0111000214
CITY'OF
1
TY OF CUPERTENO
P'I I.M1 I AP'I"I I( AI Ick)\ FORM
AP #
010
Date:
OCT "� 12 6701
BuMng-Address: '-. ;
GIL�7 2 -Sfiev PJ�� v�1. GCA(2 vfi "noe
Owner's Name:Pone
ZAWA-// f<A-COD 611 AJ
#.
`¢7—CSA-WA
(00f) J`¢17—
ontractor:
Contractor:
License #:
I—II G 7 Z� 1-;2�
Contact:
0 A l2 G
Phone #:O
Applicant/Contractor: ,
o,1ArL-I
Boiler <=100,000 Btu
B, ' emlit Info: ---� -
fes' P
Bldg Elect b f Mech
Description:
Residential: Commercial: 7iArtT�+11 N �T
Sq.Ft. Floor Area:fS�
Etr 47-C70-,
47.. - --
Arri-t2�ct/Engineer:
Valuation:
.a CD k -,Y? A h -,I) I PE, G506/ci
4 90 G6 0
Type of Construction:
l i4C)U g
Occupancy Group:
uuauntfl Fee ID
]Fee De§esu tnon
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBLDGFEE
Bldg Permits . foot
BUILDING
BBOILERI
Boiler <=100,000 Btu
MECHANICAL
BBOILER2
Boiler > 100K to 500K Btu
MECHANICAL
BBOILER3
Boiler > 500K to 1M Btu
MECHANICAL
BBOILER4
Boiler > 1M to 1.75 M Btu
MECHANICAL
BBOILER5
Boiler > 1.75M Btu
MECHANICAL
BCONSTAX. ..,
Construction Tax
BUILDING
BCONSTAX
Ind/Off/Comm/Quasi
BUILDING
BCONSTAXBQ
Con. Tax for BQ Zone
BUILDING
BCONSTAXH
Hotel and Motel
BUILDING
BCONSTAXR
Constax — Resi/Mobile
BUILDING
BELEC 1000
Elec 600V-<-- 1000A
ELECTRICAL
BELEC1001
Elec 600V > 1000A
ELECTRICAL
BELEC200
Elec Svcs 600V <= 200A
ELECTRICAL
B ENIERGY
)Ener
BURLIDENG
BENERGYADD
Energy Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
I BMITIGATC
Comm. Housing Mit. Fee
BUILDING
1of3 �7
r; 7 ��
i
CI OF °PERMIT
BUILDING DIVISION
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO,
01110002
OWNER'S NAME:
APPLICATION SUB DATE
ISAWAI & LAWAN RACHOGAN OLA
11 Ol 2001
{PHONE::
SANITARY NO. CONTROL NO.
P ARCHITECfIF,NGINEER:
BUILDING PERMIT INFO
C
BLDG ELECT PLUMB MF.CH
w
O L_1 U
LICENSED CONTRACTOR'S DECLARATION
I hmi7003by affirm shin l am apter mmeeeme
provisionalrProfession,
Job Description
p
of the Hones, and n, Code. and
.isinsmmneandefOmLaom3onneBmam<ssandProressi°asabe.anamyrcen.e
force and effect
TI,
�®
THAI RESTAURANT.
uice se
License Class Lica
One 'Contractor
ARCHITECTS DECLARATION
1 understood my plans shall tvwed as public records
UN 1.3..2002
- Licensed Professional
DatNEWBUILDER DECe
I hereby CardpIUN
M. thin 1 am cBusin from the Contns d License for the
��LD�19G,
. C : city o
< following reason. (Seaton 7031.5, Business and Professions Code: Any city or county
whbl q pc trecnnamckpplic flier, p dorI'.h me
$50000
--. _. _..__.
lifeapplicantof f 'noicnse signed swmmcm
x .peon t asranyswment
S qq
F[.rFloorArea-
),
Valuation
o
nt to the
— Nmh -Ice seep ono 00)ofhe Dswns RhcCommoner LccnseLawonsCcr9
Gadd
(commencing thS-tmn7n0lnd tOvso3 Lith Business anaPn.
the basis fnnbectsthalleged csempt'nn.Any violation
Any vi
anhufhe ii exempt zany
.it
369060010.0'0
I:� Ak
of nm on 7031.5 n iv any dr d doll fora permit subjecm the app—a....-
applicant for ppnm to a civil penalty
of
or nor mom than five mmnama dollars ($50Y.
APN Number
-
I. ,..-.•, Occupancy Type
101
- FOUNDATION
proper v n > s pensa
❑I. as alone, of the rt. ore. employees wvnwa es as their side emo tion.
will ne the work. ane ns swaure C not intended a en a ieredLaw odsor ndeno fsec: a a,
annmeos Contractor's License Law encs not apply to an
— - -
Required Inspections'
ownor of property Who builds or Improves thereon, and
pro erty Who builds o im . encs wink miner
10 3
— UFER
veo
or through his own employe=d. provided Nat such improvements ale not intended or
sum
.... _. _ 104
— REBAR . _
offered [.,.aide If, howevd, the building or improvement n ,mid year of
_
completion, the nwm lobo have the nu,aen nr Prnvmg thin nc did not build of
he did not
105
- ANCHOR BOLTS
improve for purpose of side.).
or of side.).
_ _--_- ------- _--...._ ..
