOKYO SUITE 246 05/30/2002
PHONE: SANITARY NO. CONTROL NO.
(408)243-0404
Z ARCHITECTIENGINEER: BUILDING PERMIT INFO
O
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that 1 am licensed and r provisions of Chapter
9 (commencing
j4=Zh�Bm,erebyctfired sandProfessionsCode, (oddromircure CFi 2 HEATPUMPS�mry �p�!�pL' p r 1 r+ o"^i B.v (r-qy /tieINAL.liiL:.�/Commit
n YJ '�w. n n L!'SD a RATIO OCT 2 2002 OCT 2 5 ?.9'�2
1 undersmntl my plans shall be used a chic records
OLicensed Professional
OWNER -BUILDER DECLARATION
m 1 hereby affirm that 1 exempt f theContractor's License Law for the BUILDINGIQ g,
a
following (Section 703 1 S Business d Professions Code Any city arc ubly' 6yy2 YY
D wh h q permit t contract, Ir p demolish, or repair any stra t r< '0 0 0
1....P tot B 9 thet' hp mit m file a signed thaement-
- that be slice s,dpurs ant to thep lsi s of the Contractors License (ChapterLaw9 "r ❑ O+q]QD /��'E$ V' ' Valuation
(c mmepungg w th Sect on 9000) 'f Division 3 o[the Business and QrofGssion Code)
��;lsb'2��V",3ISYL`ki�,i
or that burns exempt therefrom and the basis fnr me alleged a%emplioa. Any solation
of Section 703 1-.5 by any applicant for a permit subjects the applicant m a civil penalty n�'m1,� OccupancyType
.Of not. more man Ilse hundred dollars ($50)(1) 10 1"-N V15VNbAT ION :,'.,..."..
° I, as owner of me property, or my employees with wages as their sole compensation,
- w ll do the OR: add the structure is nor intended or'offered for sale (Sec. 704q-' -
1-02 PiERS
'Business and Professions Cole The Convactor's License Law does not apply to an 103 - UFER Required Inspections
owner of property Who builds or improvesthereon, and whod h work himself
or through h. employees provded that such improvements t tndd__._._._-......_104___-.._REBAR. ___..____ ...... _.___... ....
-':Offered fol sale If however the budding o proi ' Id thin one year of 10 5 - ANCHOR BOLTS `' "' '' `'
completion, the owner bo Ider will have the burden of proving that he did not build or f
improve for purpose of sale.'.
-- - -WATER,.-
Of. _ - ...
as wne -fthe proprty exclusively m t g thl' edcatantrs1
eons-met he pmI«r (See 70", Basins and Professions Cods:) The CaOtmetor s 2 0 2 UNDERFLOOR PLUMBING
- LccwhLwdoesnot-stich an ownwthacertywho buddsormpursuatto.th 203 - UNDERFLOOR MECHANICAL `
convecmr(s) imanxd t to the-
:. .an w o convects o c projects w t pursuant
DTwid s"Ou erns` a 204 _ -UNDERFLOOR-,FRAME-----
DT
.._
❑1 pt -Dile S '; "' B&PCf-r this icnsan i" U
205 - UNDERFLOOR"INSUliATION
° °t 301 - ROUGH PLUMBING
WORKERS COMPENSATION DECLARATION
302 - TUB & OR SHOWER
I hereb,rdirnud peoaltyofpe3ryoe of mefollowing eeelarauonc 303 - ROUGH MECHANICAL
-, ° 1 hA a andwill maintain d'Certificme of Consent to self insure for Worker's
Compensation, as, provided for -by Section 3700 of the labor Cade for me 304 - ROUGH ELECTRICAL
performnnce'af mew k In r hien this pe r sailed. 3 0 5 - FRAME
°In eand'wHlma t w kr'sCompensation-immo e, is required by Section 306 - HOLDOWNS
3700'of theLabor Cd f' the ficiorm of the work for which His Permit
issued. M` WCERTI 'CERTIFICATION F n ra c era J Pol cy mbe :_
307 INSULATION
cm � SIley 70- �.:.; 308. f rSHEETROCK, ,,r t i
COMPENSATION GRrceasl �' F'309 3- 'EXTERIOR `LATH
_ ..,31�", 7-2NTERIOR` LATH.
