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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
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CNiw"!�>i1�11141tk�.lAcT0PERMIT
aullpl]xG1AJ�p3RPsN WOLFE RD #2074
PARKWAY CONSTRUCTION &
NO.
08030186
OWNER'S NAME--
PERMIT ISSUE DATE
BENIHANA INC
1000 CIVIC CIR
06/18/2008
PHONE:
SANITARY NO. CONTROL NO.
(972)221-1979
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
-BLDG ELECT PLUMB - MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
P
with S�hereby affirm that I am licensed under provisions of Chapter 9 (commencing
tion700t1)of Division 3ofthe Business and Professions Code, and my licen¢is
REVISION TO TITLE 24 PLANS/SPECS;ORIG #07110050-
in full force and effect
Lie. s
NO
License Class
Date ARCHITECTContractor DECLARATION
NEW PERMIT.
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve- demolish. or repair any auueturu
prior to its issuance, also requires the applicant for such permit to file a signed statement
Contractors License Law 9
- --
Sq. Ft. Floor Area Valuation
that be is licensed pursuant t� provisionsofthe (gapta
7 Division 3 Business Professions Code
$10 0
(commencing with Section of of the and or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil pemlty of
7�,
316 2 010 0 y NgiTker Occupancy Type
not more than five hundred dollars (SS(l0).
.`�,L"l.t
❑ I. as owner of the property. or my employers with wages as their sole compensation.
will do the work, and the structure is not intended or offered for sale (Sec 7044, Business
Required Inspections
sod Professions Code_ The Contractors Liwue Law does not apply to an Dana of
_
property who builds or improves ti eeon, and who does such work himself orthrough bis
own employees. provided that such improvements are not intended or 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 be did not build or improve for purpose of
sale_).
as owner of the property, am exclusively contracting with licensed contractors to
a the jm (Sec. 7044, Business and Professions Codes) The Contractor's Li-
cense Law not apply to an owns of property who builds or improves thereon, and
who con r such projects with a ntractor(s) acertsed putto the Contractors
License W.
❑ lam in B&PCf this
Owner Date
WOR COMP SATTON DECLARATION
I hereby afrtrm um ty of perjury one of the following deciara low..
❑ I hs.e and will maintain a Cartificate of Consent to self -insure for Worlices Compen-
sadon, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued. -
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued
-
My Workers Compensation Insurance carrier and Policy number arc
-
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
-
(This section need not be completed ifthe permit is foronc hundred dollars ($100)
or Icsa.)
I cenifv that ih performance of the pork for which this permit is issued I shall not
employ airy• n n y in c s become subject t the or1 ri �mpensatlon
n
Laws of Calif min..
Applicant
NOTICE TO A . If, a 'ficatc of Ex pu , you should
become subject t the Worker's pre n provisions of the L• you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
-
I hereby affirm that there Is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C-)
'
L.cndees Name
Lenders Address
-
I I certify that I have read this application and sate that the above information is
' correct I agree to comply with all city and county oof(nartces and sae laws relating to
building construction, and hereby authorize representatives of this city to enter upon the
above -mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
j Iiabili6 odgments, costs and expenses which may in any way accrue against said City
oftiterranting othisAPPLI UNDER S A LL COMPLY WITH ALL NON -POINT
Issued by: DatSOUR aw-
TION
Re-roofsinco
Signature scam/Con
HAZARDOU MA DISCLOSURE
Type of Roof
WAR the applicant or fuure building occupant store or handle hazardous maieriab
as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Cade, Section 25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes W�w
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or furore building occupant use equipment of devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes o
BN�read tine hazindorrs mates ucmcnls under Chapter 6.95 of the Califor.
nia Hca & afely Code. Scales 25 S3�and 25534.1 tmderstand that if tine building
.
darn n i ntly basicflat t ynsibility m notify the occupant of the
requi err whit must tprio a facertificaicofOccupancy.
Signature of Applicant Date
All roof coverings to be Class 'y�' or better
Owner rd agcn Date
0a030/84
CUPEkTINO
CITY OF CUPERTINO
REVISIONfDEFERRED
PERMIT APPLICATION FORM
a.%r».,/Qr,kl
i
AM #31 , as --
Date: 3 l r
Original Permit
Building Address:
l m a3 N . k)ts&— R,,0 A;?674
Mailing Address (if different from building address):
W-7 !� W\Ja . bvUln, 0
AA, 14 BG 1'7
Owner's Name:
C46
Phone #:
Contractor: C48 C.`VQF
,Phone; Q14A _ 0120, _al 13
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J
"1
Fax: al IQ a1q--ZS01laI
Contractor License #:
Cupertino Business License #:
contact c4e Laaxrr, Qk+""P�
Phone: LAc{- (..obi - 75;8
v h -�-r,�c.rs
Fax. Lel L4 • G VI- -n-7 7
Building Permit Info: P.RM61&) -'b —rm c.. aL4 *-*-,6 `svw� -
Bldg ❑ Elect Plumb El Mech El
Residential Commercial
Job Description: TZ .)j%Slbr\ -}a aL4
Type of Construction (Usage Class):
* Occupancy Type:
IM11FRO 11, 11 i V-1HR 11,111, 1V V-N
Valuation (cost of project):
/00
Project Size: Standard CK Large Major LJ Valuation: ,*