The URL can be used to link to this page

00020189 CITyy F CUPERTINO PERMrr NO. - A BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: oD��O `� BUILDINGADD ESS: •/ IIAiZ/ v /tet/��'] _f /�/2 SANITARY NO. APP�LIICATION SUBMITTAL DATE OWNE /v . /Nle//f// /��VN�I / "/70�(/✓�/l. �///�S f NIC �C-^ZCONTROL L# nPLON ---I El iCHITECTENGINEER B111.DING PERMIT INFO �az oo au �a z LICENSED COMRd under p DECLARATION ^ r� �, z o — ',,Tyro m n IJ O Z= 1 hereby that 13 licensed uodm provisions of Chapin 9(commencing N Job D CTI �O with Seedon 1000)af0ivision3ofrh B..i,rc..rod Pmfeuians C Ylicenseis �x6 in full fortt < t `� I1 ,ao, Lim'Cl.u. LCm ic., (y/ FEB 2 3 LVUV L O S ARCHITF,LTS DECIAAATION i f'�j 1Y�slWl beuulu Public tooth. a<O r p I ¢S—'� OWNEWBUE.DER DECLARATION By 1 0$G 1 hereby my.that 1 sec exempt rrem the Comrsemh License law for the 3p$C fOlowing town.(Section 9031.5,Bombers and Professions Cuda:Any city w county e. 2 which mquha a permit to conswet,aBm,improve,demolish,or repair wy swcture S Ft. Floor Area primmiu issana.Nwrtquims the yglicwttm such pemtit mfileasignd nteumcni q' uBitlon p that be is licensed pursuwt tuft pwvidons ofthe Conmecror's License law fClupta 9 77 thus be xe pth Sectiout hod of Division3oflheed exeandon.An iam Coonof Occ ancy Type Net h is exempt anmfwm end rite parr far the alleged pamant to Any it Penalty of APN Number Section 1031.3 by anyapplicantdoll for a penniuubjeet.Ih applicant a civil pealry of / nm mom Nen rive hundred tlollem ISsoO). Lasownerk,and pwpmny,ar is em asslecwiNwaee.a dal( .,c0mpeaedon, Required Inspections and Bothe work,aod N Contrtan is not i Liam m aro chaead fonelapply to an vmima and property wh mu Cadet ibe Contractor's Limas law docs nm apply s lf owner of his-sm who buiW.or i uhd a thereon,sod who dos such work dand or m through his own employees,Witdi , thu such men,11 old w am nm intended m uRerod for scanIf.hwa<n Brebuildingurimprovement is cath did noneyenof r improve for Bre pOse.xiilder will neve Nc burden of Fuming Nm he did nm buiM or improve for pw- poseof¢ele). ❑1.u owmr of the property,am exclusively convecting with licensed contractors to comuuct Ne project(See.thea,Business sod R feaiam Code:)Tisa Convacmr's l.i- � cense law does rut apply to an owner of progeny wh builds or improve Neon,W woaconvafm such ptojeeu with ecovmemrts)licensed pursuwt b the Canrrecrefs License Law. ❑I am exempt under Sm. .B B P C fm Nis ream, w Owner Data �•/(��` WORKER'S COMPENSATION DECLARATION 1 heby a?rte under penury o(pmjury one of Ih followin[dalentioa: ' ❑meas aodwill forbyveCmifiate of Comemm oda.for for Workers Co of the anon,u preWdhi(m mi Section 3100 of Iha Labor Cade.Ica Ih perlommtee of the roma for which ill panto,is issued ❑l have.fts rod will ode,fon Worker's Compensation work hi h mquiad by Section 3900of dm Labor Code,for the pertwmwee of d woo fro which Nie permit is iewod. CMyWa ri.VI Gowprnsatip,•b�Ve ama.nd Policy 9I��b/e B° _ Came' /" Policy FRO 4(OEIZX �77" . CERTIFlCATEOPEXEMPTION FROM R RS' COMPENSATION INSURANCE (Thio