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1590 CITY OF CUPERTTIINO APPLICATION FOR COMMERCIAL BUILDING PERMI PERMIT NUMBER ��9Q AND CERTIFICATE OF OCCUPANCY e BUILDING INSPECTION DIVISION STREET ADDRESS OF PROJECT: s • . . e O.6�30.... aG �ir'z� �L. ✓A _ Plans Received By.................. _ ........ _...... Date _.. ........ Legal Description: Tract. . ..... ...... Block....... Lot..................... REO.: Plans.... Survey.... Calcs: Struc.... Energy.... Elect._.. Mach..... Description of Work: .. .C,LU..._....._.................._.............. .......... Plans Checked By............. .. Date .. . . 1st Struct. Improvement on Parcel: Yes.... No.... Area of Bldg,. p P 9og........... Application Approved By . . ... . -__._.................._Date .�� IQ .0..�. Separate Structure. .......... or Addition/Alteration to Exist. Bldg........... Validated By....... ...--- ..._ _ ......Date _ _. ... ...... No. of Stories �.._ Use of Build in ,��raia L!l�...... Compensation Certificate Verified By .... _ Date Valuation f Pro ct $ ...r�DO_P$ _ e 'e •• e ,�� $ Owner �.OtwH�&✓/W Pho e' Permit Fee (plus penalty f a Ilcable Contractor: GAL H � Ay Bus Llc.#,-4AS,6L..(� (P P ep PP ) ... ...)$.. �.Q..... Address:L/L4/iJ[.e�.I1JE:IV JL __ Phone:2-,�,9/gyp / Plan Check Fee (less deposit of$ _ Pct. # . .... ...._ -- Energy Plan Check Fee (Dapyof$.-g;7Z.,Rct�#........)$......_._......._... Contractor - Electrical: .0 ^'v_._../✓.. .. .. _______________________._.. Strong Motion Fee ....., . .. ..... .. _. ._.$ �..$-Q... City Business License #.�8' ¢ Phone .. . Plumbing Permit Fee „" ........$ ___ .___,. Plumbing: .._...._ _ _....... _ . .. ... .... Electrical Permit Fee .._.....r�.UV �� City Business license # .... Phone .... ......._...�-......._......$... .� ..... Heating and Cooling Mach. Htg./Cool9. Permit $ ..............................$.............. ..._._......................._.......... :.................... Construction Tax...............:..........^. r� $......... _. City Business License #. ............... Phone:.................... , '••'•"•'•••••••• Architect/Desi Designer: Phone:.............------ g ..........-......._....._........_........_. Sewer Conn. Fee _._.._..... Water Conn. Fee.............$.- ....... Engineer: ..__....._._............ Phone:.......... Landscape Fee ...._.._........... Street Tree Fee ............$......_............... .._........._..............__...._. Unknown Lender: ......._ ._ .._........_ .---_.. ._...... ....[� ........... Misc. Fee .._._ .... ............ $ ..,. .._... I certify that in the performance of the work for which this permit Is *y„ ,; e %ya!; $ w (' issued shall not employ any parson In any manner so as to become subject • to the workman's compensation laws of California." Type Const......... Group........ Div......... Occ. Load....... No. Exits........ SIGNATURE OF Floor Loads: 1st.,. 2nd.... Other.... Sprinklered._. Area Sep. Walls_.. APPLICANT/OWNER ._........................................._..................... DATE .............—............ FTff#M 4 If ' ,A.S,`„ <;;_,_ ............ I certify that as the applicant I am licensed under the provisions of the Contractors License Law and further that my License No. ............ Environmental Status: Exempt......... Other...................__................. In Classification _....._...... is In full force and effect: or Design Review Approval: Bldg. ..._....... Site .... SignI certify that I am exempt from the "Licensed are,'ped" provisions of the "'""'"""'" Contractors License Law. (State basis of exemption., Use t.Zone ........mit P.D. Conditions _..........................pa Sid...- I hereby acknowledge that I have read this application and state that the above Is Cond. Use Permit #..._. Variance #..... Parking Spaces.... Load. Sid... correct and agree to comply with all City Ordinances and State Laws regulating Approved By---......._...._......._...... ....... Date .......... building. ., 1 (We) agree to save, indemnity and keep her less the City of Cupertino -,i y..o. o- e against liabilities, lutlg me ms, cost and nses which may in any way NOFncroachment Permit ..._...... ... Grant of Easement r secure against sold City in tons uenc f ha gr ting o this permit. --- SIGNATURE OF J Q Curb, Gutter, Sidewalk,. Driveway: Replace Repair APPLICANT/CONTRACT .. .. ........ ATEA D.. Sewer............ Conn. Fee $............... Water..........._._ Meter $................ /.. .._ f. NOTE: When props y valitlas s loan constitutes a Building Pennell. This Agreement for Completion of Public Works Improvements ...............— permit expires and becomes null antl void should work not be commenced within Plans Checked By........ Date........ Approved By........ Date.......