05010092 CITY OF CUPERTINO wy
BUILDING DIVISION PERMIT ='CONTRACTOR...... MATION
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BUILDIIgc ADUREss: DPR CONSTRUCTION INC PERMIT NO.05010092
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OWNER'S NAME: PERMITL4UEDATE
E:
SANITARY O ROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+n+Op LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that I am licensed under previsions of Chapter 9(commencing S9 gy6
wiA$mJOO TIXIU)af Divi'on3of NC Business and!Professions Code.and my he r\ n
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in roti Tares arta erfmt_ 133o2 TI- -MEDICAL BLDG. PHASE 3 t
p LiccA.Class Lk.♦ I� f5
Dma 4 Contractor OAR oIS AUL tic NJxl". ( �L�\'✓
ARCHITECT'S DECLARATION
I understand my plans shall W used as public recordt
M / V 2005
a;.A.r^ Licensed Professional
3 OWNER-BUILDER DECLARATION a
ii 1 hereby affirm Aat 1 em exempt from dR Centnnofs License law for tbe i' \� . r
00 following ream .(Section 7(D 13,Business and Professions Code:Any city at county Ire ��1F
x S which requires a permit m ennswn,altar,improve,dmallsh,or repair any somaLma li�• I �, 1, !;\! �I -7
prions its issuance.also mt,nms the applicant for such permit to rile aligned statement — – –• - _
a thathe isliceased pursuam to Ne previsions Af the Contmcmr's License Low(Chaptel9 Sq. Ft.Floor Area - Valuation
QFC (commencing with Section 7")of Division 3 of the Business and Professions Code)or
A, $ that k u exempt hemfmm and Ne baso for the alleged ewnptian.Any violation of
86100000
Section 7031.5 by any applicant for a permit mbjccu dm applicant to a civil penalty of APN Number Occupancy Type
not mere than five hundred dollars($500).
❑I,uawner of Ne propmy.ar my cmploycu with wegesu Acir role cempcnsstion,
will do Ne work.and Am swew¢is nut intended oroffcred fornia(Sec.7044,Business 3 16 0 9037 . 00 Required Inspections
and Profusions Cade:The Contractor's License Law docs nos apply to an awoer of q P
property who builds or improves thereon,and who does such work himself or through his
awn employees,pmvided that such impmnmenu sue not intended aroRcsed for sale.IL
however,the building at improvement is sold within ane year of completion,Ne owser-
builder will have the burden of proving that he did not Wild at improve for purpose of
sale.).
❑h as owner of the property am exclusively contracting with licensed convectors to
construct Are pmjcct(Sec.7(L44.Business and Profusions Code:)The Conanduar's U.
cave law dors not apply to an owner of property who Wilds or impmvu thereon,and
who canmcu for such projects with A contracwr(s)licensed pursuam to the Comtrmsoex
License law.
C]1 am exempt under Sec. B&P C for this ration
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury arc of the following declarations: '
1 base and will maintain a Cmiricate of Consent to tilt-insure for Wod¢rs Compere
am on,u provided for by Section 3700 of the labor Code,for the performance of the
work for which this Permit is issued.
❑1 have and will maintain Workcls Compensation Insurance,u required by Section
17W of the Little Credo,for the performance of the work for which this permit is issued.
My Wartefs CounKnotion Iman.gl��Ad W. rM:
CarrientdR7fyaj�C BN1AN Poli No.: we 633 dY3 a36 jXr. 9/t/oS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W cemPIAW d if she permit is forone hundred dollars(5100)
A,less.)
I amity that in the perfarmar.of the work far which this Permit u issued,l shall not
employ any person in any manner at As At become subject to me Workers''Compensation
Laws of California.Dam
Applicant
NOTICE TD APPLICANT:IL after making this CCNEc'am of Exemption,you should
become subject te the Worker's Comperuation previsions of the IaWr Cade,you most
.,,Z forthwith comply with such provisinns or this Permit shall be deemed reeked.
Z Q CONSTRUCTION LENDING AGENCY
[r.N. I hereby affirm that Acre its comunion lending agency for she performance of
C' the work fur which this permit is issued(See.1007.Civ.C.)
W Q lender's Name-
D.
Le
ndcr's Address
U Q 1 certify An 1 have read his application and now that da a Wve information u
It, F-' correct.l agree to comply with all city and county ordinances and sum laws relating A
0 building communion.and hereby authorise representatives of Ads city to CARL UPnn the
W above-mentioned pmperty for inspection purposes.
