06030159 CITY 0ffCUPFICIIN0
BUILDING DIVISION PERMIT CONTRACTOR 1NT0RMATION:
BUII.DINC ADDRESS: PERMIT N0.
1.01.05 DE ANZA BLVD
":R'S NAME: PERMrt ISSUE DATE
CBRI CUPERTINO LLC 03/28/2006
PHONE: SANITARY NO. CONTROL NO.
ARCI IITECTIBNGINHER: BUILDING PERMIT INFO
BLDG LLfCT PLUMB MECH
�Op LICENSED CONTRACT'OR'S DECLARATION Job Description
fm 1 hereby afford that 1 am licensed under provisions of Chapter 9(enmmencing p
to in aScacraaddefefpivixinn3drthcBusin a dProfcasinnsCnk,endmylicen is REPAIR OF WATER DAMAGED W J TD CLUDING
in full fame and B of IJJT (++I//���I
o t(
: License rasa Lie.N DRYWALL 14 MINOR FRAMING MIXED(t
F� Da¢ Conrad.. /LJ\ I' 2D
ARCHITECTS DECLARATION w/.BVI ILly jt fes—'
d< 1 understand my plans shall M used as public records
JyU
s c.s Licensed Professional A On �a
a OWNER-BUILDER DECLARATION AVR OG ZOOfs
u<� I hereby allirm that I am exempt from Ne Contractor's License Law for the a
5O o following reason.(Section 7031.5,Business and Professions Code:Any city or county
y$V which mquires a pemtir ,,construct,aIle,improve,demolish,or repair any structure r
_26 prior to its issuance,also requires the applicant for such permit to fleadtried.statement
E tont he is licensed pursuant the previsions of the Contractor Licence Law(Charter9 Sq. Ft. Floor Area U I
at (cdmmetci ng wi to Section 7")of Division 3 of the B address and Professions Corm)or
y that he is exempt tltcreftnm and Ne basis for de alleged exemption.Any violation a(
Section 7101.5 by anyapplicant for a permit subjenus the applicant to a civil penalty ofaaOccupancy Typ
e
not more food five hundred dollars P$500). 3700
❑I,as owner ofthe morality,. my employees with wages as their.snit compensation,
will do the work,and We structure is not humored or offered for sale(See.71144,Basilicas Required Inspections
and Professions Code:The Conduct License Law does ads apply to as Owner of q p
Property won huilds lir improves thereon,and who does such work himself or borough his
own erdpldyces,provided(former improvements are not amended...Brand far sale.If.
however,the building or improvement is sold within one year of completion,are Owner-
bullAcr will hnrc the burden of proving than he did not Mild or improve for purpose Of
sale.),
1,as owner of the properly,am exclusively contracting with licensed contractors to
r
suvctthe pmjem(See.l(WI,pusiness and Rofessious Cale:)The Coloracmr's Lioe law dills not apply t.ad made,of property who builds to improves thereon,ando rommcd for auc projeed with a c.mrsetor(s)licensed punuam to the Contractoransc Law.
1 am exempt. , Sec. .B&'PSP CC ffomltis..an
'ler Dam ✓
OM PENS ATION DECLARATION
I hereby oflirm ,malty of perjury One of the following declaretinns:
d
❑ ILO ve:rdwill maintain a CenConsent iflcam of Conseno self-insum for Workers Camped.
mrian,st provided for by Section 37M of and Labor Code,for the performance of the
work fm which this permit is issued.
❑ I have and will maintain Wdrkcr's Compensation Insurance,as,eyuired by Section
37W of the Labor Calc,for the Performance or Ne work for which this pem,ir is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Carrier: Policy No.:
CERTIFICATE OP E%EMI410N FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dolls t(9HM1)
r less.)
1 ccnify that in the remormancc or the work for which this p,.it is issued I shall not
cmPlayed,personbn:ftly mango sn y�s,,tr�s�geaa'am.�vo��Inthe Wnrkcri C.mpcnsatinn
laws of California, c �47A K
Applicant
NOTICE TO API', IL of r looking this eni fcate or Had.prion,you should -
become subject to rhe War gRompeosation previsions of the Labor Code,you must
.7. 7 fanhwi t it cnmpl y wit h auc h imvidmaxor this perm i,shall be deemed mvliked,
iZ,r'O CONSTRUCTION LENDING AGENCY
E—r I hereby affirm dial dmrc is a construction lending agency l'or the Performance of
Q'.> the work far which this permit is issued(Sec.3897,Civ,C.)
W Q Lender's Name
1<ndar's Address
D
U Q I ccnify that 1 have mad this application and sum del the above information is
W Fcareer.1 agree at comply with all city and coumy eminences and slate laws dilating t.
�U building construction,and hereby amhonoo mpresenutives of ads city to enter upon the
Y'OU above mentioned pmpany for inspection purposes.
a. (We)agree m save,indcmmry and keep harmless the City of Cupninn against
rFr N (abilities,judgments.cold and expenses which may in anyway accrue against said City
U z incnvsequence.fdre mn mgcillm,permir.
