08010090 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ., C CSIRACUTOR, INF"Mu3 „ Q
BUIIDING�+gDgESS: PERMITNO.
1011..1 N WOLFE RD #2074 PARKWAYu CONSTRUCTION & 08010090
OWNER'S NAME: PERMIT ISSUE DATE
BENIHANA INC 1000 CIVIC CIR 01/15/2008
IFNE: SANITARY NO. CONTROL NO.
(972) 221-1979
ARCHnECTfENGINEER: BUILDING PERMIT INFO
BLDG EIF.Cf PLUMB MECH
u00 LICENSED CONTRACTOR'S DECLARATION Job Description
4,Js F I hereby efRrm Nn 1 em Ikeneed under provisions of CNmm
P c,9(cocIn<mg p
`j withSandon]0(IIBofDivision3ofMeButinevudProfetsiomcode,Ammylicensei- RMDL EXSTNG FULL SVC RESTRNT ON 2ND FLR OF MALL
n s in full forte eM effect.
�'� LkenseClua _ Lle.P //3 SPACE-NO CH
G OF USE
Dem — /
Con men
ARCHITECI•SDECLARATION
I undmusnd my plans shall he used an public record,
5 �a Licensed Pmfcuionel
3 OWNER-BUILDER.,I.. m.p,ri DECLARATION
a 9 I hereby e(Dm.. 11. .Bader from tau Canuacuh e:Any
4w for the
p e following moon.(Salon BI31.5.Business and ver.de oos Code:Any rity err roomy
Ile which mqutm,•permit re cnrevucL ppli impmw,demolish.i fi repair any structure
_Z� PuormiutgiusucgWin,
ant in me ukasions of for sock icure'micento Ladaammot
< that(commiscm wishSeauaottodepfDiviouofNeConuxmr'aTlu.selaw(Chepter9 Sq.Ft.Floor Area Valuation
ret€S thin he
(commencing wise Smioam,and Me basis f r of the egad excru d Prafeu vi Code)of $64000
Q .- Nu he k 31.5 b Any applicant
and in burr for the alleged pplimam.n Any l genion of
Salon 7031.5 1 by airy appllcam I,(a pump rvbjecu the appRcurt m a civil faculty of �,t�t}�t umber Occupancy Type
not more Neo M1w hundred dollen($SW). 31620037 ;7y�-
❑I,u owner of die luopvdy,wmy wplaywwW mgnsgi rev role eampensauon.
wWdotheworkandmas u umum,Inkndedwonuadfmselc(Ser.TON,BLWbos
Add Professions Code Tim CunuepoYs License Law loo at apply in an oanw of Required Inspections
property who builds ar improve thermn,md wh,doestuchwoskhimself or Ilu atth his
Am employes,provided that such Improveme a tie not imerNrL waffued fwsale If,
however,me building,orimprovemrm le sold within Arc lea acsmpledon,me away
builds will haw the hounded of proving that k did at build in improve for purpose of
sale.).
❑1.u amer of um Property am exclusively conuessint with licensed unuactws As
consdmCt ma pmjca(SAO.7044,Bo ldeo.and ProfeWons Cade:)The Conuacmrs U.
sue law docs no,Apply m in owner of property who builds or Improves thereon,and,
who dammer,for such projects with A ronuecto,m)licensed pursuant in the Condamine.
Licuum Law.
❑I oro exar p,under See ,B 6:P C for this moon
Owns Dam
WORKER'S COMPENSATION DECLARATION
I hareby aRirm under Pcnslty of perjury one of the following declarations:
ham and will mandido aCeNOcauaf Consenuo self-brsurt fwworkee,Compen-
on,An provided for by Sada.37W of um Labor Code.Ter Ne perf"rmund of um
work for which this Permit is issued.
W I have and will maintain Worker,Compeumlon Insurance,As required by Section
370Dof dm labor Candid.fee the performance of the work for which Nis permit is issued.
My Wmkn/s ComPenudnn Touranm carrier aap�pp PPyyy�ry� number am:
canerdaAeQH.eu✓ lMtnaay I..;a5,6ofsz9?,o
C iOCA�PTION FROM WORKERS
COMPENSATION INSURANCE
(T hissada wed wd be cam Plesed i f Ne permit k for one h un0ed doihn($100)
.r lest)
I certify that in the perfwmanu of the work for which min permit is Wood.I mill no,
employ any person In my mmarm As m tr we subjat in the Wwken CompensWan
Laws of Callfomla.Dau
Applka",
NOTICE TO APPLICANT:If.After making this Ceninum of Exemption,you should
become subject At me Workeh Compensation provision,of the labor Cade.you muss --.
O foMwtm comply with such Provisions w sok PemluMro
ll W Mumaud oked.
CONSTRUCTION LENDING AGENCY
.Ni Ihereby affirm me,mem is a cnnsuicunn lendingepmry for the Performance or
a me work for which this permit Is issued(Sec.3097,Cl,C.)
QLenders Name
]z Lenders Addregi
()Q I certify met I have Acted this mpikass.and,tau the the above information Is '
{S.^ corms 1 apa u comply with 41 city and county on inmces and sum laws rthdng in
.� Wildingconstrction,and hereby authorire rtprtsmutiw of this city in naso,upon the
[37 .lave-ommiumW Profanity for InsPeNan Pu,poset
G (Wer)agree to give.indemnify and kap humless the City of Cupertino golds
y uabilido,judgmenu,cusu and expenses which may in my my amu.agalut said Ctry
V Z incontequeutofthegmedngofthis permit. t
'--' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE E CATIONS.
L� -- -/'"0& Re-roofs
Signuwe err Applian anuanor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant in forum building=Put awe in handle hemdou material
As,deM1ad by me Cupertino Municipal Code.Chapter 9.13.and tht Hexlth And Safety
Code.Seeua"xs513t')' VVVV3_v((((s''''' All roofs shall be inspected prior to any roofing material being installed.
❑Ys yrve
Wi11 the applicant or rlumm building ottvpnt use equipment w dcvico which If a roof is installed without first obtaining an inspection,.l agree to remove
I bexudnu Alr unumi u dcrtad by the Bay Amo Air Quality Mmagemem all new materials for inspection.
ti
OYcs Nu
I haw mal the bmardas material$requirements under Chapmr6.95 of me Califor-
-ia Healdi SarelyCcdd.$Ixbe,35505,35533 am135534.1 uMcmmd Mai Wilding
docs not cummly have•tort.mu It ie my mvponsibi ity 0 notify the mupent of the
MV7h moa be met prior m luuao of a CcrtiRcem of Occupancy. Signature of Applicant Date
�— 1-15-- G r All roof coverings to be Class "B”or better
Owner err mthomnd aicm Dam