(We-)agree to save,indemnify and keep hasmleas the City of Cupertino against
H LaA liabilities,judgments,costs and expences which may in any way accrue against midCity
U Z s Permit.
APPL CANTCof the granting of UNDERSTANDS ArND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGUL(aT10NS.
ntlCom y o IGS Re-roofs
Signawrc of ApplicaHAZARDO Dow
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or futureWilding ams Rom or handle hu4rdous materiel
u defined by the CupM
ertino Municipal Code..ChChapter 9.13.and the HcalA and Safety
CWC.SectionYea 25512(a)? �a All roofs shall be inspected prior to any roofing material being installed.
❑wa
Will thea applicant or future building Occupant aro equipment Ar devices which If a roof is installed without first obtaining an inspection,I agree to remove
pp g pan yuipmc
A hazardous air contaminants As defined by she Bay Arca Air Quality Managcmcm all new materials for inspection.
istrict?
❑Yes
I have mad he Amardeus materials requirements under Chapter 6.95 of Ac Califor-
nia Health&Safety Cad.Sections 33505,25533 and 25534.1 understand Astir he Wilding
dos not currently have a tenant.that It is my msponei hility m notify the occuP LM of Ac
mquimmenu syhich mussbemc0 'omni ane,or.cernEeme of Occapmcy. Signature of Applicant Date
Owner or mthorizc0.,at Data
4/ All roof coverings to be Class „Be or better
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CITY OF CUPERTINO �'//j,8" P6 M17- #b
BUILDING.DIVISION PERIYIIT COA'�IT'RAOaTOR INFE;(}R14�T'ION�; oS"-o
BUILDING ADDRESS: PERMIT NG.
19000 HOMESTEAD RD DPR CONSTRUCTION INC 05010092
OWNER'S NAME P1DACr LSUE DATE
KAISER PERMANENTE 1450 VETERANS BLV 04/13/2005
. PHONE: SANITARY NO. CONTROL NO.
4082365514 REDWOOD CITY, CA 94063
ARCHr1ECDENGINFFp. PHONE N: BUIIl]DIGPERMITINFO
TI--MEDICAL BLDG. (PHASE 3) rumG ELECT PLUMB MECH
omz O O O O
a
a
�u� ? ",IRI�,+ i � -t TO ARRANGE INSPECTION JOB DESCRIpI'ION
m PE
POW
''gra Call 777-3228 between 7:30 a.m.and 3:30 p.m., RESIDENTIAL:
' "- ` Monday through Friday,at least 24 hours before Cl SFDWL ❑ KITCHEN REMODEL
=�$-m FOUNDATION/PLERSIRD.S. requi If inspection. Job address and Permit Number C1 ADDITION ❑ PLUMBING RE-PIPE
�y i UFER GROUND � tied when requesting an inspection. ❑ Mt1LT1-UNIT 0 STRUCTURAL
o d u MODIFICATION
asG PAD/SET BA LE [J�' COMMERCIAL_OTHER— ❑ INTERIOR .0 CHIMNEY REPAIR
GARAG UAB GUNITE IMPROVEMENT C1 SWDAMINC POOLS
�o04POtIE)E� - CRECE � ABOY xH�SBEENSL - `" HA7ARD0 ISFIRAHA ❑ HATH KEMODELREPAIR(3 DEMOLITION
C1 aTHJER
UNDERGROUND/SLAB YES Ir undersand tial a am A mar axmhl a
rzi ❑ y?- rumquim
°sc` UNDERGROUND PLUMBING
m ❑ NO IniliY LCH.O,f
UNDERGROUND ELECTRICAL 1,11, COMMERCIAL
. `,`.jStp'NQTyPpGi1;SEL0L}L2; _� QY;$3P1'A.".,ofBEFxf SIGNED �-; FXIm__NG ROOF COVERING ❑ NEW BLDG/ADOrTION ❑ DEMOLITION
UNDERFLOORPLUMBING - ❑ TENANT ` ❑ FOOD SERVICE
UNDERFLOOR MECHAMCAL Numtxr olaisdag covvings IMPROVEMENT
UNDERFLOOR ELECTRICAL To be mmavcd To be reuined C3 OTHER
UNDERFLOOR FRAMING VENTS
UNDERFLOOR INSULATION
kPLACENf TItBFLOO QPEYILPRSOVEf)'eSSI$ ETk51GNER TYPE OF ROOF COVERING
"" R' ""�" &�7STiNG: PROPOSED:
ROOF SHEATWOLAPHRAGM
PLUMBING ❑ Built-Up Roof C] Built-Up Roof
TUBS A SHOWER PAN C3 Asphalt Shingles C] Asphalt Shinglex
MECHANICAL ❑ Waod Shakes ❑ Woad Shakes
ELECTRICAUPOOL BOND ❑ Waod Shingtes ❑ Wood Shingles
FRAMING/STAIRS/E.EGRESS ❑ Osher(Spedfy) ❑ Other(Specify)
INSULATLON/VBxrILATION NO FINAL. INSPECTIONS Provide I.C.B.O.Report Na
_.,
f;eGYERNapRxrnnao�EHaserEN,sIGNEDx=
UNTIL ALL REQUIRED BUSINESS
ProideM(g.InedldooSpe .
