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02050052CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS WY E AND E -PING S O PHONE: ARCHITEC (ENGINEER: a WOW 6u - PIERS Required Inspections z 103 y = LICENSED CONI Z ° Z!2 1 h by Rmt that 1 am lima a y y with geaion ]DqB) of Divixion is in full fo rc . pi nd eRe<t. Lic u C l �3LL� e F �= ° g Y a xi 1 uneersmn / pla � O O Licensed Professi ER Sod uv� ; he eRnn Ibex 1 a s a following mason. 9071. O rcqui pcmti permit which sea a I re t, 3 $ uinswn, ,p�nm,o ns issuance, aisortquires the: CONTRACTOR INFORMATION: PERMIT NO, BB CONSTRUCTION 1 02050052 3535 ROSS AVE. STE 105B I.... 057657-2002 (408) 266 -6266 SANITARY NO, CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MUCH O LUJ l_I I -' 1 TOR'S DECLARATION JJp D cri Iron roar pmvmtana of chapters rcommI ng LIVING SPACE 2 9 3 0 S&U . pion J inde,pnd Pmfessio C e. end license g O� O GARAGE 452 SQ.FT. or ARA O .-. fib_ act _.s _.L IR DECLARATION O3 from the Contractor's License Low for the the basis for the alleged exemption. forapetmit subjectsthe ap,Iv.r to. :.ions Code: The Connatun -s License Low does not apply to an Who builds or improves thereon, and who does such work himself i employees. pmvidd that such improvements are nor intended or hdweven the building m improvement ii sold within one year of dc,baildc, will have th bandcociff,hrovic, thth did no, Wild or 11: as rwna nl property, am exclusively contracting with licensed contractors; to ,minact the project (Sec. TWO, Business and Professions Cori The Contractor's icense Law does not apply to an owner of property who builds or improves thereon, ad who contracts for-such, pmjacts- with.a carnations) livensed.pursuunr.sa.the ntiecmrt License Law.. 1l am exempt under Sec:','• s'rt .1 L' 1T;B'& PC for this season .. .. .., . e Iwn2r '.'.. ..;bate'. '.... WORKER'S COMPENSATION DECLARATION "f I hereby affirm under penalty of perJ'ury one,ufthe.following decimations: - I I hhdetand will maintain a Certificate of Conscm to self -iasure for Worker's 'omprnation, aa- provided for by Section 3900 of the Labor Code, for the erfonnence of the work far which this permit is issued COMPENSATION �URANCE' '• a fTh s union need n ul h comple¢d if the pemdt is for one hundred dollars I c n f th t in th K m a ce'of the work for which th y pe perm,, is issued; 1 ^hall'no, employ .any person to an conduct so as to trCmac subject tO the Worker's' nnhwuh comply with such pro visions or this peout hall be deemed revoked. CONSTRUCTION LENDING AGENCY'-'- '"'' Moil he¢tiy oRim Mat there is a cmadra&ian lending agency for the verrinuenee sf de work for which this'permit is issued (Sec. 3097; :enders Name - '. _enders Add es '. ^ ;t; 1 certify that 1 h d this m application and at that the above nl rmat on is meet 1 agree to e mply with end county ordinances nces and one laws mlming o building cnmmcto end abya zi tipmuctinal ixtifthis ctyt eon upon he W e mnoted pro pecuon purTa (We) aBrte m. , to comfy and keep hmmless she 6y of Cupcnfno against iabilitica judgmcat costs a expenses which may in any way aceroa against said -ity in conseq - of ag' t mu, \P LICANT DF Vin. DWI L COMKYWITH ALL NONAPQYNT' I�iRCERP : P`'• i11IJ.:., O Y. Will RIALS DISCLOSURE a. Chap store or handle Hc.I,h sea Sex ft, ]e, Chopmr 9.13, and,he Heahh and $a(ery' occupant use equipment or devices which 1U1 — PVU1V Lt'a11 VLV 102 - PIERS Required Inspections 103 - UFER 105 - ANCHOR BOLTS 106 --- - ---- SEWER .._ &..WATER -, -- - 202 - UNDERFLOOR PLUMBING - n 203 -.__. UNDERFLOOR - MECHANICAL---- ------- ----- - - -- -- 204 - UNDERFLOOR+ `,FRAME ;or 205 - UNDERFLOOR INSULATION 301 - ROUGH PLUMBING 302 - TUB & OR SHOWER 303 -.ROUGH MECHANICAL 304 - ROUGH ELECTRICAL 305 - FRAME 306 - HOLDOWNS 3'07',- INSULATION-•- .,,:: SHEETROCK�. S10 ,, ,_ , .,... -. q. 310 = INTERIOR LATH; ”' r' _: _.- :_,.:..3.1.1.- .._,=: SCRATCH,.. COAT _.:.__- .__,.............._._ :- _:,•— __- ............_.- -_a._. 313 - ROOF .FINAL, - ,ELECTRICAL_ ENERGY, -_ __.... _ -. __.- ._..._. 