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03060023
CITY OF CUPERTINO , MON,KkCTQR,, INF' RMAT pN BUILDING DrvIs1oN PERMIT C�O1V q . BUIIAING ADDRESS: INTERNATIONAL IND I MITN003060023 19949 STEVENS CREEK BLVD NEWS NAME: 19925 STEVENS CREEK BLVD .m PERMIT ISSWO3/2003 ICE WIRELESS INC. NE: — SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDOO ELECTO PLUMS MECHO LICENSED CONTRACTOR'S DECLARATION Job Description 1 Wmby afBfm Nat 1 am licensed under provisions of Chapter 9 (commencing w4b Section 7") of Division 3 of the Busircas aM Ptofesskm Code. and my It-- Is imfull force and TI--VOICE WIRELESS AL.E93 effect, License ClassLk. g DaaaContractor ARCHITECT'S DECLARATION JUL 2 8 2003 I understand my plana shall W used a public mearW I III ®Ipg/' BUILDING Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm Nn 1 am exempt from Ne Contractor's License Law for the Ui L. g V X71 following mann. (Section 7031.5, Business and Profesalom Cade: Any city or county which rtqulma a Permit to camaruct. alms barrow, demolish. m repair any structure poor to Its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant in the provisions or tie Comratm4 Law w(Chapter 9 Sq. Ft. Floor Area 10'QkIIYfl[I On . (commencing with Scctidn 7000) of Dividon 3 of tW Businaumd Profession Code) ser that he 4 exempt thamfrom and the basis for the alleged encs pHon. My violation of a Occupancy Type Section 7031.5 by a" applicant far a permit subjects the applicant m a Civil Penally Or nm mom than fin hundred dollars (550)), ❑ I, u owner, of the Property, car my employees with wages as their sok compensation, 101 FGTA AW will do the wart. and the eWCWR is not intended or.Beed rot sde (Sec. 71144, Business and pmfeuiom Cade: The Comennu s License Low dons not apply m an Owner of 102 egUlled Inspections — PIERS property who builds or lmprows thereon, and who doea such work himself or through his 103 — UFER Own employees, pnrvlded that such improvements see not Intended moaemd laterite. If. hawewr. the building or improvement is sold within one year ofcompledon, the owner- 104 — REBAR Wilder will have the burden of proving that he did not Wild or improw for purpose of Asia)I 105 — ANCHOR BOLTS u owner of the property, am exclusively contracting with licensed contractors in 106 - SEWER & WATER couatmet the project (Sec. ]044. Bualness and Profesdoua Cade:) The Contrsetm's la- ce eLawdoes not apply toanwinner ofpropertywboWilds orimprovesmemon,and , 202 — UNDERFLOOR PLUMBING wbo contracts for such projects with acontracter(O licensed pursuant a the Comnctoes 203 - UNDERFLOOR MECHANICAL Licence law. ❑lam exemgJu sec —�}-- Bh PC fm this mssdn 204 — UNDERFLOOR FRAME /.,t_ _'r1 /C- - Dj3e G-3-o3 205 - UNDERFLOOR INSULATION IN WORK SCOMPENI.cRAT2O SATIONDECN 301 - ROUGH PLUMBING I hereby arl6m under penalty of perjury am of the following dedaruioua: 302 — TUB & OR SHOWER I haw and will maintain a CerOeamof Consenuosel6insum for Warkeri Compm. 303 — ROUGH MECHANICAL anion, as provided fm by Section 37011 of the Labor Code, for the Performance of the work for which this permit is issued. 304 - ROUGH ELECTRICAL . ❑ I ban and will maintain Worker's Compensation Insurance. as required by Section 305 — FRAME 37W of the LAW,Code. far the Performance of the work for which this permit is issued. 306 — HGLDOWNS Ice carer and Policy number me: My Worker's Compenseuonnsuran Carer: Policy NO: 307 - INSULATION CERTIFICATE OF EXEMPTION FROM WORKERS' 308 - SHEETROCK COMPENSATION INSURANCE 309 - EXTERIOR LATH (Th4secllm coed rlotlecomplemd Ethic Permit 4 foram hummldollars($1M) mlesa) 310 - INTERIOR LATH I certify that In the performance of the wart for which this Permit 4 issued, I shall not 311 - SCRATCH COAT employ any person in any manner m As m became subject to the Worker'Compensation Laws or Califomia. Dam 313 501 — ROOF NAIL - FINAL ELECTRICAL ENERGY Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become Suomi to the Worker's Compensation provisions; of the labor Code, you must 502 - FINAL PLUMBING ENERGY iforthwith Damply with such Pmv4ious or thla permit shill he deemed rewkee. 503 — FINAL MECHANICAL ENERGY CONSTRUCTION LENDING AGENCY 504 - FINAL BUILDING ENERGY 1 hcmby.flims that them its construction lending agency for the performance or the work for which this permit Is Wood (Sm. 3097. Civ. C.) 505 - FINAL ELECTRICAL leader's Name 506 - GAS TEST - ndeAdid Lars i I certify that I Ise read this application and cote that the above infomutiun Pa 507 - FINAL PLUMBING ' ' cannot. I agree in comply with all city and county ordinances and sue laws misting m 5 - FINAL MECHANICAL building construction. and hereby to hodse mpresenutiws or this city a enter upon be above-mentionrdpropenyfor inspea0ionpugmms 09 FIN GRADE (we) agree to stn, indemnify and keep harmless the City of Cupertino against 0 FIN I N i liabilities.judgments. costs and expenses which may In my way acerae against said City I in consequence of the granting of this Permit. APPLICANT U DERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued byS 1 WORKS Date SOURCE RE ONS. Re-roofs kit__ / b-3-o0 Con Da sere O(Applicam r HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicenl or run= building occupied store or handle hammoua material AslDiuvici7 defined by tW capered Municipal code. Chapter 9.11. and the Health and safely m. section 75531(w All roofs shall be inspected prior to any roofing material being installed. ❑Yes No If a roof is installed without first obtaining an inspection, I agree to remove Will the Applicants car future building Occupant usc equipment or devices which 4 hamajous air contaminants u defined by the Bay Arta Air Quality Management all new materials for inspection. 