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03050083CITY OF CUPERTINO ^� 4 r • » '+ ? _' '� �•'• ,-•, BUILDINC DIVISION PERMIT vCONTRACTOR INFORMA'�I01 18 n.. '. jP n-t'ViS .rc.an..9 •9 }". ,Em ?5$6�?"jd'� BUILDING ADDRESS: PERMIT N00 3 0 5 0 0 8 3 PER'S NAME: PERMIT ISSUE DATE CHURCH OF JESUS CHRIST OF TT QR/04/2003 ONE: SANITARY NO. CONTROL N0, ARCHITECT/ENGINEER:BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I Wmby affirm that I am licensed under provisions of Chapter 9 (commencing p with Section 7(AXh of Division 5 of the Business and Professions Code, and my license Is in full room and a n. TI-HANDICAP t BUILDING ACCESS RAMP _ Licenuefm�s� Lie.g - Date_yg[� Cammetor ARCHITECT'SDECLAR ION CONTRACTOR: " SANTA ROSA COI'G2R$�]&�04�03) I understand my plans shall W used as public records ^h.ikLi p 0 [ 2003 ai Ci J SEP Licensed Pmfcssional OWNER-BUILDER mDECLARATION 1 hereby affirm that 1 mumps from the Contractor's License law for tW fallowing rtasnn. (Section 7onitr B..]it, and Code: Any city nr courtly 1. impose. which requires a permit re enghee improve, demolish, m repair any statement prior to its issuance. also requires n, h, prevision am for such acrmiuu file a signed ataumcm the, that Sq. Ft. Floor Area tD500 - (commencing of she Business and Pmfessinn1 Cnian or (cat .ng watt Section 7(100) of Division that is them from antl r the alleged cam Any vl"en an of he is 35`&Nagu ier00 Occupancy Type io 31.5 b or North iont to Section 9armfive any Applicatorforpctmlt subjects the applicant los civil Penalty of not mart then five hundred dollar. (1500). ' 0 1, es owner of the property, or my employees with wages as their sole compensation, gg d Ins actions p will do da, work, and the etrucWm is not intended or offered for sale 7W, Business and Professions Cade: The Ca"memos Licensor law dons nal apply in an owour of Popery who builds or improves thcmon, and whodoessuch work himself or through his y 101 — FOUNDA'i' own employees, provided that such Improvements arc not intended or offered for sale. If, 102 — PIERS . however, the building or improvement is sold within one year of completion, the owner. builder will have tae harden of proving that he did nm Wild or improve for purpose of 103 - UFER Asia')' 104 - REBAR ❑ L as owner of the propcny, em exclusively contracting with licensed corwnors to 105 - ANCHOR BOLTS construct she project (Sec. 7W, Business and Pmficaa.ns Cod,:) The Contractors Li cease law does not apply to an owner of property who Wilds or improve theater. and , 106 — SEWER & WATER who contracts for such projects with o contmemr(s) licensed Portugal to du Contractors License law. 202 - UNDERFLOOR PLUMBING ❑ l am exempt under See. ,B&PC far hi. notion 203 - UNDERFLOOR MECHANICAL no, Data 204 - 205 — UNDERFLOOR FRAME UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION I hereby alDtm ander pnuhy orperjmy"rte of she rmmwirg declarations: . 301 — ROUGH PLUMBING I haw and will maintain a Certificate ofcanum to aelfdnsure for workers Compete n. m provided for by Section 3700 of daaaWr Code. for tam peff... to of the Icly, 302 - - TUB & OR SHOWER kfor which un, not is issued. 303 - ROUGH MECHANICAL t have and will maintain Worker's Compensation Insurance, u required by Section Oaf the La W,Coe. for thepilmnotncc of lW wort ter which this pemtll is issued. 304 — ROUGH ELECTRICAL workers compensation Insurance airier and Policy number am: 305 — FRAME er: -S'_f' pmisyNo.: ISI} 306 - HOLDOWNS CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 307 - INSULATION (This section need notal completed lithe permit is for one hundred dollars ($100) 308 - SHEETROCK Icerta.) 309 - EXTERIOR LATH that in the nary mane of the work for which mit permit is issued.) shall nm employ in any manner nn as In became subject Atha Woders'Compensation 310 — INTERIOR LATH Law.C.dionon Lowe of California. Data 311 - SCRATCH COAT Applicant 313 - ROOF NAIL NOTICE TO APPLICANT: IL after making this Cellifum of Exemption, you should become whiter 1, the Worker's Compensation provisions of the Labor Cnde, you all forthwith comply with such prnvisions or this permit&hall W docmcd resulted. 