502 - FINAL PLUMBING ENERGY 503 - FINAL MECHANICAL ENERGY 504 - FINAL BUILDING ENERGY''1- 505 - FINAL ELECTRICAL - - 5'06 _ -GAS- TEST- -- __ . .- - - - - -- 50 - FINAL PLUMBING' 5 8 - INAL MECHANICAL 5 NAL DE 5 51N A:- NAL RKS �� Issued by Date Re -roofs ... i _. _. ,. s ........ ...--- y_.........e.-------- .._ .......d......... ._. If a roof is installed'Without first obtaining an "inspection,= 'I'agie "e'to'remove all new materials, for „inspection.. Appllcan[ understands and will,co_mply with,____„ all non -point source regulations_,;,(,,,, Signature of Applicant -. ,,.._. _ . -. _ - -__ Date__, _ All roof coverings to be Class, B or better OFFICE- ......_......_.... .._..._ 41TY OF CUPERTHNO CITY OF F ERMHT AF UCA 1L RON IF®RM CUPEkTI O �zo�� APN # Date: Building Address: Owner's Name: Phone #: , � �, o F- ,70�� o Contractor: License #: Contact: Phone #: r: Applicant/C2e- Fax #: 1 ' g Permit Info: Bldg Elect Plumb Mech escription: Residential: Commercial: Sq.Ft. Floor Area: o $ /Sq.Ft.: Architect/Ener: � Valuation: �— Type of Cons tion: Occupancy Group: l:St•�'`� r •ILA. Quantity( Fee ID a Descri ption ]Fee Giro APTFEE EACH STORY OVER 3 HOTELFEE ` EACH STORY OVER 3 OFFICEFEE EACH STORY OVER 3 BAPPLOTHER Other Appliances 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 BELEC 1000 Elec 600V < =1000A , ELECTRICAL BELEC 1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL H EMERG Y Energy SUR LDING BENERGYADD Energy Add Multi BUILDING BEWESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BNEWMULTI New Multi-family Res ELECTRICAL � je27® 1 of 3 P. �r��i r VJ0FC_F � ZF Z ¢ rn¢v EEOO : 2 0 Z F n � � a c-Oyt• F 04 iy vr- m >• e c...n �c v FZ> � F_ - a3" - i r ®e �C CITY OF CUPERTINO - - BUILDING DIVISION Pj['j �* su �p g7�7� a/; �y• �C®I�17�11`hli1CTOR ffi1V1L' O `✓y��1 Yi BUILDING ADDRESS: 789? , ROBINDELL WY BB CONSTRUCTION PERMIT NO. 02050052 WE' UGO E AND E -PING S 3535 ROSS AVE. STE 105B APPLICA05 /09/2002 PHONE: (408)266 -6266 SANITARY NO. CONTROL NO. ARCHITECTIENGiNEER: 4 BUILDING PERMIT INFO BLDG ELECT PLUMB MECH r —U U LICENSED CONTRACTOR'S DECLARATfON [ hereby affirm that I am licen undo provisions of Chapter 9 (commencing Job De cri t10n l 'T with Section 7 ) of Division 3 e B as and Prof C e, and licerrse LIVING SPACE 2 9 3 0 T. / is in fall fo �✓r— GARAGE 4 5 2 SQ FT Lice se Ch Lic. S . . D e _ n tor VI LARA O I una pub ' tds Licensed Professi 1 R LDER DECLARATION I her affirm that I a xempt from the Contractor's License Law for the following reason. (Section 7031. , Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure 0 - prior to its issuance, also requires the applicant for such permit to fib a signed statement thal he is;licemfed pursu5nfto the provisions of the Contractors License Law (Chapter 9 Sq. f t Flook -Area, . t l r -I �4 ' Valuation (commencing with Secqq'on 7000) of Division 3 of the Business.and Professions Code) or that he is exempt theteffoin and the basis for the alleged exemption. Any violation •' 3 6 2� 19 .I j ^ , 0 � 4 0 .0 APN Number Occupancy Type of Section 7031.5 by any applica t for a per-tit subjects the applicant toa civB penahy of not more than five hundred do ars (x500). ❑ 1, as owner of the property, ur my employees with wages as their sale compensation, 101 - FOUNDATION " will do the work, and the structure is not intended or offered for sale' (sec. 7044," Business and Professions Code: The Contractor's License Law does not apply to an ---10 2 - - PIERS - - - Required Inspections ' owner of property Who builds or improves thereon, and who does such work himself 103 - UFER or through his own employees. provided that such improvements are not intended or offered far` ile. lG however, the building or improvement is sold within one year of _ - 104 - RE BAR - - completion, the owner- builder will have the burden of proving that he did not build or 10 5 ANCHOR BOLTS improve for purpose of sale.). - ... _ -- - - - - -- - -- -- - ..... ....... ❑ C mss owner of theproperty, am exclusively contracting with licensed conuactots to ... 