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06080090FY OF C:Uj LKi udv BUILDING DIVISION PERMIT OWNER'S NAME: -TALLCO /LANDMARK r..vNE: ARCHI7EC IENGiNEER: reo a FwiLhScction7000)OfDi LICENSED CONTRACTOR'S DECLARATION t V U affirm that I am licensed under provisions of Chapter 9 (commencing - z 0) of Division 3 of the Business and Professions Code, and my license is y effect. Mw ? Lre. 8 Contrac tor ARCHITECTS DECLARATION u t understand my plans shalt be used as Public records �yU 1'u. Licensed Pfsional O OWNER - BUILDER DECLARATION aI hereby affirm that I am exempt from the Contractor's License Law for the p o following reason. (Section 7031.5, Business and Professions Cale: Any city or county K m which requires a permit to construct. alter, improve, demolish, or repair any structure u - CA Prior to its issuance, also requires the applicant for such permit to file a signed statement Z a that he is licensed pursuant to the Provisions of the Contractor's License Law (Chapter 9 x H mmencing with Section 7000) of Division 3 of the Business and Professions Code) or (co y $ that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or improve for purpose of sa ). 1, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) 7'he Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. B & P C for this reason ❑ I am exempt under Sec _ , 2 - Date f 0 D 0 Q W � a az U wF � C f"+ 0 r-t U U� Job Description T.I. BOW:�ING ALLEY /RESTAURANT (FOOD SERVICE) INTERIOR ONLY — EXTERIOR CHANGES SUCH AS AWNING SIGNS NO'P APPROVED. S a. Ft. Floor Area 31620063 1 hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent to self - insure for Worker's Compen- tion, as provided for by Section 3700 of the Labor Code, for the performance of the ark for which this permit is issued. I 1 have and will maintain Worker's Compensation Insurance, as required by Section 100 of the Labor Code, for the performance of the work for which this permit is issued. ly Workers Compensation Insurance carrier and Policy number arc: artier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) r less.) certify that in the performance of the work for which this permit is issued, I shall not mploy any person in any manner so as to become subject to the Workers' Compensation -aws of C ' rnia. kpplicant 40TICE APPLICANT: If, after making this Certificate of Exemption, you should )come subject to the Worker's Compensation provisions of the Labor Code, you must orthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above - mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SO R CE REGULATIONS. Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑Yes eo Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Managemcni District? ❑ Yes Jorko 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the buildinl does not currently have a tenant, that it is my responsibility to notify the occupant of th ft-i ircmcnts wbiGLmust be met prior to issuance of a Certificate of Occupancy. or authorircd agcnl � Date Issued b, Re -roofs $3081618 occupancy type Required Inspections Type of'.toof All roof:. shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better 08/11/2008 10:21 FAX *CITVOF CUPEkTINO 408 7711 H33 CITY CUPERTINO CITY OF CUPERTINO PERMIT ,APPLICATION FORM 1a002/004 OGcSZX%yD Quantity Date: Building Address: md Mailing Address (if different from building address): 1 D. A z N L001 7�,1.2 — Qv�ner.' , Narne• �� [rL<jN 0 Phone #: Contractor License #: C�ntact: Phone_ Fax: L/y5D 0�3-CsFH% Cupertino Business License#: Building Permit In Bld�j Elect I Plumb L,1 MechU lob Description:4m [,i`(1 rwempfrt -�Or 02 utav), Residential El Cercial Sq.Ft. Floor Ar • + Sq.Ft.: 3p ,3 OJ Cost of Project: (, ` Occupancy Group: A a 'type of Construction: , spy Please check this box if the project is a second-story addition: ❑ Project Size: Standard ❑ Lu a Major ❑ MECHANICAL Quantity Fee ID Fee Description Fee Group 13APPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BB0ILER2 I Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler 31M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX 1nd/Off/Cozz m/ uasi BUILDING BCONSTAXB Con. Tax for BQ Zone BUILDING BCONSTAXH Motel and Motel BUILDING BCONSTAX,R Constax – Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A, ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUTLDJNG BENERGYADD Energy Add Multi BUILDING BINVBSTIGA Investigation fee 13UILDINGr 1 of 3 40$ 77f JV3, CITY CUPERTINO CITY OF CUPERTINO PERMIT A►.PPLICATION FORM 16003/004 uanti Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMW New Comm Plumb PLUMBING BOVERTIME Inspection Overtime _ BUILDING BPBACKFI..OW BPCESSPOOL Atmos lxer is 'Vacuum Cess ool PLUMBING PLUMBING BPERMFCE Blde Permit Fees BUILDING BPFMURE Pblg Fixture PLUMBING BPGA.S Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCK.AUD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING 13PSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM StonmAUin Water PLUMBING BPTRAP Kitchen Trap PLUMBING BP'VENT Alt of Drain & Vent PLUMBING BPWATER InstaIUAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cf n MEC14A Al BREMA]RILAN A/C Units <= 10,000 c&n MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY ; Remodel Buswa s ELEC'T'RICAL BRBMFLXT Lighting Fixtures ELEC'T'RICAL' 13REMFURN Relocation of Furnace MECHANICAL BREMFCTRNOV ; Relo Furnace > I OK btu N MCHANICAL BREMEN EAT Heater Installation MECHANICAL BREMrNHOOD Installation of Hood MECHANICAL ... 1 2 of 3 BREMNRAPP Rern Non -Res Appliance ELECTRICAL BREMTOLE Pole/Platfouu Fixture ELECTRICAL 13RENTOWER Power Device/Apparatus ELECTRICAL. BREAMCEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Rep air /Alter Heating MECHANICAL BREMRESA.PP Remodel Res Appliance ELECTRICAL 2 of 3 -ITY OF CUPERTINO* EkT C�JPEI�TiNO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING -3S'- Soo ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL 3 3ov MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING g tt�a PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi -Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3