_... 1.06
-. SEWER .... &._WA ER .. .... _
❑ I, as owner of the pngerry, inn esemaively cmnlrrvurg with lice emrac,nrs to
constrict the Project (Sec 7634. Business and Profcssio q, e c°n,maora
2 02
- UNDERFLOOR PLUMBING
= Liceme L w s not apply to a ner of pro n builds or improves thateon,
203
- UNDERFLOOR MECHANICAL
and who t s for such p ns wit ,memos) licensee pursuam ..to
_ .. _ _....
......
Comnao'd Lic se Law.
204
- UNDERFLOOR, FRAME
m
! ❑ 1 aea under Sec; B P C for this mason
Owner i / Dine/�' c9 of O�
R'S COMPENFATION ECLAR ON
205
301
NSULATION
- UNDERFLOOR I ,
- ROUGH PLUMBING
I hercn under penalty ofperjury onirunne following deelmrtions:
302
- TUB & OR SHOWER
3 03
- ROUGH MECHANICAL
❑ 1 halt and will maintain a Cmificom of Consent to'sdGinsum for worker's
Compensation, as pr..idedfor by Section 37M or the Labor code. for he
304
- ROUGH ELECTRICAL
performance ohne work for wnicn this permit is issued.
305
- FRAME
❑ 1 have and will maintain worker's Compensation Insurance, r required by Senior
3 0 6
- HOLDOWNS
- 37W of the the work for which this perm, is
Cattle, for the pInsurance
My Mnsa
Worker's
.!f . wmker'demm Compensation Insurance .aPulianumb.r
rr
. .._..
307.
-. ,INSULATION_, _.,.
cmd t _ 1PEMP`pI.
-
308
I 1 I
CERTIFICATION OF E%EMPTION FROM WORKERS:'
COM1IPENSADONINSURANCE,' ' •. .,
,,,_ �, } O9_.,_
—"EXTERIOR
-_,EXTERIOR._ LATH. ,_. _ _ _ _ ---
(Tn Sectioniieednor n<eompletedifthepee.,tsforonehundreddollars
(This
310'-
INTERIOR LATH -• s '
311
- SCRATCH COAT_
_ .. I certifybar in hemanee
,perforior the wmk for which his Peron is issued. 1
313
- -ROOF NAIL,;
s coe subject the worker:
Can, no( nnploy any person in any rammer so os m hemm
rmpcnon.i. laws ofcatimmili. Date
501
• ''
- FINAL ELECTRICAL ENERGY
-Applicant502
NO110E TO APPLICANT: II, Cfter making this CcniBcmc of Exanptian, you xhnuld
--FINAL PLUMBING' ENERGY "
become subject to the Worker's Compensation provisions of labor Codc, you must
503
- FINAL MECHANICAL ENERGY
forthwith comply with such Provisions or this permit shall be deemed revoked.
504
— FINAL BUILDING ENERGY — -
"•CONSTRUCTION LENDING AGENCY
1 hemlijaniffinor that then is a conswction lending agency for the performance
5 0 5
- FINAL ELECTRICAL "
of the work for which this Permit is issued fsec. 309]. Civ. C.I
506
GAS TEST
p Loneer'aNamc^>-,:...�-„:.,......•
<naprsnaandd
507
--
- FINAL PLUMBING
, Icertirrthat ihave naamidapprca6omamasmr<mmmeawstinrormanonis
508
- FINAL MECHANICAL
icer. I agree t ropy th CII cur aha county oreinonces and sure law: rcleting
j mbuildthgc .vection. andherebyaarhodre representatives ofthis dry to enter upon
-509
- FINAL GRADE
the aMw cntioncd,prapcny for inspcmion ,pose..,,
�(Wc).8maldswe:mdcmm an hmmlcss the City of Cupertino against
'' "� 510
- FINAL PLANNING
liab'liiies, judgmcn oat end pen ich rosy m eny way seine egeian saiG
C' in consequ - f the eon g o .i perms.
514
- NA P WORKS Q ��
A'I' ICAN N RSTAND q ILLCOMP{A H LLN - ONT'
Issued b
DllIC
Sign or A -comic to or • :�. ,. . ,D =
Re -roofs
HA OUS ill RIALS DISCLOSURE
d eapplic (.In filing.,ofcore or handle hazardous mmcrod
Type of Roof
... - - •.
f y the Cu o u p I Cade Chapter 9.12. and the Health and Safety,
f °tat
for 255. ,
❑las! No �•� s1. lea
+
m, : ” I
s, t I
_All roofs Shall
r tir
be inspected prior to any,riiofing material being installed...
w'uth phcan, or future building receptoruse equipment or devices which
If a roof is installed
without first obtaining an'inspection, I agree to remove
=mit hexa do it emomminants as d fined by ire Bay Arca A Q al ty Management
Diulo"
all new materials
for inspection. Applicant understands and will comply with
oYed,o&no
all non-point`souice
regulations.
halt read the hazardous materials requirements under Chapter 695 of Ne
CaliPomia Heald & S.mty C lions 25505, 25533 and 25534. I understand that
if the huiMinBd c note amwnk that it is my T<sponsin0ity to nrlify the
- "- -
cupant oft ' e taus 'ech most be met pri-nmissaenci of a Certificate of
Date
Signature of
Applicant
All roof coverings to be Class `B" or better
c {a M1�d est ate
i