106- - --SEWER--& WATER construct the project (Sec. 7044, Business and Professions Code:) The Contractor's 202 - UNDERFLOOR PLUMBING License Law does not apply to an owner of property who builds or improves thereon, and who. contracts for.such projrrts .with_acontractor(s).hcensed pursuant. to the . _ - 203 - UNDERFLOOR - -- MECHANICAL CAL- Contractors License Law. ❑ 1 am exempt under Sec.' . B & P C for this reason 204 - UNDERFLOOR ' FRAM$ Gwner_ Date 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION 3 O l - ROUGH PLUMBING • I hereby affirm under penalty of perjury one,of the following declarations: 302 - TUB & OR SHOWER ❑ 1 have'and will maintain a Certificate of Consent to self -insure for Workers 303 - ROUGH MECHANICAL Compensation, as provided for by Section 3700 of the Labor Code, for the 304 - ROUGH ELECTRICAL performance of the work for which this permit is issued. 3 0 5 - FRAME ❑ I hale' Anil will' maintain Worker's Compensation Insurance, =red by Section 3700 of the Labor. Code, for the performance of the work for which this permit is 306 - HOLDOWNS issued. My Workers C mpensation Insurance Cartier and Policy number arc: �.9 307 -.- - INSULATION ¢r.,m .CERTIFi_ 308' - 'SI EETROCKt t - 10N OF E EM OM.WORKERS' GANCE . COMPENSATION . 3 0 9•.- - EX-'IERI.OR., - -.LATH - ._.._ .... _ .. ' • (This section need not be completed if the permit is for one hundred dollars 310 - - INTERIOR LATH (s100)or- less.) 31.1 - -- SCRATCH COAT •. - . I certify that in the.perform5nce of the work for which this permit is issued,.[ 'sh'al( 313 - ROOF NAI Ii' •- not employ my person in any manner so as to become subject to the Worked Compens:ationLawsofCalifomia .Date Applicant -- - • - -- 501 502 - FINAL- ELECTRICAL ENERGY - - FINAL PLUMBING ENERGY NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 503 - FINAL ME CHAN I CAL ENERGY CONSTRUCTION LENDING AGENCY, 504 - FINAL BUILDING ENERGY • I hereby effum that them is a construction lending agency for the performance ' 505 - FINAL ELECTRICAL of the work for•which this'permit is issued (Sec. 3097, Civ. C.) [finders Name. - - ..... -.. 5 0 6' - GAS TEST_ . . L.enaers address 50 FINAL PLUMBING I certify that I have read this application and state that the above information is correct. 5 ICAL I agree to comply with and county ordinances and state laws relating to building construction; and reby a orize representatives of this city to enter upon 5 the above - mentioned pro pection purposes. (We) agree to s e, in maify and keep harmless the City of Cupertino against 5 "NRKS liabilities, judgment costs a expenses which may in any way accrue against said City in conseq of e g in ermit. 5 RKS -�/ P 2CENT D DWI LCO�IPLYWITHALLNON 0[NT Issued bDate r S gdatur .of App m Cont mcr, D Re -roofs HAZ�tb S MATERIALS DISCLOSURE Will the applicant.or re budding occupant store or handle hazardous material Type of Roof - - tried by the Cupc�ino unicipal Code, Chapter 9.12, and the Health and Safety Code; Section- 23532( ? ❑ Yes, "° All roofs shall roofing.materi ng installed. ._ be inspected prior to.any bei Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? all new materials -for inspection. Applicant understands and will comply with ❑Yes No • •t all non - point _ source regulations. I have read the hazy s m vials requirements under Chapter 6.95 of the Califomia Health & Saf ode lions 25505, 25533 and 25534. 1 understand that _ - if the building does cu-1 aant, that it is my respons'bihty to otify the occupant of the irements w ' h mus met prior to issuance o Ce ificite of Occupa"cy Signature of Applicant Date All roof coverings to be Class "B" or better sorter a dmorized a t OFFICE- Mad Z OO m U 6t...Z b <a Z Z O;O a�F-t Y�22 " XOaV �3u,F F�0 r�al�p0 wow F?Q F a3� O Q z, a0 �z U wF O Uz CITY OF CUPERTINO BUILDING DIVISION PEROT BUIL'018a4,13DRRsDBINDELL WY BB CONSTRUCTION PERMIT NT 2100015 OW`0UFAYAF: HUGO E AND E —PING S 3535 ROSS AVE. S TE 10 5 B APPLICATIgt "NY 2 0 0 2 // PHONE: 4 O H 2 6 6 — 6 2 6 6 SANITARY NO. CONTROL NO. ARCHITECrfENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION 1 hereby affrftn that 1 am licensed under