EXTERIOR SHEARJHOLD DOWN -
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEE-MOCK SHEAR INSPECTION SPECIAL INSPECTION REQUIRED p DATE INS?
LATH/W-SCREED
SHOWER
SHOWER LATH
-f);[Ox1'APE f1FtrPGASPER+UFFLIC,ci{-B,�ttF7w".',eI
SCRATCH COAT S
SEWERIWATER 2 NO� ��
TEMPORARYAPPROVALS
OCCUPANCY - A ..
Z $F0A_05%.�xa �as °. -FRa� Q ��BC !�!�/�R)i.v ✓GCS
Z o PLANNING 777-3308 CUPEWTINO SANITARY DIS RICT
r? Closed circuit video inspection of property line cleanout,point of connection
> GAS TEST and sheet lateral required prior to passing FINAL CITY PLUMBING
?I p GRADE(P.W.777-3354) INSPECTION. Call the District(408-253-7071)for an appointment.
Z) Z FIRE-CALL(408)378-1010
J O HANDICAP
>MjELECI'R1CAL IMPORTANT
.r>„ y PLUMBING
J Z MECHANICAL - When a permit has expired,a charge totaling one-half the fees to
ENERGY obtain a new permit must be paid to reactivate the permit.
VISUAL FINAL ONLY
BUILDING [f a permit has been expired for more than one year,a charge totaling
+�V_m the full fees to obtain a new permit must be paid to reactivate the
OCpC�tFE M1.
J NffIYRE,WTIIStt:iC+)ED.. YsBP ' -==`= 0s A='x'e;; CERTIFICATE OF OCCUPANCY ❑
• PRE-(NSPECTION: -�11-2--
/,•`// PLYWOOD: BJ-PROGRESS:
INSP, DATE -- INSP. DATE INSP. DATE
TEAR OFF MSPECTION: BATTENS: FINAL:
INSP. DATE WSP. DATE FISP. DATE
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
r Community Development
10300 Torre Avenue
£" Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
41UPEkTINO
Building De artment
JOB ADDRESS: 19000 HDPERMIT # OS o 1 Oo
M�STBRo RD
OWNER'SNAME: K46PA PeN&'NTe PHONE # 40$-2-36 -ss/4
GENERAL CONTRACTOR: DPA 4Pr45rRuc-T10H 1AC. 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
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
• Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing ALLIFW6 kooF/N
Septic Tank
Sheet Metal
Sheet Rock
Tile
• DS�I�/oS
er/Contractor Signature Date
CITY OF CUPERTINO
CITY OF - PERMIT APPLICATION FORM
CUPEkTINO
APN # 316 o9 o 3 T Date: 09//7,/os
Building Address: Mailing Address (if different from building address):
19000 FtoM�sre19 0 RA
Owner's Name: KPhone#:
KAISER- PER-MRN EN TE 409-239 -SS- /4
Contractor: License #:
DPI GDNSTRyt:T/oN, SNC.
Contact: 5oECN6EN MUL/q Phone: (sJo-$2;--T9i$ Cupertino Business License#:
Fax: -$ _ o
Building Permit Info:
Bldg R Elect ❑ Plumb ❑ Mech ❑
Job Description: I NSTyLL ROOF SCREEN /
Residential ❑ Commercial Lld
Sq.Ft. Floor Area: 1 ZJ OO O SF $/Sq.Ft.:
Cost of Project: �INCLOccupancy Group:
(� t1DL�D tN TH6 U06 COST)
Type of Construction: 0 -P SPRINKLE& Please check this box if the project is a
T I - MCD i CRL L 6 N SFr 3 second-story addition: ❑
Pro'ect Size: Standard ❑ Laze ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
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
r , 1173 z
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(Q- CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
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
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 rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain & 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
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 Device/Apparatus ELECTRICAL
BREMRECEPT Rept], Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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hQ.- CITY OF CUPERTINO
W. .•'
CUP-,Ty0 O PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
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 Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Plan ing Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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