----.... 120 days from validation date, or should authorized construction be suspended or Zz abandoned for a period of 120 days altar work Is commenced. ERMIT L TOTA LNUMBERcle INSTALLATION than11000..... NO.. . EACH FEE Gas SYtemPERh IT I S INSTALLATION ,_F r.lr�y e o- b L,,^re ........ INSTALLATION NO EACH FEE Fixtures ..... ........................... $ 4.00 ( ) $ .50 Each additional outlet ............................................ 1.00..........'­ Range ... Range........ Cooking Unit........ Oven........ ... ................. 2.00 . .............. Water System (Installation, Alt. or Repair) ................ 4.00.............. Dryer....Garb. Disp..... Dishwasher.... .._.... .__......_ .... 2.00 ........ ..... Water Closet.... Water Heater.._ Ld. Tray.......... ......... . 4.00....._....... SERVICE OR TEMPORARY POWER to . . ... 2.00 ....._.__.. Lavatory.... Shower Pan.... Bathtub.... Sink......... 3.00,_„_,....___ ............. 100 amp/$5.00, 200/$7.00, 500/$9.00 Wash. Mach..... Dishwasher.... Garb. Disp..... .... .-...... 3.00.............. 800/$20.00. 1200/$40.00 ..............._.._ .._._.........._........... ..........__. Sewer ..................... ...... ................. .....---......... ......... 8.00, ............. MOTORS,Generators,Welders, Heaters, Lawn Sprinkler Sys. $6.00 Ea. add Sys. $2.00. ................................... per HP—KW—KVA to 1/$2.00, 5/$3.50, Vacuum Breakers ........... .................... ..........._ 4.50 ..._.. ... 20/$6.50, 50/$10.00, 100/$12.00, Slop Sink........ Floor Sink........ Floor Drain ................ 4.00.............. 500/$15.00 ..............._................._..................__..........._.... .... Urinal.... Interceptor.... Water Softens r.... ........_............ 4.00 ............. 4.00 Signs with I XFMR .........._........................... ...../.._.... 2.00 -.o•._,.... .. Plumbing Piping without-fixtures ..._................. ............ ............. Each additional XFMR/Time Clock .................... .50 ................ Misc. .................._.........._......._............. ..................._....._...._.........._....:. Annual Electrical Maintenance ............. ... 25.00 ...._..........' Permit Fee ................_. .................................... $ 6.00 Other (see Ordinance Current) ................................................ _..... ...... TOTAL PLUMBING PERMIT FEE (plus penalty if app. p) $ ..... .. _ _ ..__ ..... ... .... .,I. _ e Permit Fee ..........--........................................................ $ 6.00 PERMIT INSTALLATION NO. EACH I FEE TOTAL ELECTRICAL PERMIT FEE(plus penalty if app.❑) $GG O. Forced Air Unit...............to 100M ................................. $ 6.00 ............... ",�l° e "• s r ae ;„ .-„ .r. , :.' over 100M ...... ___--- 1 D.00 . Comfort Cooling Unit.....to 3 ton/HP .........—................ 6.001............... Forms / Foundation............................... By:.................. Date:................ to 15 ton/HP................ ........... 9.50 ............... Plumbing Ground Work ......................... .... .........................----........ to 30 ton/HP.......... .... ........ . 2 ..............00 .. ".......ugh Electrical ............ _ ........_.............._.................. to 50 tan/HP ,willillsib 17 me - Plumbing and Heating ............. ........................ Space Heater........ Wall Heater ......................................s.Do ............... . 'ulation / Energy............................... ............—..................................... Flues - other than above .................................... ............3.00 ............... GasTest ......................................—.—...................—................................. Vent Fan: Kitchen........ Bath .................--.................. ...3.001............... Temporary Power Gas / Elect.................__.......................................... Commercial Range Hood .............................................. 8.00 ............... Final - Electrical ........................................................................................ Misc. .—...—..........................................................................IS..................... Final - Building/ Mechanical .................................................................. Permit Fee ...........—.........................................................$ 6.00 Final - Design Review / Landscaping .................................................... TOTAL Htg./ Coolg. Permit Fee (plus penalty if app. p) $ Final — Public Works........................................................... Sheet 2 • Ya • CITY OF CUPERTTINO BUILDING PERMIT Permit No: Address: 114610 • 1 Date: BUILDING PROJECT IDENTIFICATION \5'ORKEAS'COVPENS.ATION DECLARATION Applicant's Mailing Address /6e/ ��-.