06080195U2
z�
CITY
TOR INF„yOI3MATTON
BUILDING DIVISION PERMIT
CONTRA
BUILDING ADORFSS:
PERMIT "0 6 0 8 0195
19805 STEVENS CREEK BLVD
OWNER'S NAME:
PEANUT L%UEDA'fE
CEC ENTERTAINMENT
09/26/2006
E:
SANITARY N0, CONTROL NO.
ARCHDECT/ENGINEER:
BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
LICENSED CONIRACrOR'S DECLARATION
Job Description
P
Vans of Chapter 9 (rommcncing
1 hereby affirm that 1 am licensed under ProL'
tion 3af NC Busincv and Profcssiuv Carlo. and myliccnscu
fares
in full and
REVISION -RELOCATE EXTERIOR DOOR IN REAR OF
Lmcnazt LK'”
y-1LC
BUILDING-ORIG PERMIT #05120141 -NO NEW PERMIT
Dateomnctor
ARCHOECTS DECLARATION
I understand my plans shall he used as public records
Licensed Pmficam d
OWNER -BUILDER DECLARATION
I hemby anion that I am exempt form the Contractor's License Law for the,
following mason. (Section 7031.5, Business and Professions Code: Any city or county
which rcquira a Permit to consumer, alcor, imprmvc. demolish, or rcpalr any suuch m
! prior to in issuance. also requires the applicant for such Prod to file a signed sulement
of the Canuazmr's Ucense law (Chapter 9
Sq. Ft. Floor Area
Vara&QQ 0 0
that M It licensed purnum to the provisions
(commencing with Station 7") of Division 3 or Ne Busincas and Professions Code) or
that he u exempt Ncmfmm and the basis for the alleged exemption. Any violation of
er
ApN �g�
Occupancy ane Type
Section 70315 by any applicant for a permit white. the aPplk.t m a civil penalty of3
nos mom Nan five hundred dollars (2500).
162 3 0 0
❑ I.nowdes of Ric propory,amy wploycas with wegn asthe'u sole compensation,
Required Inspections
eer
will do dhc war and the structure is not intended or offered runale(Sec. 70th, Business
and Professioas Code The Conuamm's Li. Law doesoat apply m an ownof
q P
property who Wilda in improves Rureen, and who does such work himsel f orthough his
own employees, provided that such improvements are not intended oroffere l forsale. If.
however, the building or improvement is sold within one year of completion, the owner-
builder will Mare the burden of proving that he did cot bund or improve for purpose of
/w
`-
role .).
\
❑ L as owns of true progeny, am owl contracting with licensed
construct the project (Sec. y0aa, Business and Profession; ion; Cade:) The Conuacmr's U.
cop
e-
f dima.ars d
law cOcs an owner of progeny who builds or improve Nemoa, and
rout
who contracts for such projects with a eontncmr(d Iiceved pursuant to the CanuazmYs
who suchp r e
✓
law.
V -
I am aempd under Sea ' . B & P C for Nis mason
0 ma
Owper Dau
WORKER'S COMPENSATION DECLARATION
Ir
1 hereby aRm under pemlty of perjury ane of IM folb ng declarations:
1hsare and will maintainomon37M of Conwnuo fa Worker'sce
orcifor of me
wtian, as provided for by Section JT00 of de labs Cade, for the perfomance of the
w which this permit ie issued.
I Mve and will maintain Water's Compensation Insurance, as required by Section
TIDO of the labor Cade, for the ptrfommec of the work fa which this permit u insu i.
My Workeh Compensation Insurance artier and Policy number am:
Came, Policy No.:
_
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This Palm wood not be complewd Inde Permit Is for on MndmAdnllvs (SIM)
or less.)
I certify that in tM perf.smmce of the work for which this Permit is Wood. l shall nod
employ any person in any manmrw as to became subject to the Workers' Compensation
Laws of California. Data
Applicant
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the labor Cade, you mum
' foMwith comply with such provisions or Nu permit shall be domed revoked.
j CONSTRUCTION LENDING AGENCY
thi that Nen u lending agemy for Nc perfurmamc of
I Nor
which
' work for which this permit is issued (Sec. J09T, Civ. C.)
sued (Sec. 30
Lc Name
Under's
L,[ndeYS Address
,
j 1 tent, Nat 1 have road this application and mule then the above intimation is
' correct. I agree to comply with all city and county im inmers and sum laws muting to
building construction, and hereby aahorim represcmauves sof Nis city to enter upon he
I shove-mcnduncd Property forimpcction purposes,
(We) agree to save, indemnify and keep harmless the City of Cupenim astir,
j liabilities,//uudgme rasa andexpcmo which may in any way we= against saidCity
in cornsegpcncc "granting of is permik
' APPLICANT ERSTAND N WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURGE LATII
Re -roofs
Type of Roof
n awmof Appli err Data
terDOUS MATERIALS DISCLOSURE
�Ilcam
Will thea or future building Occupant store orMMlc ousrdous material
az defuted by Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
dc, Section 25532(ayi
❑ Ya
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainin an ins ection, I to
Will thin applicant or future building Occupant use equipment or devices which
agree remove
$ P $ '
emit h®ardom air contaminants w definod by the Bay Asea Air Quality Management
all new materials for inspection.
D'suicd?
❑Yes Nu
I have mad the harardous mauroditne uiremenuunder Chapter 6.95of Ne Calirm.
nor N&S ty Cadc,Sotias 25w5, 25533 ard25534.1uMcrsund NmiftM Wilding
it. ly have a u t that it is my respamihility re notify Ne occupant of the
hiehraw tPriormhssusuceofacerdfir cram
1.1
Signature of Applicant Date
All roof coverings to be Class "B" or better
or amN dagent new
01