501 — FINAL ELECTRICAL ENERGY CONSTRUCTION LENDING AGENCY 502 = FINAL PLUMBING ENERGY I hereby affirm that there is a consuuclinn lending agency for the performance of 503 - FINAL MECHANICAL ENERGY me work for which this permit Is issued (Sec. 7097. Civ. Cd Under, Name 504 - 505 - FINAL BUILDING ENERGY FINAL ELECTRICAL IndarsAddress I certify met I new read Nis application end sore that the shove information u 506 - GAS TEST mann. l agree to comply with all city and county ordin mms and sue laws relating w building construction, aro hereby authorise atpalmloatiws of mit city to enter upon the FIN PLUMBS G above-mentioned property for inspection purposes. indemnify OE FIN L (We) agree to save, and Imp harmless the City of Cupertino against liabilities, judgments, msu!adex;AN( in any w'ay aecme against mid City 55!Aouc m gDf J (� WITH ALL NON POINT Issued by:5 NG Date 00fFpplicanVCor 03 Re-roofsec Type of Roof Date N R US MATERIALS DISCLOSURE Willthcapplica or future Wilding occupant slam or handle hazardous mtenal as tlefined by the Cupertino Municipal Code. Chapur 9.13, and the Health and Safety c, Section 33552(a)? All roofs shall be inspected to any roofing material being installed. ❑Yes No prior 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 it hamrduus air mmaminane m dciime! by the Bay Ama Air Quality Management all new materials for inspection. - iWlel? ❑Yes No I have mad me hemNtws materials r,yuiatmenu under Chapur 05.95 of me Cali(ory ria Health&Safety Code. Secdons 25515.355)7 uu1255Ja.l underused thuiftbe Wilding docs not currently haw a unanh that it is my responsibility to andty the atomism of me requimmems which must W mat mor to isaaance ara C,Nfiate onxculancy. Signature of Applicant ,Date All roof coverings to be Class "B" or better Owner or authorized agem Dam CZU aZa _ern 3�w J �w �yU LL y � N . �OC 1 u-- u E=c F- d�� L CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATI BUILDING ADDRESS: PERMIT N00 3 0 5 0 0 8 3 OWNER'S NAME: PERMIT ISSUE DATE CHURCH OF JESUS CHRIST OF LATT 2003 PHONE: SANITARY NO. CONTROL NO. ARCH ITECTIENGI NEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH L= 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing P with Section 7000) of Division 3 of the Business and Professions Code, and my license is in e eet. , "-"'15? -3 TI–HANDICAP BUILDING ACCESS RAMP Licensforce e Classnd Lic # Date 'f A:7&,— 7rs7;-{ Contractor_ —, 16,�yLfi 7 . CONTRACTOR: SANTA ROSA CONTRACTORS (08/04/03) AR HITECTS DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the follnwing reason. (Section 7031.5. Business and Professions Code: Any city dr 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 Contractor's License Law (Chapter9 Sq. Ft. Floor Area — Valu$gPD5 0 0 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of 3 9,YNNu&ffief0 0 OccU anC T e P Y YP Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mom than five hundred dollars (5500). ❑ I, 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 Contractor's License Law does to an owner RR Inspections and not apply of 101 – FOUNDATd property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended oroffered for sale. If, 1 02 — PIERS however, 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 10 3 – UFER sale.). 104 – REBAR ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to 10 5 – ANCHOR BOLTS 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 thcmon, and . 106 – SEWER & WATER who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. 