Ill I slfon dot he cnmpl redf theQerm, is for one hundreddllary
so i55E< 1 - SCRATCH COAT
..Com moto'beIf rs nkat Chep f 'c fth kfr'nich the pe_� tai AI -- .—,.3:13.., -.-" ROOF ' -NAIL .: 'y, , ,. :: --...:..- -.. ..._..-
sh II n t mplin any person n any mon as m became q t sb the W roar.+• 501 - F I NAL ELECTRI CAL I ENERGY
pe w, of Cal f m D to
' Appl a t -- - '- --' -- ---502 -'-- "FLNAL—PLUMBI'NG"ENERGY"-
NOTICE TO APPLICA im If, ft' 1.k g th C rl f t f Exemption, yoi hold .
haome inbjecl to the wok rs Corons t pm safm Luber coae,y ma -a 503 - FINAL MECHANICAL ENERGY
irnn.
jfirth m r __ - dnpro visions _.__,his tsIa . deemed .. _,_,_.-, 504--.---FINAL..-BUILDING ENERGY
CONSTRUCTION LENDING AGENCY " 505 - FINAL ELECTRICAL,:; „ '
I h rehy ffrm that the co t ct o i le ding ag y for the performance
q LedesH `incl 506. -..-_..GAS .TEST_......
., of thework fowhichthi p rmt i,'ma d(3 309
L a Ase 507 - FINAL PLUMBING-
' 508 - FINAL MECHANICAL
i 1 certify
"a',
h ,Ih dm application n d state that the oboe f ton is
y c rcct t gee ro.Oo nPly m all city and county ordinances d state laws mining 509 - FINAL GRADE
to 1-111.1 co nruaion andh by uumorz `premiv fm tyro em rupon
Q the b t nedp penyf iispst purposes. 510 - FINAL PLANNING
y (W) g em de ify addkap humbl .v theCty fCpnno against
I b l t 1 dg nut a expenseswhich
may ,nay y against said 514 - FINAL UB C WORKS J
Cry eq ofthegg t gOfth p i
APPLICANT UNDERSTANDS AND I ILL COMPLY W TH ALL NON POINT'"'
is, UR Tee 0 Issued by: Date
ig t Applica VC mine[ -, Ua¢ Re -roofs
,HAZARDOUS MATERIALS DISCLOSURE "
W II th' e t f , b al ¢ e, p t tore 2.h die Health an m 1 ..,..Type of Roof........ ...
am 25532(c)"y r ..' :. -
❑Yes �Na ' d Safety
tis ' 4 'hall be inspected pnor5tq j e ei t 3
' iY r- t �' N' ,r, .r
`..`. Pt n t Health 65 n y t Q rt O IQ Yn
.any roofing material being installed
If a roof is
Alro ss
Willthe airc aaminants as defined
ea g p_ t equipment or Quality Mims mon lustall''ed without first obtaining an inspection'; 4�agreetti'remove
emtha rd 'arc contaminants t as den dby the Bay Area Q'ItyManagemem
District" .._,_all new materials for inspection Applicant understands and will comply with,_._
al] non-point'source regulations
,I h ve rcad the hazallous mann Is requirements' under Chapter 6.95W,the
Caidorro Heath & Safety Code. Sections 25505; 25533 and 25534: 1 understand that
tithebuilding foe not w have arena , that t' my responsibility nohfy the
i nts which t III p rto I .ounce of a Certificate of
oaaP temm r TTA ,my\ 05_ kt/ Signature of_- pplic'11 Date_
P 9
All roof coverings to be Class B" or better
Der ar uthonzcd agent
- ... ....OFFICE . ......... ... _.. _ _..._ — — - _.
Lit 0 C
FC
V] Q V
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a3 -
CITY OF CUPERTINO
CONTRACTOR aT_F(DR.7UAT#Nio
BUILDINGDMSION PERM[
BUILDING ADDRESS:
PERMIT NO.
10123 N WOLFE RD
OMEGA CONSTRUCTION
02050186
OWNER'S NAME:
APPLICATION SUB DATE
BENIHANA TOKYO
SUITE 246
05/30/2002
PHONE:
SANITARY NO. CONTROL NO.
(408)243-0404
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I rI LLD u
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed and r provisions of Chapter 9 (commencing
with Section 70009 of Div�+913 of the Bus' ss and Professions Code, andjny license
is in full and effect.'1�
REPLACE 2 HEAT PUMP S
Lic nse s .lam Lt . N 0 �iJ
e
ARCHITECT'S D 41RATIOM
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 70315. Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
$20000
poor to its issuance, also requires the applicant for such permit to file a signed statement
-
' � ' "-`3 ' ;
Valuation
that he is, licensed pursuant to the,provjsions of the Contractor's License Law (Chapter 9
(commencing with Sectioh.7000) of Division 3 of the Business and Professions Code)
I , :1S�2FC
��r' : :. �
or that he is exempt therefrom and the basis for the alleged exemption. Any violation
.
of Section 7031.5 by any applicanlk for a permit subjects the applicant to a civil penalty
of not more man five hundred dollars (s500).
