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05110117rZ 74 CITY OF CUPERTINO..�+craxa CORAC'i'OYi INfSRMATIUIV BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. SOUTH BAY CONSTRUCTION CO INC 05110117 0 GOMMARIANI AV PERMIT ISSUE DATE :APPLE UUMPUIER (PHASE A) 1/U KNOWLES DRIVE, STE 12C SANITARY N ARCHITSCII NGINEER: - m3 U U BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description o 1 hereby anion Net 1 am licensed under provisions of Chapter 9 (commencing with Serums 7")ofDivisia 3 ofte Business and Profession Code.andm Ixcnseu in null force and n. -'- 3 Llccnse CI s Uc. g S ' TI -RESTROOM CORE/HVAC/NEW WALLS Data Co.. ARCHIECTSDECLARATIO( DOORS/PAINT/CONF ROOMS/KICHEN I understand my plans shall bo used As public records TEMP PERMIT #06010031 (EXPIRES 02/05/06) Licensed Professional OWNER -BUILDER DECLARATION 1 hereby eRrm that I am exempt from the eomranres License law for the following reason. (Section NO 1.5, Business and Profexsions Cock: Any city m county which requires a permit to construct, after. improve. demalish, or repair my gmcmre prim m its issuance. also requires the applicant for such prrmit to Ne a signed gatametn that is licensed pursuant to the provisions of the Contractor's Umnn Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Sutton 70110) of Division 3 of the Business and Profession Code) or But he Is exempt therefrom and the basis fee the Weged exemption. Any violation of APN Number Occu Section 70313 by any applicant for a permit subjects the applicant to a civil penalty of not mon than five hundred dollus (M), 0 i, As ownm of the property, or my employee with wagers theirsolo compensation, 316 2 2018. 0 0 Required Inspections will do Be work, end the mucncre Is mommeded reopened fresele (Sts. 7014, Business and PmfeaelDa Code: That Contricmh License law dm nm apply m an reveres of who W improve Here who dauuchwmk himself rrthmugh his man prove prover fee ownemployes,provided antear dwutaer, of cmplersed prsaltimprovemattare however. de Wilding ord"of pnantissold Sem of completion, Ne owner- did builder vena have the Wrdan of proving that na did not bold or Improve for purpose of e 1 �G / tile.). 0 I, as owner of the Property am exclusively contracting with licensed comractars to comwn the project (Sec. 7044, Basement and Profession Code) The Conactofs U. cells law dors not apply to an mune of propeny what Wilds or improve Nems, and, who contracts for such pmjccm with a eonmemr(g) licensed pursuant to the Commences Lice. law. 0 l an exempt undee Su. , B At P C for N4 reason Owren Data WORKERS COMPENSATION DECLARATION 1 hereby affirm under Penalty of perjury use of the following declarations: ❑ I ham and will maintain a Cen(Oate of consent toself-insure for Workeea Campen. , orlon, As provided for by Section 370D of the Labor Code. fee the, performance of the work for which this Permit is issued. 011 have and will maintain Worker's Compensation Inunna, u required by Section 3700 of the labor Code, far the Performance of tbo work for which Nu Permit is issued My Workces Compensation bur nae unif and Policy number are: Greer. QP�7CERIFIC��ITION FROM WORKERS' COMPENSATION INSURANCE (Thissecdon mud not W completed If Ne permit is forma hundred dollars (SIM) m ICM.) 1 anify Net in the performance of the work fee which this Permit is issued, I snail not employ any person in any mannerm as an become subject o the Workea'Compenetion Iowa of California Data Applicant NOTICE TO APPLICANT. IL after making this Certificate of Exemption, you Mould become subject to the Worker's Compensation provision of the LAW Code. you mus, forthwith comply with such prevision or this permll shall bo deemed revoked. CONSTRUCTION LENDING AGENCY 1 Wmby affirm that then is a cotuwcuan lending agency for the Pcrtmmancs of the work for which this pemtit Is load (Sec. 3097, Civ. C.) Lendoes Name Lander': Address I certify that I have