05110108 CITY OF CUPERTINO -% *" ✓' ^ .r'w"k ��="Y +ss
BUILDING DIVISION PERMIT P CONTRAGTQRINTQ,,RMA.T70N _
BUILDING ADDRESS: ALLEN SIGNS INC PERMIT NO.05110108
10935 N WOLFF. RT)
OWNER'S NAME: PERMIT ISSUE DATE
ROYAL TEPPAN STEAK HOUSE 1982 STOUP AVE ll /IR /200c;
E:
SANITARY NO. CONTROL NO.
(408) 280-6500
ARCHITECrPENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+op LICENSED CONTRACTOR'S DECLARATION IbDIIOn
U C 1 hereby affirmOOSCOp
that 1 am licensed under previsions of Chapter 9(commencing
b wiN Section]0(IU)of Divldon3afdrc Businev aM Prafevsium Code.aM my licc„se is
± „ in full rm<evtwerr — R ] SIGN--INDIVID. CHANNEL LETTER
l tg E Liee an d`u1n/'�''-''c''`y'�''�,{�� Lr.;1 v v• RNA fts� /,] �a
it-W DafCommems—
t--CTS DECLARATION fIf'1177�\Y r�f//tA a•,s,_,;.y�"�.
1 undersand my plans sha11 he used ss public reeoNs RWYIR/ Xxt �t`F{F�fA�+`3xf-rd3ga^7f!}Y}4Yy
pyU
C t; Licensed Professional
OWNER-BUILDER DECLARATION JAN 1Z-1 hereby aRres that 1 am exempt from the Contractors Ucanrc law for the1006
p O following reason.(Section 703I.S.Business and Preface..Code:Any city m county rill
S m which acquira permit m constmct alter.improve,darruil h,or repair any suucture ss n .. $2000
prior to its issuance.also requires the applicant for such permit to file a signed moment <-
< dwheislicensedpurnsmL10thpmvisionsOfuseConmetersLieComLaw(Chapter9 Sq.Ft. Floor Area {'I H � Valuation
z�0 (commencing wit Section 70DO)of Division Sof the Business and Prefessiav Code)ar prslf`has
y $
that he is,oxempt tetefrom and me baexemption.basis for due alleged emption.Any violation of s .n
Section 7031.5 by any appltrant for a permit subjects to applicant to a civil penalty of F J U Occupan6y Ty'pa"
not mom than five hundred dollars IS500).
❑1,as awrcj of than paopmry,or my employes wim wages as their sole compewdon,
will do the work,and the somcture is notintendW or offered for sdle(Sea Trial.Bumitcss Required Inspections
and Prefeaiov Code:The Commences License law des ree nst apply to an owner of q p
ptopeny who buildsorimprovameton,and whodaes such worthiest Waugh his
owe employes,provided dist such improvements art not intended oraffasest(orale IL
however,the building or improvement is sold widtinaro year of completed,the Owner,
Wilder will have the Widen of poring that he did not bmld Or improve for Purpose of
ak.I.
❑1,u awner of the propeny,am emIcamly contacting wit licensed anomalous to
construct me project(See 7060.Business and Prefcamota Code:)The Commucear's U.
cove Law dais dot apply to an own of property wine Wilds or improves threon,and
who caramels for such projects with a commoners)licensed pursuant to the Conmacmrs
License law.
❑I am vempt under See ,B k P C for this mason
Owner Dae
WORKERS COMPENSATION DECLARATION
1 hereby Orion under penalty of perjury arc of the following declaration:
hmmdnd will milutain v Cert(tent Cramer to alf--ivurefawarker6Compen-
Mo.es provided fm by Sactian 3700 of dee labor Cade,for to Performance of W
work far which this permit is leant. ,
❑I bars and will maintain Workers Compensation Ivurors,ss required by Seaton
37W of the labor Code,per me performance of da work forwhich this permit Is issued. '
My Wafters Campenatian Ince.artier and Policy n/ 'Tork,r
fi ,m /f-'
erier. 7-F1A An(�S LI
Policy No.: IgI fI oW
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thissectlon used not be completed 0 dte permit Is forone hundred dollars(SIM)
unless)
I century mat in to parformuce of the wart for which this Permit Is issued.1 shall rust
employ any Parana in any mannerm aa On become mbjca in the Workcri Compcaauon
Laws of California Data
Applicant
NOTICE TO APPLICANT.If,after making this CcniBam of Exempdan.you should
become abject b the Wohers Companamon provisions of to labor Code,you man
., O foMwit comply wide mach provisions or dais permit shall W deemed revekcd.
z� CONSTRUCTION LENDING AGENCY
E+ 1 hereby afrrm that there u a eavtmetnn lending agency far is performance err
C'> dus weak far whim the per ail I,issues(See 309'1,Civ.C.)
�W A Lenders Name
z UmhosAddress
U0 i certify mat I have mad this application and sate that the above informatun Ir
Ly ^ carnal.I agree w comply with all city and county are.vW sum laws relatng m
0 SV^ building cWmuualmn.and hereby authoria¢p¢rcauives of mu city to enter upon me
shove-mentioned property for inspection inaper s
tom„ y
(WO)agree to ave.Indemnify and keep harmless the City of Cupertino again,
rn liabilities,judgments,come and expenses which may in my way accmc,ssina said City
U z in APPLICANT
or Negmntin DS the permit
APPLICANT UNDERST NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU U TIO - i
i� �^ Re-roofs
Signmurt of Appli -onuacmr Date
1 AZARDOUSMATERIAISDISCLOSURE Type of Roof
Will me I' t or facers Wilding aseuponl store or more hmmid.mvtcfial
as deRned by mfr Cupeniw Municipal Code.Chapter 9.11.and dte Hostile and Safety
cans,Scctier 25532Lm37
❑Ya I�Nu All roofs shall be inspected prior to any roofing material being installed.
Will ter applicant or future building occupant tic equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hvasdov aur coaumiwm u dc0ncd by the Bay Ara Air Quality Maar,.ent all new materials for inspection.
District?
by. � u
Ihavcread Whaardtymate
tcquireder Chapard.93 of e Cil
d.om$SanyCadc,Sectav Ls05.V5533 sets M34. osuM thmifthc Wildirt;
nustcun , v • na , t tis mynpondmilityce nfY
requreW
mn' i
I CJ1
- ,�
rte rex t 'miniaumecoraeemrcacorOcicnp ey. Signature of p ieant Date
n
Ownermmien dig r, �Date All roof coverings to be Class"B"or better