�JgDf^��. I hereby affirm that I have a certificate of consent to self-insure, or a certificate of Workers'Compensation�}]nsur�n or ertified Address of Building 0 �6/�i✓ �s19. cop)'thereof (Set 50..�b.C.�.C—/Y�r/i :l Ad Policy No. Cumpany ® Certified copy is hereby furnished. Owners name Certified copy is filed with th coun wilding ' spection Telephone No. �departmen ordcyunty de t n nt. , Date M t7gPPlicant Contractor's Name N r GsDL- ayvV Contractors]tailing Address 9 CERTIFICATE OF EXE\IP ON FROM WORKERS' COMPENSATION INSURANCE Cc. No. (This section need not be completed if tete permit is for one Architect or Engineer hundred dollars 15100) or less.) Architect's or Engineer's Address I certif) that in the performance of the work for which this permit Lic. No. is issued,I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. LICENSED CONTRACTORS DECLARATION Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of I hereby affirm that I am licensed under provisions of Chapter 9 Exemption, you, should become subject to the Workers' (commencing with Section 7000) of Division 3 of the Business and Compensation provisions of the Labor Code, you must forthwith Professions Code,and my li ense is in full force and effect G� comply with such provisions or this permit shad be deemed revoked. License Claryg - S Lic. Number.3 Date ✓✓—� O Contractor Cql—N CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the Performance of the work for which this permit,is issued,(Sec.3097, OWNER-BUILDER DECLARATION Civ.C.).Lender's Name 1 hereby affirm that I am exempt from the Contractor's License Lender's Address • Law for the following reason (Sec.7031.5, Business and Professions I certify that 1 have read this application and state that the above information i Code: Any city or county which requires a permit to construct,alter, s correct. I agree to comply with all city and county improve,demolish,or repair any structure,prior to its issuance,also ordinances and state laws relating to building construction, and requires the applicant for such permit to file a signed statement that hereby authorize representatives of this county to enter upon the he is licensed pursuant to the provisions of the Contractor's License above'-mentioned property for inspection purposes. Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he is exempt therefrom and Signature of Applicant or Agent D.te the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500).): ❑ 1,as owner of the property,or my employees with rages as -OWNER-BUILDER VERIFICATION their sole compensation, will do the work,and the structure is not intended or offered for sale (Sec. 7044, Business and Professions "Attention Property Owner. "An 'own Code: The Contractors License Law does not apply to an owner of er-builder' building permit haz been applied for In property who builds or improves thereon,and who does such work your name and bearing your signature. himself or through his own employees, provided that such "Please complete and return this information in the envelope improvements are not ini ended or offered for sale.If,however,the provided at your earliest opportunity to avoid unnecessary delay building or improvement is sold within one year of completion,the in processing and issuing your building permit.No building permit owner.builder will have the burden of proving that he did not build will be issued until this verification is received. or improve for the purpose of sale.). 1. 1 personally plan to provide the major labor and materials for construction of the proposed property improvement es or no ❑ 1,as owner of the property,am exclusively contracting with � P W P Pe Y P _ fY ) licensed contractors to construct the project (Sec.7044,Business and 2 i (have/have not) signed an application for a Professions Code: The Contractors License Law does not apply to - 6nepP an owner of property who builds or improves thereon, and who building permit far the proposed work contracts for such projects with a contractor(s) licensed pursuant to 3. 1 have contracted with the following person(firm) to provide the Contractor's License Law.). the proposed construction:Name reason am exempt under Sec. , B.&P.C. for this Address City Date Owner Phone Contractors License No. 4. 1 plan to provide portions of the work, but I have hired the following person to coordinate,supervise,and Provide the major work- Name Address City Phone Contractors License No. 5. 1 will provide some of the work but I have contracted(hired) the following persons to provide the work indicated: Name Address Phone Type of Work • Signed: Property owner Social Security number Date: