03090178 CITY OF CUPIIt'1'INO 3'^"� �. s,nx �- ✓�a—� '�""'' �c� �"BUILDING DIVISION DIVISION PERMIT L CONTRACTOWINFORMATION A
BUILDING ADDRESS: JAR ENTERPRISES PERMIT NO03090178
0525 DE ANZA
:R'S NAME: PERMIT ISSUE DATE
JIV KOHLI 578 SANTA MA UAITA bR. 12 /04 /2003
NE: SANITARY NO. CONTROL NO.
(831) 688-4031
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
+op LICENSED CONTRACTORS DECLARATION
ica F 1 hereby afri that I am licensed under provisions of Chapter 9(cm oorming Job Description
<b With Section 70C( of D' of Business andPofessions Cod .and license is ���
mfellfmc,odcifof v,.,gn�C` Cf ; pro 2 -1 TI-SUBWAY RESTAURANT AL
EC)� License CI,�s �/�� —Lim.N E®
�Fp Do. /sG 'T' y) � Contractor
ARCHITECT'S DECLARATION
fa� l understand my plans shall he used as public records ]UPJ 2 12004
e N Licensed Pntrannonal
ceps OWNER-BUILDER DECLARATION pp,�
a S 1 hereby affirm that 1 am exempt from be Contractor's License Law for the ISV11BBA
'ar®'IrC
00 following reason.(Section 711]1.5.Business and Pmfecdons Code:Any city or county
`e m which requires a permit to constme,altor,improve,demolish,or mpair any structure 0
uzi prioneils issuance.also requires the applicant forsuch permit to rile a signed Statement
a
that he is named moment to me previsions of the Contractors License Law(Chapter 9 Sq. Ft. Floor Area Valuation
(core mencing with section 700A of Division J of B usinec and Professions Code)or
45§ Inco he is exempt therefrom and the,bash for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permiuubjects the applicant to a civil penalty of �&18Sg�frlger00 Occupancy Type
not mom man five hundred della.(S50)).
❑ I,m owner of the pmpeny,or my employees with wages u their.mle compensation,
will do the work,and the structure is net intended or offered for sale(Sec.70,19,Business
and Pmfessions Code:The Conua.orY License Law docs not apply to an owner of Required Inspections
pmpeny who builtls m improves menton,antl who doesaueh work himself or through his
own employes,provided that such improvements are not intended or offered for sale.If.
however,me building or improvement is sold within one year of completion,the owar,
builder will have me burden of proving mat he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting wit licensed connotations to
mouct the project(Sec.704A,Business and Pmfeasiom Code)The Contractor's Li
Co.law does not apply to an owner of pmpcny who builds or improve dmwon,and
who contracts for such projects with a contractor(s)licensed pursuanno the Contractors
License Law.
❑I am exempt under See. ,B&P C for this reason
Date
WORKER'S COMPENSATION DECLARATION
^mil
I *1 hereby vRrm under penalty of perjury one of the fallowing daleratinns:
1 have and will maintain a Ceni ricate of Consent to self-insure for Worker's Conr:n-
emlon,u provided for by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued. f
I haus and will maintain Worker's Compensation Insurance,az required by Section
3700 of the labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy num Mr am:
Cannot. Policy No.:
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
(ThissccsionnecdnoiMcomplewdifthcpermitisforonc hu tldnllars(5100)
less.)
i Bendy that io the parfo anee of the woe r x)ttlh Coxperrn ieued,I shall not
employany Carsonina nncran w c :f I(' t Iorkers Comperoation
Laws of Cahfomla
Applicant
NOTIC P CANT. , for ma r Chi c - f acception,you should
Wcome Su ct the War r' Compensation pmv ions of the Labor Code,you must
Z forthwith y with sec revisions or this permit Shall M deemed revoked.
zCONSTRUCTION LENDING AGENCY
I hereby aRfm mat there is a construction lending agency ler me performance of
x 7 the Werk for which this permit is issued(Sec.3CN7,Civ.C.)
Irl Lender's Name
y Lcndcr'a Address
Z)z
U Q I cenlfy mat I have read this application and slow mat the above information is
D, F correct.1 agree to comply with all city and county ordinances and sate laws relating to
0U building crnstmetion.and hereby authorim representatives of this city to enter upon the
r W shove-mentioned pmparty for impccnon purposes.
(We)agree to save,indemnify and keep humlcss the City of Cupertino against
H� BabiLIIICS,judgments.costs and expenses which may in any way accmc against mid City
U in consequence o(Oc granting of this permit.
APPLICANT UNDE STANDS AND WI OMP TH ALL NON-POINT Issued by: Date
/ SOURCE REG S.
jN Sign to iinnveom mer Dam Re-roofs ,
1 HAZ DOUSMATERIALSDISCLOSURE Type of Roof
ill the applicant or future building mcupam store or handle hazardous material
creed by the Cupeninn Municipal Code.Chapter 9.13,and the Health and Safety
c.Section 11111 ti)? All roofs shall be inspected prior to an roofing material bei.
Y. ON. P P Y g g installed.
Will thea licant pr fwu.building 9aa ant me e i or devices which If a roof is installed without first obtaining an inspection,I agree to remove
PP g p a Air n
,,it ha'nrdnus air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
DistrlCl7
❑Yes ON.
1 have read me ha>aNnm materials requirements under Chapter 6.95 of the Califor-
niaHcalm&Ssfcty Cede.Sccnom25S05.2553. 25574 ndc.londthatifthc Wilding
dee not currently h a renin,that' s ms to notify the acupanl of Ne
requimmena wh' must he temp- tai a `s eNrcaw of Occit army. Signature of Applicant Date
own or oozed tote All roof coverings to be Class "B"or better
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDINIARSTSG) DE ANZA BLVD JAR ENTERPRISES PERMrr N®3090178
OWNER'R":IV KOHLI 578 SANTA MARGUAITA DR. PERMIT TT?R/2003
NE 4082529007 APTOS, CA 95003 SANITARY NO. CONTROL NO.
