03110062 C[TY Ol"CUPEISION ,v'C0 ' %RA0T R
nuu,mrvc orvrsloN PER CON PrI2ACTQRINFORMA�IN
vi" ,T t
BUE.DINGADDRESS: TEAM SERVICES INC PERMIT ND03110062
10101 N DE ANZA BLVD
OWNER'S NAME: 3028 SCOTT BLVD, STE C PERMIT6UEDATE
M7 CORPORATION 11/12/2003
E (408) 982-0373 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
i o o LICENSED CONTRACTOR'S DECLARATION-
<�E 1 Thereby affirm mat 1 am Raasm under provisions of Chapter 9(commencing Job Description
'ztu with seaion7IXg))or Dimsmn3or The Busirresa vena Promssirm code.and myfiaaae is
or to"
TI-ADD 2 PASSAGEWAT DOORS
>,y,? License Class Lie.k
c, Dam Contractor
5t3 ARCHITECTS DECLARATION
4 e a 1 understand my plans shall The used as public records
Tau
m t— Licensed Pmfcssimal
"OS OWNER-BUILDER DECLARATION
"sed a y 1 hereby affirm That I am exempt from tire Contractor's Liccnsc Law for The
00 following mason.(Section 7031.5 Business and Professions Code:Any city it,county
<m which requires a Permit to construct,alter,improve,demolish,or repair any structure $5000
O¢O prim to its issuance.also mquims the applicant for such permit to rile a signed sutemenl
<
That he is licensed pursuant to provisions of me commcmra Licenso law(Chapter9 Sq. Ft. Floor Area Valuation
YFG (commencing with Section 70(10)ofDivision 3orthe Busiomsand Professions Codd)of 32634071 . 00
.y $
That he is exempt therefrom and Ne basis for The alleged uemption.Any violation of
Section 7031.5 by any applicant for a permit subject meapprcao.toadvilPenaltyof APN Number Occupancy Type
not more than five hundred dolm.S u5oo).
❑I.as owner of the patiplay.or my employees with wages as Their sole compensation.
will do The work,end Nc swcture is notinrended or offered rarsalc(Sol.7044,Business Required Inspections
•
sod Professions CadTim e Contractor's License Law docs not apply to an owner of 9 P
property who builds or improves thereon,and who does such work himself or through his
own employees provided R aT such impravcmanu are not intended or offered for sale.If.
howeveq The building or improvement is sold within ane year of completion,the owner-
builder
wnerbuilder will hart The burden of proving That be did not Wild or improve for purpose of
sale.).
'®1,as owner of The property,am exclusively contracting wit licensed contractors to
?paused the project(See.7044,Business and Professions Code:)The Carrs acou's Li- �S
come law dose not apply to an owner of property who Wilds or improves themon,and,
no contracts for ch projects with a contramons)licensed persua m m The Contractor's
WLa .
❑lam ea der Sec. .B&PCT Thix n )
,� to
WORKER'S COM PENSATION DEC ATION
I hereby affirm under penalty of perjury one of c nllowimg declarations:
I have and will maintain a Certificate of Consent To self-iesum far WarkceaCompen-
sation,as provided for by Section 3700 of the labor Code,for The performance of The
work for which This cermil is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
37W of The Libor Code,for the pcdprmance of The work for which This Permit is issued. '
My Worker's Compensation Insurance carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORK ERS'
COMPENSATION INSURANCE
(This section need not W completed if the permit is rm one hundred dollars(Slot)
Thr less.)
1 certify that in the performance of The work for which this Permit is issued.l shall not
employ any Person in any manner so as in Weome subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should .
become subject to the Worker'sCompensation provisions of the labor Code,you must
Z Forthwith comply with Such provisions or This permit shall W deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
I hereby affirm That there is a construction lending agency for the performance of
x > The work for which this Permit is issued(Sec.3(Y)7,Civ.C.)
W cz Lender's Name
Leader's Address
U Q 1 molly That 1 have read this application and sum that the above information is
B. F correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building consumetion,and hereby authoriID representatives of This city to enter upon The
r fA abovcmcntioned poultry for inspection purposes.