provisions of Chapter 9 (commencing REVISION--IN nQhh� I�CJU-`'�cr� ONLY with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect ORIG. 302050052, NO NEW PERMIT ISSUED License Class on Contractor Date Contractor NO FEES--PER POH Y. ARCHITE S DECLARATION I understand my plans shall be used as public records Licensed Prufcssional , OWNER- BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors License Law for the following reason. (Scctiun 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure: 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 $ 2 9 7ti on (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and die! basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for i permit subjects the applicant to a civil penalty of 6*P"�AeP U Occupancy Type not more than five hundred dollars ($500): ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business Professions Code: The Contractors License Law does to equlred Inspections and not apply an owner of 10 2 - PIERS 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 sale.If, 103 — UFER however, the building or improvement is sold within one year of completion, the owner- 1 O 4 — REBAR builder will have the burden of proving that he did not build or improve for purpose of sale-). 105 - ANCHOR BOLTS ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to 10 6 — SEWER & WATER construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and , 202 — UNDERFLOOR PLUMBING who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. 203 — UNDERFLOOR MECHANICAL ❑Iam exempt under Sec. B & P C for this reason 204 - UNDERFLOOR FRAME Owner Date 205 - UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION 301 — ROUGH PLUMBING I hereby affirm under penalty of perjury one of the following declarations: 302 — TUB & OR SHOWER ❑ 1 have and will maintain a Certificate of Consent to self- insure for Workers Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the 303 — ROUGH MECHANICAL work for which this permit is issued. 304 — ROUGH ELECTRICAL ❑ 1 have and will maintain Workers Compensation insurance. as required by Section 3 0 5 - FRAME 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: 306 L — HOLDOWNS Carrier: Policy No.: 307 — INSULATION CERTIFICATE OF EXEMPTION FROM SATONINSURAANCEORKERS' 308 — SHEETROCK (rhisscction need not he completed ifthe permit isforone hundred dollars ($ 100) 309 - EXTERIOR LATH m Ices.) 310 - INTERIOR LATH 1 cenify that in the performance of the work for which this permit is issued, 1 shall not 311 - SCRATCH COAT employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date 313 - ROOF NA I L Applicant 501 - FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Co&, you must 502 — FINAL PLUMBING ENERGY forthwith comply with such provisions or this permit shall be deemed revoked. 503 - FINAL MECHANICAL ENERGY CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of 504 - FINAL BUILDING ENERGY the work for which this permit is issued (see. 3097, Civ. C.) 5 0 5 - FINAL ELECTRICAL Lenders Name 506 - GAS TEST Lender's Address 1 certify that 1 have read this application and state that the above information is 507 — FINAL PLUMBING correct. l 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 5 FINAL MECHANICAL above - mentioned property for inspection purposes 09 F I N (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any wayaccrue against said City 5 N G / in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by5 1 l/ v I WORKS Date SOURCE REGULATIONS. Re -roofs Type of Roof C7 1 Signature of ApplicanL/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ Yes C] No If a roof is installed without first obtaining an inspection, I agree to remove 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 all new materials for inspection. District? ❑ Yes ❑ No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health &Safety Code, Sections 25505,25533 and 25534.1 understand that ifthc building does not currently have a tenant. that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class "Br' or better Owner or authorized agent Date