ARCHTFCT/ENGINEER: PHONE k: TI-SUBWAY RESTAURANT BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
wo= 0 0 0 0
p
%�1*5U"WjPR0 +"' r<`,", TO ARRANGE INSPECTION ]OB DESCRIPTION
'INSPECTIONS'a"', s' DATE t SPEC., CALL 777.3228 MONDAY-FRIDAY 24 HOURS RFSMENTIAL'
Z�z.`£°'8a "� •'"�'�' "^9I^"rfITMs"'"I "� BEFORE REQUIRED INSPECTION.JOB ADDRESS ❑ SFDWL ❑ KITCHEN REMODEL
I'w FOUNDATION/PIERS/H.D.S. AND PERMIT A ARE NEEDED WHEN PHONING. D ADDITION 0 PLUMBING RE-PIPE
UFER GROUND 0 MULTLu NTT 0 STRUCTURAL
p i u
S LL MODIFICATION
PAD/SETBACK-CERT RESIDENTIAL�l� yL
R 0 INTERIOR D CHIMNEY REPAIR
p 5 GARAGE SLABS/PREGUNITE IMPROVEMENT D SWIMMING POOLS
_ _. _...
pp -P011R1ObCONCRETE•UNTL�ABOVE€H2:S_'BEEN SIGNED- f-pE �HA a J( RAq� ❑ BATH REMODEL/REPAIR ] DEMOLITION
�= vUNDERGROUND/SLAB - _ OYES Byeundersandrt
s-I aa Class A,00f -mely is mgaiml. OTHER
¢io UNDERGROUND PLUMBING faRB'0 ®@�G
ONO Initial JCaU LG
UNDERGROUND ELECTRICAL COMMERCIAL
••}DO,NOT,POCR2!�FLOOR"UNTIL aBOVE'H•kS,BEEN SI�NED;•,• EXISTING ROOF COVERING D NEW BLDG/ADDITION 0 DEMOLITION
UNDERFLOOR PLUMBING D TENANT 0 FOODSERVICE
UNDERFLOOR MECHANICAL
Number of cxisting coverings 0 IMPROVEMENT
UNDERFLOOR ELECTRICAL To be mmarrA To be ret' -
MSHEATH/DIAPHRAGM
OOR FRAMING VENTS WAIdl
OOR INSULATION
s..«��«-. • TYPE OF ROOF CO N SUBFLOORUNTWABOVEHAS BEENSINED ,<<ATH/DIAPHRAGM EXISTING: 1 'Am,0 Bmb-Up Roof mh-0p Roof \GHOWER PAN ❑ Asphalt Shingles sph-11'S,h'`� �']v p,ICAL 0 Wood ShakesC ���p�q®�1TCAL/POOL BOND - ❑ Wood Shinglcs v11 ^^ ��' • R I1v'E1 V 1
RAMING/STAIRS/E.EGRESS 0 Olhcr(Specify) �A' IJ'"[]Olhei(Specify)
SULATION/VENTILATION Po,vidc I.C.B.O.Repon No.
,COVER�NO,WORKVt�TIUK'BOVE HkffFEN�§IGNED x' -`i Providc Mfg,.Insullntion Specs.
EXTERIOR SHEAR/HOLD DOWN
INTERIOR SHEAR/HOLD DOWN INSPECTION SPECIAL INSPECTION REQUIRED ❑ DATE INSP
SHEETROCK/SHEETROCK SHEAR'
EXTERIOR LATH/W-SCREED
SHOWER LATH , Com'�L�- �el1 x`,
}NO TAPE ORTP[:ASTER UNT2dABDVEFIAS BEEN SIGNED' �132/'s7 �/1� 0/e
� Z _2Z -O2
_... ......_ J
SCRATCH COAT
SEWER/WATER
TEMPORARY APPROVALS
OCCUPANCY
Z PLANNING 777-3308
> GAS TEST IMPORTANT
yp GRADE(P.W.777-3354)
Z) Z FIRE.CALL 408 3784010 LL c When a permit has expired, a charge totaling one-half
( � 3 P
JO
) P
1. HANDICAP 't3-03 the fees to obtain a new permit must be paid to
WELECTRICAL -reactivate the permit.
i~ p, PLUMBING L '7i
:J 'Z MECHANICAL
ENERGY If a permit has been expired for more than one year,a
VISUALFINALONLY charge totaling the full fees to obtain a new permit
BUILDING must be paid to reactivate the permit.
'OCCUPANCY )FBUILDINGHS,f TTE MI M '_-�� ❑ Initials
pcnl w xv� saa r Ir xtcsr n 0
UNTIL 13 TlD NGPINAL IS,SIGNED BYABUILDIN0
k
1ffOPEG'fOR ',, •„ ,,; „� ,, ,y�<, ` -a�,,�- CERTIFICATE OF OCCUPANCY ❑
'RE-INSPECTION: PLYWOOD: IN-PROGRESS:
INSP. DATE INSP. DATE INSP, DATE
TEAR OFF INSPECTION: BATTENS: FINAL:
INSP. DATE INSP. DATE FISP DATE
NOTE: OSHA APPROVED ACCESSTO ROOF SHALL BE PROVIDED FOR INSPECTION
OA
(1) m
33
Cc
CJ
U 0
00
m LD z Z
N-I
30 z
z 0
ti)
:1
M OO
ca
ro
cc
Nf,% C--
4j1