01120079 CITY OF CUPERTINO
BUILD NG DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10050 S DE ANZA 01120079
OWNER'S NAME APPLICATION 5 B DATE
KIMPTON HOTEL/RESTAURANT GRP 12/20/2001
I�HCNE: SANITARY NO. CONTROL NO.
v
O-Z° ARCHITECT/ENGINEER: BUILDING PERMIT INTO
z U BLDG Lr
PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
z m i I hereby firm tha,I a.licetned under f Chapter 9leommencin Job Description
'yr=° prmvian,nn p e ELECTRICAL PERMIT-138574 SQ FT
- u with Sauon 7000)of DirsimnJof,he Buzincss anCd�Pyrj�{ CGale./and myliccnsc
Lm 'aClasbill ean rceet/ Li, 208850 208850 LESS 70276 GARAGE
O i U Data Clasz_�./� Contrac
<6 e
1y F
Data %ABC_
HITECTS DECLAR.C((rJN� `D ---
°g I nnaenund n,y plan,shall be used as pnhre records
i E<O Licensed Profosinnel
OWNER-BUILDER DECLARATION
X=I I hereby atinn but 1 un,<xempi fru.,he Cmmmemr i License Law for,he
C?< following reason,(Section 7031.5.Business and Pm@ssions Code:Anv city or county
Y S° which requires a permit to vonsima.after,improve.demolish,or repair any structure
a3w 'norm"i'xrin',alkomouim"he applicant fnrmch panoom file r,i,n,d,rummutthat he __—
dommslcdwdp .0 1, th p nfoftheBusinesL la omCo(Chapte) Sq.-Ft Floor Area, ,: Valuation
(comms p with S ct ]poen f Division asis3 of oft l,gaid d Pr teen o s Code) t t�'` n i 4 a
or that hes 1.5 b therefrom and,he hula tonne subjects
the
exncant to Any l Pe n lty 'S'" 3 � N' "
of Section703than
n iv anyapplicanton,for apermit subjecu the applicam toa civil Penalty
nn
of not more man Rsenanama dmnan(EsooJ. APN Number •P•�' . , Occupancy Type
❑1,as owner of the property,ur my employees with wages as their sole coinpensation. 304 - ROUGH FT.RCTRT2AL
-will do the work:and,he structure is not intended or-offered for sale'(Scc.7044,-
Business and Professions Code:The Contractor's License Law docs not apply to an 501 — FINAL ERFcPTRIDGJ)&tiFuNERGYa`''
r of property Who builds or improves thereon,:lad who does mcb work himself
ow,,. intended. 505 — FINAL ELECTRICAL
or through his own however t provided that such improvements art not
:oRdr<d'for dale IL M1owcvcr,oft Wilding or improvdmcni is sold within one year of
completion,the owner-builder will have the bmrden of proving that he did not build or • ' "' `
improve for purpose of sale.).
. _owner y,am exclusively "- - -... - contractors"— . . _ ... .... . .. ...
v � Laamwner rjec pmpenye.exclusivelydPmctingwhhlicensehCctor's - ,,• ;�_,.r, r,r,lr. .y. -----License Low
construct oft does
n lapplec. to a,Business and Pmfunaio Cada)The Conlm neat,
License law rx not apply to an owner of.amen/who builds seimproves,o,the
"
C and wct.,,ho mm fI..I Projects with a conuactor(s)licenses pursuant ao oft _ _ .. __... ._ ...__._ _...._..__..__..._
Cnmmnor's License Luw _.. -. .-_................ _. .—..._......... ...._... .
❑l am exempt u' S ' " B& 111this mason
0 ? ORKEOMSATIONZC� O/
R'S C
LARA ION
I hereby affirm under penalty of perjury one of the following declarations: AUG
gg 2002
1 have and will maintain a Cenifcam of Conant on self-insure for Worker's V❑ C1
Compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this Permit is issued.