seminn need wt be wmpleted JIh pmNt is forms,hur,Nodod tlolbre($100) ml u.) 1 employ my that in Ne mypalfmacce.ftimt roma for which thin permit is ns,C.l shall hat employ any person I.my mentor w ns m became aubjcm m the Warken'Cammn- ' abort laws o(Califomie.Dem Applicant NOTICE TO APPLICANT:If,after making this Caoffiease of Exemption,you should becotm subject to Ne Worker's Cnmpemmilen previsions of the labor Code,you must ronhwids.,I,with such provimmns"is permit shall h deereW mated. CONSTRUCTION LENDING AGENCY p 1 hereby aRimt Nat IN.is a construction lending agency for the perfmmwce of IN work for which Ni.permit is issued ISec.3091,Civ.C.) ' E.. Lender's Name (Yj lenders Address L1 unify thin 1 have mad this appliation and eros that the shove Informants,is comot.I agme to comply wish ell city W county oNiramha es amem laws miming to U Obuilding construction,rod hereby authorise repmenmives of this city to enter upon the shove-mentioned property for inspection purposes. k+ r. (We)agree to save,indemnify and keep harmless the City of Cupertino eg,irut t.7 liabilities,judgment..costs and expenses which may in my way eccme agmost,.id City �.e a in conuqueuce of she gmmdng of this perm,. LL EO APPLICANT UNDERSTANDS AND WILL COMPLY WI1'H At.[.NON POINT V Z SOURCE REGUTATIONS. Sirmumal APPlicwvComrw,tm Data HAZARDOUS MATERIALS DISCLOSURE Will the epplicantor fumm building meup....oramiundlehaaatdous material Re-roofs as definad by the Cupertino Municipal Cod,Chapter 9.12,and the Health and Safety Cade.Section 25532(e)1 b / Type of Roof ' ❑Yes �l6 Will the cep nicart or future building occupant use equipment or devices which All roofs shall be inspected prior to any roofing material being emit haardous ah comanlnwu as deBnW by the Bay Arca Air Quelhy Management installed. If a roof is installed without first obtaining an inspection D6N(! Yes gg I a vee to r move all new materials for inspection. Applicant I have mad s roquimnrnu uMm Chapter695 oflh Celi- U de a will comply with all non point source regulations. fmNa Hal sof Y Code ens 255th,25st,and 25s1a.1 untlmssmW tiro it rite riding m nti ate LNm it is my rtspmaibiliry wwti(y Ne acupwt Qom•/ %%o//7—QJ the t d.'snoranne afe CeniOcau of Oeeupemy. Signature of Applicant Date cane gent Dam All roof coverings to be Class`B"or better OFFICE 9REMACOVER IAC UNIT >I0000Cr d j,%IEC-ANICnL IBREMAIRHAN JA/C UNITS <= 10,0GCCFM IMECHANICAL JBRENIFURN IRELOCATION OF FURNACE MECHANICAL 1BREMFURNOV IRELO FURNACE s 1CK 9 i U IMtCHnNICi+L BREMINHOOD INSTALLATION OF HOOD IMECHANICAL BREMRELOCA IRELOCATION OF HOOD INIECHANiCALI BREMREPALT IREPAIRIALTER HEATING MECHANICAL BREMVENSYS IVENTILATION SYSTEMS IMECHANICAL PPERMITFEE PLUMBNG PERMIT ISSUEPLUMBING BNUMULTI NEW MULIFAMILY RES PLUMBING BNUSFD NEW SINGLEFAMILY RES PLUMBING BPBACKFLOW ATMOSPHERIC VACUUM PLUMBING BPCESSPOOLCESSPOOL PLUMBING BPFIXTURE PBLG FIXTURE PLUMBING BPGAS GAS PIPING SYSTEM FEE PLUMBING BPINTERCEP IND WASTE INTERCEPTOR PLUMBING 0 BPREPIPE REPIPE OF FIXTURES PLUMBING SPSEWAGE SEWAGE DISPOSAL