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Permit Number 08120137
Status x C - Closed
Zoning Applicant Contractor' Defined Fields
Master Number
IC31 Notes
Project
1 TEMPPMT IQI
Apply Date " 12/23/2008
Ii'< Operator
Permit Issue Date 12/23/2008
Operator
Certificate Issued
Operator
Certificate Type
30000
Certificate Number
0
Address19750 STEVENS CREEK BLVD
City/State/Zip CUPERTINO
0 APN 36960008. M R KI
IQI Unit
SylviaM 0�:iarFrtt,,lr;onn,a;�,
SylviaM (Owner Name'I MURUKI CORPORATION
Use Default
Address Home -19750 STEVENS CREEK BLVD
City/State/Zip CUPERTINO
Permit, Property
Zoning Applicant Contractor' Defined Fields
Permit Details
Permit Type "
1 TEMPPMT IQI
TEMPORARY STRUCTURES
Usage Class"
N/A IQI
NON APPLICABLE
Applied Value x
30000
SQUARE FT.
0
Calculated Value
0 IQI
US C-404 Type
327 IQI
NEW: STORE/REST RAUNT/TAVERN
Permit Form
AUTOPERM - PERMIT
Ownership
1 - Private
Project Size
COUNTER - OVER THE COUNTER
Enter the purpose or any special conditions for this permit
CA 95014
CA 95014
Purpose/Special Conditions
TEMP PERMIT NO INSPECTIONS AFTER 1723709 SHE ORIG
PERMIT FOR REST OF INSPECTIONS- 08110061
FILMED 572011
IEoAdd Default Text
M
CIT4' OF CUPERTINO
BUILDING DIVISION PERNUT
OWNER'S NAME:
ARCHrIEC UENGINEER:
Q p a LICENSED CONTRACTOR'S DECLARATION
oa I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
Z with Section 7000) of Division 3 of the Business and Professions Code, and my license is
n a a in full feree and effect r
zLicense CI p
t ❑ Dae /�—Contractor NnON S
� ARCHITECT'S DECI-ARA't10N '
Q< 1 understand my plans shall be used as public records
7yU
t U. y Licensed Professional
n 0 OWNER -BUILDER DECLARATION
M 1 hereby affirm that I am exempt from the Contractor's License Law for the
G O following reason. (Section 7031.5, Business and Professions Code: Any city or county
y m Pi which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to rile a signed statement
-?
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
y Na (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
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 penally of
not more than five hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered forsale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li.
ccnse Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License law.
❑ I am exempt under Sec , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations
I have and will maintain a Certificate of Conscnt to self -insure for Worker's Compcn-
inn, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued
My Worker's Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cnis section need not be completed if the permit is for one hundred dollars ($ 100)
or Ices)
1 certify that in the performance of the work for which this permit is issued. 1 shall not
employ any person in any manner so as to became subjectWor!4'ComperLsation
'C
Laws of California. Date f
Applicanty�
NOTICE TO APPLICANT:afte
1l r making this Ccnificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
0 Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
F~ -c r�•i I hereby affirm that there is a construction lending agency for the performance of
LYi 7 the work fur which this permit is issued (Sce. 3097, Civ. Q
aM Lendces Name
Z Lender's Address
U Q 1 certify that 1 have read this application and state that the above information is
(y correct 1 agree to comply with all city and county ordinances and state laws relating to
0V building construction, and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
H0.(We) agree to save, indemnify and keep harmless the City of Cupertino against
rn Iiabilides,judgmcros, costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit
r" APPLICANT UNDERST NDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULA 0 I' .
I Y, 31 -G
Signature of Applicant/Contraclor I Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building ocnrpantstore or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑ Yes No
Will the applicant or future building occupant use equipment or devices which
Mil. hazardous air contaminants as dcrrned by the Bay Area Air Quality Management
District?
❑ Yrs No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534.1 undcrsrand that if the building
dors not curmndy have a tenant, that it is my Msponsihility to notify the occupant of the
requirements which n but be mel prior to issuance of a Certificate of Occccuu ancy.
F J ?*1
Owner ora to homed agent Date
TEMP PERMIT'
Sq.
APN N
Issued by:
Re -roofs
Type of Roof
PFKMff NO.
nal gni -17
PERMrr ISSUE DATE
S CONTROL NO.
BUILDING PERMrr INFO
BLDG ELECT PLUMB MECH
Job Description
Required Inspections
Occupancy Type
Date
All roofs 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'. ' or better
CITY OF
CUPEkTINO
CITY OF CUPERTINO
TEMPORARY PERMIT
PERMIT APPLICATION FORM
e4; i?/�o0�
APN #
Fee ID
Date:
Original Permit #
D 4�F l/5, d /
Permit Type
Building Address:
1 TEMPPMT
Flat Fee)
Temporary Permit
(Commercial only)
B
Owner's Name:
Phone #:
-74V,JD-r-s-4zn
Contractor:
Phone #:,n '2 -
Fax #:
Contact:
Phone #:
Contractor License #: 270 -S7 U
Cupertino Business License #:
Job Description.-
escription:Valuation
Valuation(cost of proje
Type of�l}sruction:
G Gds
_JJ
Project Size: Over the Counter-��
Quantity
Fee ID
Fee Description
Fee Group
Permit Type
1 TEMPPMT
Flat Fee)
Temporary Permit
(Commercial only)
B
1TEMPPMT