reed this application aad sun Nu the above information is ' cmnen. l DIM to comply with all city and county ordinances and ren laws misting is building construction, and hereby authorise representatives of this city m enter upon the shove -mentioned Property for inspection PuIPOsea (We) agree It, Rave, indemnify and keep harmless the City of Cupertino againsi liabilities, judgments. costs and expense which may In any way acres against old City in consequence of the granting of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIIONIN ,J��/// Re -roots Type of Roof -7 /V signuurc pplie vcmnuacm HAZARDOUS MATERIALS DISCLOSURE Will the Applicant or fumrr Wilding m1mpantg0se or handle haeallous material As dcOned by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety Code. Section xss3x(.)7 Dy. PAll II(No roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will de applicant .,r. Wilding outspent use equipment or devices which hursrdnus air conuminanu As dcfiud by the Bay Area Air Quality Management all new materials for inspection. District? EJ Yes 1?(Nu I have mal the banrtd nn materials requirements under Chapter 6.95 of the Cali for. nit Health &SafelyCDde, Socdou 255(15.25533 And 25531.1 undeerand dm if the Wilding does not currently how a nnanl. that It is my responsibility to notify the occupant of the requirements which mug be/oet pri2Liwmce inuof a Ce OrAm of Oce Signature of Applicant Date iJ —sSLL�/F� V All roof coverings to be Class "B" or better Owner or esurrim0 agent Dan.'W CITY OF CUPERTINO BUILDING DIVISION PEP"ITT I AV PERMIT NO. SOUTH BAY CONSTRUCTION CO INC 05110117 PERMrT ISSUE DATE PHONE: Al'eJ h UUMYU'1hX (YHALih A) 1 /U KNUWLES llKlVE, S'J'E 12 SANITARYNO),3/2U/2OUrf®OLNO. ARCHITECT/ENGINEER: (21IJ6) _3 /_4-5bUUBUILDING PERMIT INFO BLDG ELECT PLUMB MECH = LICENSED CONTRACTOR'S DECLARATION ° Job Description F 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing 1) `try' with Section 7000) of Division 3 of the Business and Profession.% Code, and m license is w in full force and ct. — ' " 3 - Cl k ? a;s Lic p atc Contractor /Oog^t+S' /'v' Date TI -RESTROOM CORE/HVAC/NEW WALLS ARCHI7ECT5 DECL.ARAT10 DOORS / PAINT / CCNF ROOMS / KI CHEN U 1 understand my plans shall he used as public records TEMP PERMIT #06010031 ( EXPIRES 02/05/06) f- Licensed Professional v � OWNER -BUILDER DECLARATION g 1 hereby affirm that I am exempt from the Contractors License Law for the °y' following reason. (Section 7031.5, Business and Professions Code: Any city or county ty which requires a permit to construct, alter, improve, demolish, or repair any structure y prior to its issuance, also requires the applicant for such permit to file a signed statement < that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 Sq. Ft. Floor Area Valuation p (commencing with Section 7000) of Division 3 of the Business and Profession% Code) or that he is exempt therefrom and 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 APN Number OCCu e not more than five hundred dollars ($500). 0 1, as owner of the property, or my employers with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law docs not apply to an owner of 3 16 2 2 0 18 0 0 Required Inspections property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for We. If, It owever, the building or improvement is sold within one year of completion, the owner• builder will have the burden of proving that he did not build or improve for purpose of sale-). 0 1, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li- cense Law docs not apply to an owner of property who builds or improves thereon, and , who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. 