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CITY OF CUPERTINO
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BUILDING DIVISION pERVII'j'
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BUILD�Np�tDG'+ WOLFE RD #FC11
TBD - TO BE DETERMINED
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P08080034
NER'S NAME:
PERMIT ISSUE DATE
TERIYAKI EXPERIENCE
10/13/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECLIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm dou I w licensed under provisions of Chapter 9 (commmxing
with Section)Of,U)of Divivon3afth Budmat and Profesdhns Cade. and mylicunreu
T.I.TERIYAKI EXP -KITCHEN HOOD,FRONT
in rulL(«m andercemyp A txg
License Clm !'
COUNTER,INCLUDES ELECT/MECH/PLBG-INTERIOR ONLY
DemfO.E/'/ a _/✓ Conlnm«_
R�CTS Ds /
U
public bit.
1 undersms nJ my piashall beeused u recneds
Licensed Ruhationsl
OWNER -BUILDER DECLARATION
I hereby air,. that 1 am eanmpt from the Conlranors Uccose Iaw for the
following reason. (Section 7M1.5. Business and Prefessium Code: Any city or county
which requires a permit to consWct almq improv, dcmallsh, or rep car any structure
prior to its issuance. also mgldTJ Use appllWll for such permit to Me a signed slamment
Contrcmr's Liesse law(Chapmr 9
Sq. Ft. Floor Area
Valuation
Nat he is licensed pheasant In thou provisions of the
$50000
(comencing with Section 7000) of Division 1 of the Burnoose; and Predilections Cade) or
m
deal he is exempt thendo a and the bus for the alleged caemption. An, violation or
�.tQtt/ pta�w�},�Nt���t�umber
316 2 010 0
Occupancy Type
P Y yP
Section 7031.3 by any applicant for a permit subjects the applicant th a civil penalty of
scat mom than Eve hundred dollars (afro).
. 1' 1. l 1
f pmp«ry, «my unploYeet with wages u Ne cumpensatim,
Ido
Required Inspections
Mia the wml the She Nteaded of nRCRrafar (Sec. st
the Muir. and(ply IDM. BYL «Of
1
and Pnywine code The CmsrccaM1 Lienar law don oat apply lf an
Pr Cc Coruscate.
rough is
prope'tYwho buildsviimposesthereon.alewho docsetmn work his
crofff«tiumgh
ne «olfcred r«sak.If.
provided that such Impsvvemmu art not ou
ycar of mproe tartheownv-
ho er, due of
bolder, Nebuildingorimprowmmt Vcold within
et
builder will Nw the Wrden of Proving that he did rot build «improv tar puryose of
cans.).
❑ 1, u owner of the property am sa iefively contracting with limed conmcsars to
"
mssems:l the project (Sec. 7044. Business and Prefessiou Cade:) The Coomtmors V.
,
ecus d«s rot appy m an owner of property who builds or impmvua thereon, and
ho onuacsforsuchpmjecswithaconuactor(s) licensed puswnt m Nc Conoahors
" "se Law.
1 oro caempt under Sec . B & P C for this maser,
VIM
Dam
WORKERS COMPENSATION DECLARATION
hereby aRim under penalty of perjury one or the following declarations:
ham and will maintain a Certificate of Consent to self --insure for WorkeB Compen-
Isd1
v
saloon, u provided for by Sectum 3700 of Ne labor Code. for she perfomansx or dm
work for which this permit is issued.
'
❑ 1 have and will maimain Wagers Compensation Insurance, u required by Section
3700 of Nc labor Code, for dee performarme of the woods for which this permit u issued.
My Workers Compensation Luumnm carrier and Policy number am:
Cartier. ' Policy No.:
CERDFl OF EXEMPTION FROM WORKERS'
ANCE
CO PEkVft
Cndo sctim(set c IV(«one mneme dobses(slo0)
orlets.)
I certify Nat in Neaneofh Nis permit is issued, l shall noJJemployanypenonman
mec de Wo n'Cam madd
laws of Caliromia.
Appaont
NOTICE TO APPLICAN -5.7aftermadulthus Ccrtianm o' Exemption, you should
become subject m dee Wortcrs Campe'ss+uon provisions of tho Labor, code. You mus
forthwith comply with such provisions or this permit shall ed doomed revoked.
"
CONSTRUCTION
mameduDINGAGENCY
1hereby affirmdw there V•stj(Sc.3 ten ding agcnry for ane perfarmasse of
Ne wort for which Nit permit 6 iu«A (Sec. 7097, Civ. G)
Landers Name
.
1
lenders Address
1 1 certify that I have mad this application and Nm thm Ne above information is
' comet 1 agree to comply with JI city and county ordinances and stuns laws relating m
ibuilding comarurdon, and hemby anthonim rtPmmnutiwa u city m cnmr upon the
aMve-mentiamA p y inspemim purpomv
(Wc) agree I mw, t dcmnify sod kecp nam Ne Ciry Of Cupertino against
j IiaMlities,judgme .cosh des peuesw ch may nanY w+Y accrue a8lutsaid City
I. consequence o the granti of this pe h.
-P01
I APPLICANT U DER TA DS AN ILL C MPLY WITH ALL NON61A-1
Issued by: Date�--
SOURCEREG TIONS.
Re -roofs
Type Of ROOF
2
Signaturtof AppliwHAZA « Dam
HAZARDOUS MATERIALS -
LUO.DISCLOSURE
WIII dm applicant «forum building ecmpant score ore nuaNu mate
orial
dh0md by tix CupeCupertinoMunic I Coder. Chapter
r 9.12, asW the Health and safety
t
de, Section 25532(a)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yca No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building ampanl caw equipment or denim which
emit havamou air cents m' defncd by Ne Bay Ama Air Quality Management
all new materials for inspection.
D'stria7
Y. Nu
'Ihuc mad the sseriaLtrequirt under Chapmr 6.95ofNe Calif«
niaHcalln&Wcty Sud Lff0f.25533 534.1 ustivsund Nniflh building
does rot cwmndy have mnanl t iI4 nsibi' ratify ds oecupane of Ja
mquimmntrwnichmnst mel arm' per tificamarO upany.
Signature ofApplicant Date
lD
All roof coveringsto be Class':q` or better
Owner Or auNarimd agent
Dam