101 AIN
l��jr� ��]�`�r�r't}f�j��p7
bAT I ON Occupancy Type
❑ I, as owner of the property, or my employees with wages as their sole compensation,
1' V V LV
will -do the work, and the structure is not intended or offered for sale (Sec. 7044,"
Business and Professions Code: The Contractor's License Law does not apply to an
'
Required Inspections -
owner of property Who builds or improves thereon, and who does such work himself
103 -
UFER
or through his own employees. provided that such improvements are not intended or
104 —
REBAR
offered for'sale. If, however, the building or improvement is sold within one year of
completion, the owner builder will have the burden of proving that he did not build or
105 —
_
ANCHOR BOLTS '
improve for purpose of sale.).
106 -
SEWER & WATER
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
202 -
_
UNDERFLOOR PLUMBING '
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's
License Law does not apply to an owner of property who builds or improves thereon,
203 —
UNDERFLOOR ME CHAN I CAL
and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractors License Law.
2 04 —
UNDERFLOOR FRAME
❑ 1 am exempt under Sec; , B & P C for this reason
205 -
UNDERFLOOR INSULATION
Owner Date
301 —
ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
—
TUB & OR SHOWER
I hereby affimt ander penalty of perjury one of the following declarations:
303 —
ROUGH ME CHAN I CAL
❑ I have and will maintain a Certificate of Consent to self -insure for Worker's
3 04 —
ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
3 05 —
FRAME
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
306 —
HOLDOWNS
3700 of the Labor Code, for the performance of the work for which this permit is
307 —
INSULATION
issued. My Workegy's C pensa1.o lI mmicer and Policy number are:arier: S'� 'Poicfid`
3 0 8 -
,SHEETROCKCERTIFICATIONQFEXEM
o WORKERS
3 09 -
EXTER•IOR LATH
COMPENSATION INSURANCE
310 -
INT$RIOR -LATH
(This section need not be completed if the permit is for one hundred dollars
311
SCRATCH
( S 100) or less.
-
COAT
I certify that in the performance of the work for which this permit is issued, 1
313 -
ROOF NAIL
shall not employ any person in any manner so as to become subject to the Workers
501 —
FINAL ELECTRICAL ENERGY
Compensation Laws of California. Date
Applicant
502 -
FINAL PLUMBING ENERGY
NOTICE TO APPLICANT. If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
503 -
FINAL MECHANICAL ENERGY
forthwith comply with such provisions or this permit shall be deemed revoked.
t
504 -
F I NAL BUILDING ENERGY,
! 'CONSTRUCTION LENDING AGENCY
t
505 -
F I NAL ELECTRICAL
I he affirm that there is a construction lending agency for the performance
t of the work for which this permit is issued (Sec. 3097, Civ. C.)
506 —
GAS TEST
Lenders Name
Lender's Address
507 —
FINAL PLUMBING 1
� I certify that I have read this application and stain that the above information is
508 —
FINAL MECHANICAL
r correct. I agree to comply with all city and county ordinances and state laws relating
509 -
FINAL GRADE
! to building construction. and hereby authorize representatives of this city to enter upon
.�
the above-mentioned property for inspection purposes.
510 -
FINAL PLANNING
t (We) agree to save, indemnify and keep harmless the City of Cupertino against
in
514 -
FI NAL UB C WORKS
1' liabilities, judgments, costs and expenses which may any way accrue against said
City in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND y ILL COMPLY WrrH ALL NON -POINT
Issued b y:
Date
S1�UR Tl>9 C� r 7t , tl
�.j i"
I
ignature ApplicantyContracto� Date
/
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future' building occupant store or handle hazardous material
Type of Roof
- -
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
°Yes Iko
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without fust obtaining an inspection, I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
Districtl,///'''
all new materials
for inspection. Applicant understands and will comply with
Cl Yes I(o
all non -point source regulations.
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that
if the building does not currently have a tenant, that it is my responsibility to notify the
occupant of the requirements whichst be met prior to issuance of a Certificate of
Occupancy.
a5 (
Signature of Applicant Date
All roof coverings t0 be Class `B" or better
agent Date
ner or uthorized
OFFICE