0 1 am exempt under Sec. B & P C for this reason Q Z H U LQ (1. Ln Z Owner Date _ WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penally of perjury one of the following declarations 0 I have and will maintain a Certificate of Consent to self-insum for Workers Compen- sation, as provided for by Section 3700 of the Labor Code, for Ilse performance of the work for which this punmh is issued 0 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Cartier. at,—:A J (I C T,1&nV,J_L Policy No.: 03/ 2?_ 2 — I 1 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he completed if (he permit is for one hundred dollars ($700) or less.) I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workeri Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Ccniricatc of- ,, omptio� n, you should become subject to the Worker's Compensation provi,-,'ions of the Labor Code, yotl!must fonhwith comply with such pmvisiom or this permit shallye deemed mvokcd. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ, C.) Lender's Name Lender's Address 1 certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned propeny for inspection purposes (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATION Signature ofAppli l/Contracto Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by (he Cupertino Municipal Code, Chapter 9.12. and the Health and Safety Code, Section 25532(a)? 0 Yes XNo Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? 0 Yes 140 I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Cmdc, Sections 25505, 25533 and 25534. I understand that if the building docs not currently have a tenant. that it is my responsibility to notify the occupant of the requirements which must be e( prior to issuance of a Certificate of Occ cy. no Owner or au orized agent DaLC Issued by: Re -roofs Type of Roof Date _�;i 2,d _-) All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better CITY OF CUPEkTINO CITY OF CUPERTIl. 0 ..�, , j PERMIT APPLICATION FORM APN # Date: Fee Group BAPPLOTHER Building Address: FhAc A Mailing Address (if different from building address): CA C. Owner's Name: Phone #: MECHANICAL Ljog -q-14 - Z_1 -5i Contractor: License #: BBOILER3 _ kiq Co ct: Phone: 6?v--..86a ZL2 2LI Cupertino Business License#: y� C ii Fax: - /185' MECHANICAL Building Permit Info: /vett,, 4vvq c,,5 -- (6 f P— �%Aw �►'� , W � ��IS i ��Ys ('�;Kt � C�,� r . �� 5 � V-1 Boiler > 1.75M Btu Bldg Elect PlumbMech KI Job Description: N'e-�% sT��cr,.�- G,o► e, r✓,2u, qv-,6<-� - s, ►��r�, ��i�` c4, F. ,�� s r A14 Residential El` -1 Commercial - Sq.Ft. Floor Area: $/Sq.Ft.: Ind/Off/Conun/Quasi z� 37 i�, Co t of Project: Occupancy Group: RT TTT TITAT(: Type of Construction: Please check this box if the project is a 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 BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1 M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Conun/Quasi BUILDING RPnXTCT A XRn ('nn Tn..- fnr 11() 7nna RT TTT TITAT(: 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 1 of 3 es, 40 FAX 408 771 J:1J:i L l 1 1 1.W, I.— ... olu�l �p, Disabled .Access UDreasonable Hardship Application k-ojett Address: 00'—JO-0 M A -it A A--t.-L % PN ti— >,4 v E_ Owner. Telzybaa2 ;;o_: Applicant: Pett No.: (Complete Part I OR Parts II h Ag Part I I am the owner/adept for the Above referenced property and attest that ALL required acc,ss:ble. ,evures weer the )atest edition cf Title 24_ The. efore, an unr"sez;2ble hardship for dis2b!cd access is ^or zpp!icab!e to this property cr this project. SIGNATURE DATE PRINT NAVT- : J/ t Part It: z) Whac is the cost of the project (valuation)? 2) What is the cost to provide ALL required 2ce&-ss features' s') To provide AJC required access features reould incre2se coostructiaa cost by howmuch' )'def 4) �m�� is What is the 2mount aecess2ry to qualify for o, f :he exception' (20% of valuation) , r (Soo."e amount ccs shaven en Section G, Parr 111) 5} 12-m the of the 2bove refrrenrrdproperty smd•attest that etre stro-oe costs Arc accurate and trut. I 2➢50 -2 ree to allocate expenditure for the accessible Ceatures as described oo the back of this Application. SIGNAL URS F'`rLllr'T NA�'� DATE