(We).,me to,save,indemnify and kccp harmless the City of Cupcnino against
F' f4A Iiabilitics.judgmens oesand expenses which may in any way acerae against said City
U Z APPLICA TU De RSTANDSIAND rWILL COMPLY WITT]AL NO OINT Issued by: Date 1/
SOURCE r: 10
IL 4
Re-roofs
Si (cord npprca'Z-ZR O Date'HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ill the applicant or future building occupant store or handle hazardous material
as do tied by the Cupenion Municipal,Code,Chapter 9.12,and the Health and Safety
Codc,Section 25532(a)' All roofs shall be inspected prior to any roofing material being installed.
❑Yes [ Nu
Will me applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
.mit hvardous air conmminans as defined by the Bay Area Air Quality Management all new materials for inspection.
Diseia7
El Yes IQ No
Ihavc mad Thc hear smamrials mgnircmcnu under ChapmrR95 of the Califon
ria Hcalth,k5afmyCoes255115.25533.dM534.1undcrsundmazifiM Wilding
dors mol curcmly n ant.Thal it is my responsibility m noufy I c cupant of thc
mquimmemsw en t n rtuissganeenracenirmmoro m�anc Signature of Applicant Date
z�a
ownm ser au orir.cd agent I .gym All roof coverings to be Class "B" or better
FCITY or cuPER•I•tNo �EUILDING DIVISIONPERMIT s�CON,TRAC POR INFORMATIONDING ADDRESS: TEAM SERVICES INC PERMITNOO 3110062
101 N DE ANZA BLVD If 100
tl'47
'SNAME: 3028 SCOTT BLVD, STE C PERMITISSUEDATE
CORPORATION 11 12 2003
(408) 982-0373 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECTE
PLUM!B MF.CH
1
I" LICENSED CONTRACTOR'S DECLARATION
e.5 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
$iw with Section"ILYIU)uf Dlvlxion 3nf the Business and Profession,Cade.ind my license is
mfull rrreeamdeffeet' TI—ADD 2 PASSAGEVIAT—.DOORS
License Class Lit.N
�Fo Date Contractor
to ARCIIITECIS DECLARATION
f z 1 understand my plans shall Iw used as ti.hire records
JyU
Licensed Professional
OWNER-BUILDER DECLARATION
171 hereby affirm that I am exempt from the Contractor's License Law fur the
p o following reason.(Section 7031.5,Business
and Professions Code:Any city or county
<m which mqulrm a Permit to consumer,dtcr,improve demolish,m repair any structure $5000
u—w prior it,its issuance.also requitestheapplicmt btrsucb permit m file asi,rodmitement
7 u
�' that heislicensedpunuano(bepmdxionsoftheContracto.xuanseLaw(Chapter9 Sq. FL Floor Area Valuation
e=G (commencing with Section 7000pel Division 3 of the B others and Professions CerB)or
05§ that he is exempt therefrom and the bxsu for the alleged exemption.Any violation of 32634071 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
not more than five hundred dollars(S50 B.
❑I.as owner of the pon,seny,or my employees with wages m their sole compensation.
will do the work,and the structure is not intended or offered for sale(Sec.7W,Business
and Pmressiosu code:The Contractors License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
ownhow employees.me
provio r improvement m t such imprntFmcnts are ne intended or offeredmpletion.for sai owner-
Willer a me building u eofprovis sold within one year or completion,the res,r
builder will have the burden of proving Na M did not Wild or improve for puryam of
sale.).
1.as owner of ct property.,Business sivnd conuasi ns wire licensed crnoactos i.
M um La me project LSec.oBaa,wneoand professions ds or
The Contractor's nd .
come law core not apply fin er owner of pmmny who Milds or improve menton,and /
who wmvcs for ch pmj¢u with aconuamor(s)licensed pursuant to the Convector's
License La .
1 em gx der Sec. .B k P C R Nis on
L�unt 11 12 p D�
WORKER'S COMPENSATION D116aagAtlON
I hereby off m,under penalty of perjury one of t ollowing duelantiom:
ve and will maintain a Certificate of Com ent to self-insure for Worker's Compete
sationgas provided for by Section 3700 of me labor Code,for the performance of rhe
work for which this permit is issued.