NG
p 1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the latmr Code,for the performance ofthe work for which this permit is
ssbdM WorkersC pe .l Inmrunce cart er and Policy number ere '
_r �x -
-arr ,' i - Policy fIUN WOR ID,' tt .') I ..
!t CERTIFICACOMPEN COMPENSATION
INSURANCE M.WORKERS;' •�1t • y % r,\ �p rs5�, t` 6'(�I'F.S C,''`SL �t� \; � ' 'I•,) 1.,_
COMPENSATIONINSURANCE �
(Thion need not be completed if the penia is for one hundred dollars ''t] V'u- l
(EI Wl or less) � •
fi c n fy that r the d p of the k fwhich@ perm t issued.issued.1
shall'l opt i n Pe.1 Y Y sm dm
s to becoe bjea to oft Wmrki er '
Compsa
cn ,ion taws of Californmia.Den
Applicdni- g1.__.x._..
become
subject
APPLICANT h making rh' Cen Bcme the boli yo u�hvuld
st
OZ be<�meh bj a y the Workers Compcnsm provisions of o Labe 111. you must 1 '
� comply with - h p s or o- perm t hall be deem d �ked,
CO.N,S.T.R..Ur.C_T:IO.N.r'L-E_N.DIN..G..AGENCY
up
p 1 hereby nthat,hee i a co I lending agenc.y"for
th_e.p.e.r_fo,rm._a-n:c.e
thefor'whih this permi'Cisaustl(Sec.397,Civ.C)
Lene,',Name
IMcr'sAdtlms
�,,.- ,—. r•t
--
�_0 •correct.
I agree
to comply reit„all city
and
and ordinances
and state
laws mime is ` \
[.. cdrtect.I agree to comply with all vary and eounyordinaneas and stay laws reining
the abdingconsyaction:andherebyauotimn pepresenmlives of lois City lO soler upon O
�s til, the abo(We)agree to pmperry for ify and
p harsdevs
FCconseuenosave.indemn,ofmikeephannlcss the City 61 Cupertino ej;ainn
lip liabiloics,judgments,costs and expenses which may,in eny way a<crve.,air,,said
V.`Z., Ciry in cnnsequenm min6 ofmi,permi'� '.;' Z-
•
APPLICANT UNDES ' D, AND WILL COMPLY WI—TOALLN10
S t Issued by: Dale
ma r• an na ,D a Re-roofs
HAZA US MATERIALS DISCLOSURE '
Will oc it'lium umm building occupan,'store or handle tiai trdous mdba a0
as defined by the Cupen'n Municipal Cade.Chapter 9.12.and the Health and safety -Type.of Roof.
Cdde.OYn2553(a)v - s. to d { 1 .t (1'. . E» �i r- 1N'yti'J 2.5'� .... ..._. ...
> t -.All roofs,shal] be.inspect6Y. riot to any-roofing material being Installed.
Will the -Pilot-or rfuture building occupant use elmlstan.or davi, whichIf a roof is m
msii lied without first obtaining an inspection, I'agree,to'remove
donat hoar contaminants.ara defined by theBay w Quality M g eel
�Dvtoy _ all new materials for inspection. Applicant understands and will comply with
- all
non point source regulations." - P Y - "
I h -rtad oft haiturdirt, le '1 -
California Health&Safety Code.Sections_5505.25533and25534„lund�rs and that
;doe buiMing does net currently have a renin:that it i>my respmnsibilityto notify the ""
occupam of rhe require un M mer Prior to ixsuancd of a Cc clad f
ecapp�ey.. Signature of Applicant
Date,/ Dn All roof coverings to be Class "B" or better '
...OFFICE
BUILDING DIVISION PERMIT lk.lva.3Yar�iavf.:
BUILDING ADDRESS: PERMIT NO.
10050 S DE ANZA 01120079
OWNER'S NAME APPLICON SyyB DATE
KIMPTON HOTEL/RESTAURANT GRP 12720/2001
❑❑❑' PHONE: SAMTARY NO. CONTROL NO.