^ APPLICANT UNDERS \NDS AND 1 L COMPLY WITH ALL NON-POINT Issued by: Dale �,� C/C
SOURCE RErUU'N
i
Re-roofs
Signato.e OI ApfRicarNPon
IIAZ/j/RDO'r Dam
I MATERIALS DISCLOSURE Type of Roof
no
Will dm a,plicom ol(olys2huilJing accupam srom lir hanJic hovallous mnrcrial
a,derided by the Copeland Muni opal Code.Chapter 9.12,and the Ilcalth and Safety
Ge Sc Yea,25532('I)1 All roofs shall be inspected prior to any roofing material being installed.
,l
❑Ycs No
Will the applicam or future building acupam use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazadmn air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Dlvict7
❑Ycs u
I have mad Nff uisards maten'alkmyvimme no imad,Charter 6.95 of d,Cali In,
,is Health&Safety look,Se'uom 255(152 533 and M5b l todcmmid thus if tic hu dog
es
donor cunendy h{ to lit,dust isy respamjdality In notify(M relies.,of the
rcyuircmcndwpfc dotted our 4smare ora CcNRcaue..rood Signature of Applicant Date
Onhtrtiaed agcnt� Dam All roof coverings to be Class "B" or better
® CITY OF CUPERTINO
I[: 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rug: Sub: Elk: Lot:
APN . . . . . . . . : 35909017.00
DATE ISSUED. . . . . . . : 03/28/2006
RECEIPT 4 . . . . . . . . . : 33769
REFERENCE ID # . . . : 06030159
SITE ADDRESS . . . . . : 10105 DE ANZA BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CBRI CUPERTINO LLC
ADDRESS . . . . . . . . . . : 280 SECOND ST, SUITE 210
CITY/STATE/ZIP . . . : LOS ALOTS CA, CA 94022
RECEIVED FROM . . . . : ANDREA JULIN
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
® TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 147.96 71. 02 0. 00 71.02 0. 00
BPERMFEE VALUATION 8, 000.00 147.96 0. 00 147.96 0.00
BSEISMICOM VALUATION 8, 000.00 1.68 0.00 1.68 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 220.66 0.00 220.66 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------ .
OTHER 220.66 M/C
TOTAL RECEIPT 220.66
March-23, 2006.ti_
°� t� r • Andrea Julln
Corporate Realty Management
280Jecondit juite 210.
Los Altos., CA 94022
Re• 16105Y. DeAnza 61.
RICHARD
PED]LkV Cupertino, CA �
ARCH3T3:bT
rvTrnorsx•rw.'Nmc Dear Ms.Julin: l `°i r
On March 17, 2006 1 conducted a site inspection of the recently
completed construction'at.10105j.:DeAnza;61, Cupertino,,GA
I looked at the plywood sheathing;:nailing,seismic holdowns,
building paper, insulotion and,gypsum board. I found that they all
were Installed to current"construction standards.
If you have any questions regarding this issue please contact me
at (408) 244-5200.
® f incerely,
Richard J. Pedley
Architect
J
NO.0 '9
OFF GON CUR
1793 Lafayette St: .Suite-2404 Santa Clara,Ca. 95050
Tel: 408.244.5200 Fax: 408.244:5240-ricchardpedley.com
Community Development
�` 10300 Torre Avenue
Cupertino CA 95014
„'ke�""9✓�
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Dartm ent
JOB ADDRESS: PERMIT #�
OWNER'S NAME: G�ErLI PHONE #
GENERAL CONTRACTOR: N?_ FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
C�n - wtlu(, �KIL S c.�asT2.a7 OZ
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal l3 d Y1�
Painting/ Wallpaper
Paving Ace 4-10
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock �h6J�l W1
Tile
Owner o tractor Signature Date
aT(F�7, CCITY OF CUPERTINO
CUPFI�TINO PERMIT APPLICATION FORM >�03� L5
APN # Dale:
357 69 O/ Mares 2-0 200
Building Address: Mailing Address (if different from building address):
I610S S. be, s� S 216, l ps lt1lh&, 16'0 2
Owner's Name: Phone #:
12� LZYf1v�a i w usro . 55%. %%/3
Contractor: License#:
Contact: Phone:kbjY G)S2s JIM Cupertino Business License#:
Q Fax:
Building Pennit Info:
Bldg 9 Elect ❑ Plumb ❑ Meeh ❑
Job Description: eR%iz eP uAi 2 S *tfl �,A,quq,t-t ILYuz,,nn, > � "%" D2 R A-AIU.,
Residential ❑ Commercial rt1 v
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: j0CC)
Occupancy Group:
Type of Construction: � / ^I Please check this box if the project is a
V I second-story addition: ❑
Project Size: Standard ❑ Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOTLER2 Boiler> 100K to 500K Btu MECI4ANICAL
BBOILER3 Boiler> 500K to 1 M Btu MECHANICAL
BBOiLER4 Boiler> IM to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/ nasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONS'rAXR Constax — Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
® BINVESTIGA Investigation fee BUILDING
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CCa. CITY OF CUPERTINO
cmbF PERMIT APPLICATION FORM '
CUPERTINO
Quantity 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
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPTNTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Re eat Fee BUILDING
BPRE PIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Stomi/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt ofDrain & Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLT Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANTCAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res AP21iance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREAIRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res A22liance ELECTRTCAL
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CITY OF CUPERTINO
CUPERTly"Or O PERMIT APPLICATION FORM
)ijantily Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BRENIVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Seb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECTAL Special his ection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Eleebical sq foot ELECTRICAL
je EPERMITFEE Elee Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Chane BUILDING
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