202 – UNDERFLOOR PLUMBING ❑ I am exempt under Sec. . B & P C for this reason 203 – UNDERFLOOR MECHANICAL Owner Date 204 – UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION 205 – UNDERFLOOR INSULATION I hereby affirm under penalty of perjury one of the following declarations: 301 – ROUGH PLUMBING ❑ I have and will maintain a cenificatc of Consent to sclf-insure for Worker's Compen- cation, as provided for by Section 3700 of the Labor Code, for the performance of the 302 – TUB & OR SHOWER work for which this permit is issued. 303 — ROUGH MECHANICAL 1 have and will maintain Worker's Compensation Insurance, as required by Section 304 ROUGH ELECTRICAL 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 am: 3 05 – FRAME Carrier: — Policy No.: Cine ///-- 3 0 6 – HOLDOWNS CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 307 – INSULATION (This section need not bccomplctcd ifthc permit is forone hundreddollars(5100) 308 – SHEETROCK or less.) 309 – EXTERIOR LATH I certify that in the performance of the work for which this permit is issued. I shall not Compensation 310 – INTERIOR LATH employ any person in any manner so as to become subject to the Workers' Laws of California. Date Applicant 311 – 313 – SCRATCH COAT ROOF NAIL 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. 501 – FINAL ELECTRICAL ENERGY 502 – FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of 503 – FINAL MECHANICAL ENERGY the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name 504 – FINAL BUILDING ENERGY Lender's Address 505 – FINAL ELECTRICAL I certify that I have read this application and state that the above information is 506 – GAS TEST correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorivc representatives of this city to enter upon the F I NA PLUMB I G ahovc-mentioned property for inspection purposes. O 8 F I N L (We) agree to save. indemnify and keep harp Icss the City of Cupertino against liabilities, judgments, costs and expc cs whi ay in any way accrue against said City in consequence of th granti of s 5 per APPLICANT U ERS D AND COMPLY WITH ALL NON -POINT Issued by:5 4A NG Date SOU Re -roofs Type of Roof Si ature of pplicanVCo act Date H R US A1ATERIALS DISCLOSURE WIf the applica r or future building occupant store or handle haiardous 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 No Yes 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 Arca Air Quality Management all new materials for inspection. District? ❑ Yes Nu I have read the ha7Arduus materials requirements under Chapter6.95 of the Califor- nia Health & SafetyCodc, Sections 25505.25533 and 25534. 1 understand that if the building docs not currently have a tenant that it is my responsibility in notify the Occupant of the requirements which must be met prior to issuance of a Certificate of Occupancy. Signature of Appl icant Date All roof coverings to be Class "B" or better Owner or authori/ed agent Date CITY OF CUPEIITINO C1T1' OF CUPERTINO PERMIT APPLICATION FORM APN # �' 77 4 Building Address: In -17 22 a(zzF:e A� Owner's Name: Phone —6v&&11kA1A %� Contractor: License #: Contact: Cupertino Business License#: c� v !ter BBOILER2 B .., n,� ,,�ermit Info: I Bldg Elect ❑ Plumb ❑ Mech ❑ Job EWription: / lelfityp,1G4r° mwl&6 A4Ws G Gz esidential ❑ Commercial Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: ^SnILIIv WW4171- b oo, C90 Z. Type of Construction: Construction Tax Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permit sq. 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 BELEC 1001 Elec 600V > l OOOA 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 ,> AT 1of3 .µ. CITY OF CUPERTINO C�Y OF CUPERTINO 0 PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMIVfM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING 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 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 2 of 3 C„ y CUPEkTINO CITY OF CUPERTA PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & 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 Insection 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 3 of 3