O O ARCHITECT/ENGINEER: BUILDING PERMIT INTO
m— BLDG E PLUMB MICH
L_I L-i
a
LICENSED CONTRACTOR'S DECLARATION
5y� I hereby an that l am licenud under provisions of Chapter 9(commencing Job Description
flirt
'•„F witM1Seniony 0)ofDirizion3oftheBusincssandP dmyucenx ELECTRICAL PERMIT-138574 SQ FT
lms� lull
iaincoxe an fiber.ARCHITECT'S a
S/
}(p 208850 LESS 70276 GARAGE
0a Commit.,
1 undcmantl my plans shall be used az public records
Y
i e O
Licensed Pmfesvoml
or e OWNER-BUILDER DECLARATION
Z'sn 1 on.r. .tS.c 1 am es-mpt from the Contact.,',sine, ,:Any ccense law for the
”?a following reason tS¢tion constr.Business and Professions Cade:Any city or cowry
E s C which squires n permit re construe,alma improve.a-enrol t or repair any ewcmrt
c.it -phone i¢iesuanceunuard to the the ovisio so for mchp-mduoice s Law(Catemenl
(col hewitpursuant tothep ofDivision
of the Ceilusmcs°«nx lawns Code S Ft: Floor Ar .
(commencingHs exam t thei Foran a d the basis o t the alleged
andmp Professions Code) " y, 9' 3' r t aluation
or Net h'-is Exempt thetefrom and the basis for the alleged ncmpnt to Any violation o v
of not mater than by any hundred
Mars a permit subjects the applicant to a civil penalty A ' N
arnotmarelhanRanuneraaaanars(ssoo). APN Number Occupancy Type
°I,as owner of the pmperty,o my employee with wages as their sole compensation, 304 - ROUGH RT.FrT14AL
will ne the work,and Ne oructure is not intended ore feredLaw for snot(Seeapply Sou, 5 01 - FINAL ERFtP RfllQi�Ec i@NERGY '
Business and Professions Code:The Cves dia is.and w Law does not apply to an
ref his
thereon,and who does such work nhimself 505 - FINAL ELECTRICAL
or through his own employees. building
that such improvements within
not intended or
completion,
for vie.If,ho-build the building er improvement is sold within one year ofoprove for
th<Owner-builder will have the bvrtlen of proving that he did not build os
improve for purpose of sale.),
.. °L as owner of the property,am exclusively contracting with licensed contractee to
onw
sa the pmjm(Sec.7644.Business and Professions Code)The Conttacmr's
License Law does not apply to an owner of property who builds or improves thereon,
and who contracts forsuch projects wit a commcmr(s)licensed pursuant to the AUG - - -
Cenmr
oacaLicenseLaw 2 6 2002
❑lam exempla S J ...,.B& Cfor this reason
ORKER'S CO�r�N5AT10N7 CfAR�0�
BUILDING
1 hereby affrtn under penalty of perjury one of the following declarations:
° I have and will maintain a Certificate of Comm un self-insum for Worker's
Compensation, as provided for by Section 37M of the Labor Code, for the
perfomtance of the work nor which this p<mtit is issued.
°1 have and will maintain Worker's Compensation Insurance,as required by Section
37M of the Labor Code.for the performance of the work for which this permit is
issued.M Workers C 'a.uI a In mance carrier and Policy number are:
vr�Cp stbloss4�
anile.
Policy No
CERTIFICATION OFEXEMPTION FROM.WORKERS'1 ' s
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars
15100)or lcssJ
1 certify that in the psrfomtance of the work for which this permit is issued,I "
shall not employ any Person in any manner so as m become subject m the Worktio
Compensation laws of California.Date
Applicant ._
NOTICE TO APPLICANT:If,after making this Cenificnte of Exemption,you should
z 0 borome subject to the Workers Compensation provisions of the Labor Code,you must
forthwith comply with such provisions or this permit shall be deemed revoked.