0 ye. Nu Ibevdresddommrr amamrlalsmquimmcn4undcrChapmr6.95dftheCalifonHcolth& Safety Code,Secu x254415,15533 and 15534. I undersand thatirthe buildinge non cone by ban a moans Nat it is m ramensihillty to notify the occupant of theuiremcn anWmaprio,w ceof. ccr0camar upmcy, Signature of Applicant Date 6^ 4 All roof coverings to be Class "B" or better ,drauthddvcaears ami 0z Z2 BUILDING DIVISION PERMIT BUILDING ADDRESS: WELKIN INTERNATIONAL IND I MIT NC03 06 0 02 3 19949 STEVENS CREEK BLVD OWNER'S NAME: 19925 STEVENS CREEK -BLVD FE�� T'UO 3/ 2 0 0 3 VOICE WIRELESS INC. PHONE: — 96 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. License Class Lic. p Date Contractor ARCHITECT'S DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the following reason. (Section 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 Contractor's License Law (Chapter 9 (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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). p 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 and Professions Code: The ContractorsLicense Law docs not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements arc not intended or offered for sale. If, 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 sale.). t1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li- cense Law docs not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a eonuactor(s) licensed pursuant to the Contractors License Law. ❑ I am exemp�u der Sec. . B & P C for this reason oe� /(/� JNV WORKBit'S COMPENSATION DEC ON I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain aCertificate of Consent to self -insure for Worker's Com pen- sation, as 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 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 Workers Compensation Insurance carrier and Policy number are: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This seclion need not be completed if the permit is for one hundred dollars ($100) or Icss.) 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 Workers' Compensation Laws of California. Dale Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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.) Lenders Name Lender's Address 1 certify that I have read this application and slate that the above information is correct. I 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 ahovc-mentioned property 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 U DERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE RE ONS. n Si urc ofApplicaro/Condfador Da 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)? C] Yes �] Nu 1` 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? ❑ Yes Na Ihavercadthchazardo &materials requirements under Chapter 6.95 of the Califor. nia Health & SafctyCodc, Sections 25505, 25533 and 25534.1 understand that if the building docs not carte dy have a tenant, that it' m reSp f=hiIity to notify the occupant of the requiremen h' ust be met pno r to i ce of a Certificate of cupancy, f v° :A3 Job Description TI --VOICE WIRELESS A ,iC VU@�WJW ..�.VY+iIYt ryl'i �N ,.. d BUILD" ING So. Ft. Floor Area on Occupancy Type 102 - PIERS +Required Inspections 103 - UFER 104 - REBAR 105 - ANCHOR BOLTS 106 - SEWER & WATER 202 - UNDERFLOOR PLUMBING 203 - UNDERFLOOR MECHANICAL 204 - UNDERFLOOR FRAME 205 - UNDERFLOOR INSULATION 301 - ROUGH PLUMBING 302 - TUB & OR SHOWER 303 - ROUGH MECHANICAL 304 - ROUGH ELECTRICAL 305 - FRAME 306 - HOLDOWNS 307 - INSULATION 308 - SHEETROCK 309 - EXTERIOR LATH 310 - INTERIOR LATH 311 - SCRATCH COAT 313 - ROOF NAIL 501 - FINAL ELECTRICAL ENERGY 502 - FINAL PLUMBING ENERGY 503 - FINAL MECHANICAL ENERGY 504 - FINAL BUILDING ENERGY 505 - FINAL ELECTRICAL 506 - GAS TEST 507 - FINAL PLUMBING 5 - FINAL MECHANICAL 09 FINPA GRADE 5N -,OI Issued by5 1 WFI WORKS VIT Date Re -roofs Type of Roof 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 I CITY OF CUPEkTINO C. fY OF CUPERTINO PERMIT APPLICATION FORM °7 APN# Fee Description a.. BAPPLOTHER .p Date:....... 7[ BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Building dress: MECHANICAL BBOILER2 Boiler > l OOK to 500K Btu ccl�y Sfcv C 1- MECHANICAL Owner's Name: Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Phone #: Yo 1 0 ; PC-- L -G-55 _TMC BCONSTAX r©- Z 7-(o — 7L9 0 Contractor: BCONSTAX Ind/Off/Comm/Quasi BUILDING License #: WC- i- r -i ,J �N `T t o►J Hotel and Motel BUILDING Contact: Constax - Resi/Mobile BUILDING BELEC1000 Cupertino Business License#: Bg Permit Info: -, Elec 600V > l OOOA ELECTRICAL /1�1 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Bldg Ele BENERGYADD Plum M ck Job ription: BINVESTIGA Investigation fee BUILDING esidential ❑ Comm. Housing Mit. Fee BUILDING Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: a CSS ,---- Occupancy Group: Type of Construction: r- I - Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > l OOK 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 1 of 3 v-,xTY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWM-ULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOlVfNT New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIlvIE 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 din 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 ls�� CITY OF CUPERTINO CITY OF CUPERTIN PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMPOWER Plower 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 Sips 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 01- ELECTRIC Electrical sq foot ELECTRICAL (111 EPERNHTFEE 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