❑1 have and will maintain Workcrs Compensation Insurance,as required by Section
37B)of thc labor Cock,fur me performance of me work for which this permit is issued.
My Worker's Compensation Insunme carrier and Policy number art:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed fine permit is for one hundmd dollars(3180)
,at less.)
1 eenify that in the performance of the work for which this Permit is Isvutd.I shall not
employ any person in any manner an az lu Become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this CeniEcate of Exemption,you should .
become subject to the Worker's CrmP:mmlon provisions or the later Code,you must
Z forthwith comply with such Provisions or this Permit shall be deemed marked.
Z O CONSTRUCTION LENDING AGENCY
I hereby affirm that mem is a consometion lending scene,for the Performance of
D: the work for which this permit is issued(See.AA7,Civ.C.)
W Q 12nde,'x Name
S Lender's Address
� z
J Q 1 certify that I have read this application and sure that the above information is
correct.1 agree to comply with all city and county ordinances and state laws Fluting to
V building comammd(n.and hereby amhmixe mpresenutisu of this city to enter upon me
T ulahave-no ntioned pmpcny for institution purpose:.
y (We)agree to save,indemm fy and keep hamaeu me City of Cupertino against
F-' N Liabilities''it la oxo and expenses which m ay in any way accrue against said City
L)Z in consequrf a ranting of this Permit
^ APPLICA U RSTANDS AND WILL COMPLY WITH AL NO DIM Issued by: Date
SOURCE E 10
Z B Re-roofs
S1 store A plica mr.mcmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ill the applicam or future building occupant surtc nr handle hanNuua material
4 red by the Cuyenino Municipal Cork,Chapter 9.12,and me Health and Safety
.section 25532L)P All roofs shall be inspected prior to any roofing material being installed.
❑Yea 11�10
Will mea applicant or future building t use equipment ordcvices which If a roof is installed without first obtaining an inspection,I agree to remove
pp g bythe Bit
ier, m air eonlvninanu az Jc6ncd by me Bay Arca ph Quality Management all new materials for inspection.
fin?
❑Ycs No
I have mail me Maar s materials requirements under Chapter 6.95 of the Cakfor
nia Hcalm65afcry dc, tens 25A15.25533and25534.lundcrae dmaifmc Wilding
Jnm not curtcnrly ag am,mm it is my respunsibility ro nndly r e receptor or me
mquircmcnix ch t n kq' rwissuanceoraCenlficide. cupwmy SignatureofApplicant Date
71i / /z�a
Ownmmsu r i.ndagtnt ( are All roof coverings to be Class"B" or better
(( CITY OF CUPERTINO� o 6
CITY OF PERMIT APPLICATION FORM U ll
CUPEkTINO
7PN #3-l6 � � O � / Date:
Building Address: Mailing Address (if different from building address):
X9xo% 'N �z �tiin `3 �Z foo
Owner's Name: Phone#:
m.� Lei• as cc O✓� Joe o Sa O'l i 2
Contractor: License#: -7 I SS Z
Contact: \ 1 Phone:`We B 30 0-1' Cupertino Business License#: •-7
_�o c vel �+✓� Fax:Lto 850 o-io\
dilding Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Job De, ption: NA&I's z wty
Re ' ential ❑ Commercial 1)S r
-Sq.Ft. Floor Area: S/Sq.Ft.: c 'D
Cost of Project: o Occupancy Group:
Type of Construction: a 'c is _ h c is a
• eco -s oradditi
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu. MECHANICAL
BBOILER2 Boiler> 100K 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/Quasi 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 > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
Z3 7,*7
lof3 / 0
;P z 3 /•
an *ITY OF CUPERTINO*
CITY OF PERMIT APPLICATION FORM
CUPERTINO
nQuantity Fee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Farmly 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
BOVERTRAE Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pb1g 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 e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
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
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI 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 MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Devi ce/A aratus ELECTRICAL
2 of 3
Slum-
OTY
tITY OF CUPERTINO°F PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BREMRECEPT Rc tl, Switcb & 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
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
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Change BUILDING
i
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