F .�. CONSTRUCTION LENDING AGENCY
Ci } 1 hereby M.that there is a com nd ion lending agency for the perf orm nce
of the work for which this pc.it is issued(Sec.3097,Civ.C.)
gL Q Lender's Name .. .... _
U Z Lcndcr's Address
U 0 1«reify tha 1 have read this application and orae the above informmnn is \
correct.1 agree to comply with all city and county ordinancane
es and state laws elating
U 1.buildingprop"d hereby of this cityto enter upon
} A. the abo(We)agree I.property for ify and
purposes.
sl:y d (We)agree m save.indemnifyand
expo and which
hm may
in the way a emengainst against
V]' liabilities,judgments,casts anti expenus which may in any way accmc against said
U ZKgzanx
ntingof thispermit.
0.NDWILLCOMPLY WITH ALL NO -POIN Issuedb
V/
Z y Date
nD e ' Re-roofs
US MATERIALS DISCLOSUREmore building«copam start m handle actimaus ounce, Type of Roof -
as defined by the Cupenmo Municipal Code.Chapter 9.12.and the Health and Safety '
Cotle,Section 25532(.)?
°Y" All roofs shall.be inspected prior to any roofing material being installed.,
Wrdousll she applicant Ormfuts o Wildinggbythe nt Bay
irQualityment or .nage ant If a roof is installed without fust obtaining an inspection,I agree to remove
emit hazardous au contaminants Or Fors as tilting by the Bay Area Air Quality evicts mem
Dis°'c" all new materials for inspection. Applicant understands and will comply with
°Y`a o-H`� all non-point source regulations. PP P.Y
I have read the hazardous materials xquitements under Chapter 6.95 of the
Califomia Health&Safety Code.Sections 25505.25533 and 25534.1 understand that
if Ne building does not currently hiss-a¢runt,that it is an,responsibility to notify the
cupant of the require uu be met prior to issuance of a Ce tem f
ccupency.
Signature of Applicant Date
oa All roof coverings to be Class"B"or better
OFFICE
A
��- CITY OF CUPERTINO
PESIIT APPLICATION FAM
CUPERTINO
APN # � — -� Date:
d�
Building Addiess;
�` D/07Gb17
OwnerName: one #:
ContractoasCO License #:
Contact: ,Qra/�, _7qS(Ve� Phone #:
Applicant/Contractor:
Building Permit Info:-
Bldg
nfo:Bldg Elect Plumb Mech
Job Description:
Residential: Commercial:
Sq.Ft. Floor Area:
ArchitectlEngineer: Valuation:
Type of Construction: Occupancy Group:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER" Other Lkppliances MECHANICAL
BBLD TEE -B-Idg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> IOOK 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/ uasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax —Resi/Mobile BUILDING
BELEC1000 Elec 600V<= 1000A ELECTRICAL
BELEC1001 Elec 600V> IOOOA ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BNERGY Energy BUILDING
BENERGYADD Eneray Add Multi BUILDING
BINVESTIGA I investigation fee BUILDING
BMITIGATC I Comm. Housing Mit. Fee BUILDING
1 of 3
d
;�� CITY OF CUPERTINO
°TM° P�ZIT APPLICATION F&M
CUPEI�TINO
Adlk Quantity Fee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BNUSFD New Single Family Res PLUMBING
BOVERTIME In ection Overtime BUILDING
BPBACKFLOW . Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE — ..Bldg Permit Fees BUILDING
BPFIXTURE PbIg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i eOfFixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen TrapPLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMA UiAN A/C Units<= 10,000 clin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> IOK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE1 Pole/Platform Fixture ELECTRICAL
2 of 3
Iap
CITY OF CUPERTINQ.
CITY
CUPER,TINO P&�IT APPLICATION FIRRM
Quantity Fee ID Fee Description Fee Group
ww BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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
BSF&2FAM Single &2 Family BUILDING
BSFNA Single Family New Add BUILDING
BSPECIAL Special Insection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
• BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE " Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
3 of 3