PLUMBING BPSEWER SEWERS PLUMBING BPSPRINK LAWN SPRINKLER/BACKFLO PLUMBING SPSTORM STORWRAIN WATER PLUMBING BPTRAP KITCH TRAP PLUMBING BPVENT A• AENT PLUMBING BPWATER INSTALL/ALTER WATERPIP PLUMBING BPWHEATER WATER HEATER/VENT PLUMBING BPWSVCS MAIN WATER SERVICE PLUMBING ZDEVAGREE DEVELOPMENT AGREEMENT PLANNING ZDIRTM DIR TENT MAP PLANNING ZFULLHR FULL APPL BASE*HR PLANNING ZFULLTM FULL APPL TENT MAP PLANNING ULLUP FULL APPL USE PERMIT PLANNING ZFULLZONE FULLAPPLZONING PLANNING ZGPAMEND GENERAL PLAN AMEND PLANNING ZLIMAMEND LIMITED AMEND PLANNING ZUMTM LIMITED NT MAP PLANNING MUP LIM D APPL USE PERMI PLANNING ZMATEMPUP MIN AMEND TEMP USEPERMPLANNING ZMINHILLEX MINOR APPL HILL EXC PLANNING ZMINSIGNEX MISC SIGN EXCEPTION PLANNING ZMINTM MINOR APP TENT MAP PLANNING INUP MINOR APPL USE PERMIT PLANNING ISCASA MISC ARCH SITE PLANNING ZMISCEXT MISC TM AND UP EXT PLANNING ZMISCFENCE MISC FENCE EXCEPTION PLANNING IS GEN MISCELL APPL GENERAL PLANNING I CPCINT MISC PC INTERPRETATION PLANNING IGN SIGN PERMI . PLANNING ZTF:MF5IrJN ITEMPORARY SIGN PLANNING ZVARIANCE DIRECTOR VARIANCE PLANNING 2 oft • Ra.iW tVtlY99 Oty. it Applicable Fee ID Fee 0escription Fee Group IsF== IBLDG PERMIT FEES IBUILD6NG IBCONSTAX (CONSTRUCTION TAX IBUILDING ISENERGY (ENERGY IBUILDING BENERGYADD (ENERGY ADD MULTI ISUILDING IBOVERTIME JINSPECTION OVERTIME IBUILDING BTEMPPERM TEMPORARY BLDG PERMIT ISUILDING BMITIGAT JHOUSiNG MITIGATION FEE IBUILDING BPLANCHK PLAN CHECK FEE BUILDING BPLANCKADD PLAN CHECK ADD MULTI BUILDING BPLANCKREP PLAN CHECK REPEAT FEE BUILDING BREINSPECT REINSPECTION FEE BUILDING BSCBLVD SCB SPECIFIC PLAN BUILDING BSEISMICOM SEISMIC COMMERCIAL BUILDING BSEISMICRE SEISMIC FEE RES BUILDING ESPECIAL SPECIAL INSPECTION BUILDING BSWIM SWIMMING POOL BUILDING ZADDCHG ADDRESS CHANGE BUILDING EPERMITFEE ELEC PERMIT ISSUANCE JELECTRICAL BELEC1000 ELEC 600V �1000A ELECTRICAL BELEC1001 ELEC 600V>1000A ELECTRICAL BELEC200 ELECT SVCS 600V c=200A ELECTRICAL BNEWMULTI MULTIFAMILY RES ELECTRICAL BREMBUSWAY REMOOELBUSWAYS ELECTRICAL BREMFIXT LIGHTING FIXTURES ELECTRICAL BREMMISC MISC APPARATUS ELECTRICAL SREMNRAPP REM NON-RES APPLIANCE ELECTRICAL BREMPO POLEIPLATFORM FIXTURE ELECTRICAL BREMPOWER POWER DEVICEIAPPARATUS ELECTRICAL BREMREC PT RCPTL, SWITCH &OUTLETS ELECTRICAL SREMRESAPP REMODEL RES APPLIANCE ELECTRICAL BREMSIGNAD RMDL SIGNS ZO BRANCH ELECTRICAL BREMSIGNS REMODEL SIGNS, MARQUEE ELECTRICAL BREMTHEATR THEATRICAL LGHTNG FIX ELECTRICAL SSF&2FAM SINGLE&2 FAMILY ELECTRICAL BTEMP TEMPORARY POWER ELECTRICAL STEMPSVCS TEMP DIST SVCS ELECTRICAL MPERMITFEE MECH PERMIT ISSUANCE IMECKANICAq BAPPLOTHER OTHER APPLIANCES MECHANICAL BBOILERI BOILER c=100,000 BTU MECHANICAL BBOILER2 BOILER:,I 00KTO500K BTU MECHANICAL BBOI BOILER>500KTOIMBTU MECHANICAL BBOILER4 BOI >1M TO 1.75M BTU MECHANICAL SBOILERS BOILER> 1. SM BTU MECHANICAL BREMAPPLI APPLIANCE INSTALL MECHANICAL SREMH HEATER INSTALLATION MECHANICAL BREMVENFAN VENT FAN SINGLE DUCT MECHANICAL BMNEWMULTI NEW MULTI-FAMILY RES MECHANICAL SMNEWSF&2F NEW SF&2F RES SLOGS MECHANICAL t a[2 PWW aloes