08050113 CITY OF CUPERTINO hY4t�pgx�x7ate5#�'+aS` °" � 'lip�,�`" ly `
BUILDING DIVISION PERMIT � .1At'!•CTl:7 A�I O4�LY� II '
PBRthan'NO.
"'L T.a3QD['h WOLFE RD #FC5 TBD — TO BE DETERMINED 08050113
'NE1R'S NAME: N PERMIT ISSUE DATE
SUNNY GHAT 08/12/2008
PHONE SANITARY NO, CONTROL NO.
ARCHrfECf/ENGINEER: BUILDING PERMIT INFO
BLDG EI.ER PLUMB MECH
woo LICENSED CONTRACTOR'S DECLARATION Job Description
myF I hereby affirm that 1 sum ImensN near provisions of Chapter 9(commencing P
nib withScelkn7D0)ofDivWon3ofNaBusinessandProfusionsCode.andmyIt..in T. I FOR POPEYE' S CHICKEN & BURGER KING-SINKS AND
c�EE? ummesenClau�evem Lm.g r � COOKING EQUIPMENT.
ca Mte�l��Contncmr
e ARCHrrECPrS DECLARATION
U I untleraund my plans shall W used u recordspublicrecordspa
Licensed Professional
5 Oat I am UnDER mDECLARATION
c S 1 mem.(Om on 1 1. nampl from the ConmmoYs Code:
License Law for the
p o following reason.(Section 71D I.I,Business and ere.Ourns Cole:Any city or county
$� which mqulrn•pcmil m conswcL alter,impmw,damalbh,fir moxas any amc,um
poo
rmits iasmme,Wumquim lW applicantfor such pemiuo file asigneJ wtemam
sG thathedlkstunce,MalanuothmthreAponsp(thrSucnuumitoicenseLaw(CaaPter9 Sq.F FlFloorArea Valuation
I-$ (commencing with Section 7")or Division 3 of the Business and Profusions Coca)or 5165�00
yes — that he k esampt therefrom and On basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant ma civil penalty of Number Occas
Out mom One five hundred dollars(SIDE. 316 2 010 0 .'�. Occupancy Type
1,u names of the piopnty,ar my employees with wags u their=Is compensation,
will do the waft and the sacrum is not intended Or offered for sale(See.7014,Budom
and Podes ioru de CaTim Communes Liars¢Law clan own
ser apply to an owr of Required Inspections
NopertywM Wilda urimprow thereon,and wW doessuch wort himmif or through his
Dora ernplaym,proadN this such imprownwW art nm inataN moBuW fm tela If.
however,Nc Wilding or Impmwmml 4 hath a did oro yeas of m axon for the awrcs-
W ildm NO haw IM burden of prating that W tlitl not ddb a impnaw(a purpose of
tele.).
❑1.u Dorms a the propary,am excluunly cnnuuriq with limned mnaurors to
ennstmm On project(Sec.7014.Buslnm and Pmmssiam Coda:)la<Cenauwea U.
eche Law deco not apply to an ownm of property who bolds or improves Nems.and
who communist for such projects with aconuuwr(s)licensed pursuant m Ne Conmemr's
Lice=Law.
❑Iweaemptuntln See ,BAPCfor OO;.m
sur Dam
WORKER'S COMPENSATION DECLARATION
I hereby alliin under penally of perjury mm of the fallowing daWatiotte
❑thaw and will marry •tion3am of flanentrsade,far far Workr'a the session,r provided far mi Section 37D of the labor Code,fm On peAonnwn of Ne
wort for which Nd permit is Wised.
❑I haw and will maintain Workees Compensation Interstate,u acquired by Section
37D of the labs Code,for the Wnfawance of lha work for which this panni,is luuod, '
My Warkels Com en tion Imummen artier aM Policy number are:
Carver: M Policy N.:
CERTFICATE OF 114EMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITh seem need not W completed if the permit bfaranchundmel tlWlan($10(r)
or mu)
I certify that in to performance of tha work for which this Permit is issued.l shat ant
employ anyperson in my mawer ,as in become subject N On Works Compensation
Laws of California.Data
Applimnt
NOTICE TO APPLICANT:If.after reW ng this Certificate of Enernptien.you should
become subjm in Ne Worker's Compensadun ptovitiau of IW Labor Coda,you masa
.,z forthwith comply with such provisions or thin permit shall the decmd revoked.
z^ CONSTRUCTION LENDING ACENCY
[-a.�. I hereby sabot that Nem is a eontauetirm lending.pney fm the performance of
FL tha wok fm which mus permit Is issued(Sec.3097,CN.C.) '
ALattices Name .
= z Leader's Adelman
V C 1 certify Nat 1 haw rad Ws application and sum that IW aWw information is
!L!'. conecL E agrte m complY with a all city and county melanomand slam I."muting N
`SJ^
bottom, and hereby summin representativesof this city N enter upon Ne
yy W aWw-mcndooed property far lmpecthon purposes.
(We)agree m Lw.indemnify and keep harmless the City of Cnparuno against
Rabiliiin,judgmenu.costs to expcnm which may in my my erne against saidCity
V 7 In consequence of No gnming of this manall.
•7 APPLICANT UNDERSTAND AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RECULAvosis./1` � e
S_
/� Re-roofs
Signature of ApplinHAZA DO Dam /
HAZARDOUS MATERIALS DISCLOSURE Type of Roof !/_J�/
Will tihe applicant Cupertino
Duni Wilding e.Chaptumamr handle Health mmatesisi
as defined Section
the Cupeeno Municipal Coda.Chapter 9.13,and the HasiN and Safety
say"zss33(.)a All roofs shall be inspected prior to any roofing material being installed.
❑Yen �No
Will the applicant or future Wilding axupant can equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hvarMus air contaminants a defimd by the Bay AuaAir Quality Managemem all new materials for inspection.
District?
❑Yes ,$rte
I have read the harardmas maerlW mquimm,nU under ChmW 6.95 of the Caiifm.
nu Heal"Safety Code.Se mu 35505,755331 W 25534,1 vrmermrm da tribe Wilding
dm not cunendy have•uaant Nu it k my responsibility N mthly Jr'accustom of Ne
require ykn Wmlprarmeuaamaf,CMP Signature of Applicant Date
Owner a aumadsd agent tJ �fJDaa All roof coverings to be Class'W'or better