02110067 CITY OF CUPERTINO ^` "` ��
nuu.uwclnvlslon pFi 'IUION
•,
BIJ24NIO)0 12 STEVENS CRK BLV PERMTrrp.2110067
WN�EERV.IELD REALTY APPLICAII0I1rOe/t2002
10NE: SANITARY NO. CONTROL NO.
ARCHMTCrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o 0 0
�Op
LICENSED CONIRd under SDEium,of bar Job Description
�u G ON
1 hereby affirm That 1 am llOCamd under p ...ficns"f Chapter 9 laom scrac is SIGN p
with Section AMXB nI DivisibnJnf the Business am nd/eaninns Crwle� J yliccna is
< mfall fo defiles. ,p 734.7
AL1_ LicenscC Lica
0Z;- pare Cnm r pAW 6RAP//Cf �Bp
ARCHITECTS DP-C TION $/6N CO, y�� B�
dentanJ myspllsshall Mused es is records •YALE®
3u.I- Llw dPofcsdonal 2003
N W O J Oat I am BUILexempt
DECLARATION JAN 1.3 L
st.Z i.•0 I hereby.(lute that I am cacmpt from the contractor's is :Any c rots for the $2000
�SpO following reason.(Section 711715,Business and Professions Code:Any city or county
w$ which requires a permit in construct,alter,impose,demolish,or¢pair any suucmm
,Z4 prior m its issuance,also maims the applicamfnr such Permiuo file asigneJ smsement
ss that he is licensed pursuant to the provisions of the Contractor's License Lnw(Chapmr9 �BtL2
Aa Valuation
F$ (commencing with Section 7(XXq of Division J of the Business and Professions Code)or
..
that he is exempt therefrom and that basis for the alleged exemption.Any violation of
Section 7071.5 by any applicant for a permit subjects the applicant to a civil penalty of IUXpN anC OQen
not more man five hundred dollars(SSW). 103 — UFER - Occupancy Type
1,u owner of the property,or my employees with stages as,their able compensation,
will do me work,and the swau a is not intended preached for sale(Sec.7044,Business
and Professions Code:The Contractor's License Law does not apply to an owner of 1o5 - ANCHOR I tl'T�Inspections
property who builds nr improves thercbn.and who does stub work himself or through his
own employee¢,provided that such improvements are andateaded proffered for.ealo.B. 304 — ROUGH ELECTRICAL
however,the building or improvement is sold within one year of completion,the owner- SOS — FINAL ELECTRICAL
Wilder will ham the burden or proving that bu did not build or improve for pumom of
ak.). 514 - FINAL PUBLIC WORKS
❑1,as owner of the property,am exclusively contracting with licensed conlrecmrs to
construct the project(Sec.7(W4,Business and Professions Code)The Contracors Li- .
cense Law duce not apply to an nwncr of profit who builds or improves themm, Md.
who contracts for such projects with a enntractnr(s)licensed pursuant in the Contractor's
License Law.
❑I am exempt under Sec. ,B&P C for this reason
War Dow
WORKER'S COMPENSATION DECLARATION
1 hcrchy effort under penalty of perjury one of the following declarations: '
I have and will maintain aCenificate bf Consem to self-insum for Workers Compen-
sation,a provided for by Section 77(X)of the labor Code.for the performance of the
work for which this permit is issued. I
❑1 have and will maintain Workers Compensation Insurance,in required 4 Section
TATO of me Labor Code,for the performance of are work for which this permit is issued.
My Worker's Compensation Iromorm carrier and Policy number art:
Ca 'er. I,TT ffAKTFofW poli'N : S7 WEccz 95S R
CBRTIFICATF.OFEXEMPfI WORKERS'
COMPENSATION 1 RANCE
(This stolon need nm M1ett,mplemd if the permit is mote¢M1undred dollars(Slip)
nr
less.)
I eenify that in the performance it the work for which this permit is issued.[.,hall not
employ any person in any manner sn as to become subject o the Workers'Compensation
Laws tar Celifnrnia.Dam
Applieant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject b,the Workers Compensation provisions of the labor Code,you muss
OO forthwith comply with such provisions nr this permit shall be deemed mvnked.
N
CONS'rRUC1']ON LENDING AGENCY
[-. I hereby allirm mat mere is A construction lending agency for the performance of
a the work for which this permit is issued(See 1097,Co,C.)
0 landefs Name
z Lenders Addrea
U 0 I ccnify that I have read this application and some that the above information is
{L H correct.I agree In comply with all city and county ordinances and state laws relating to
Q U building Construction,and hereby authorim ournesenmtiva of this city in enter upon the
W above mentioned property for inspection purposes.
(We)agree to cast,Inde expenses
and keep harmless Iht City of CupenstA against
in liabiliti( costs keeh may hminanywayaccmearolinaid City
V z tAnPPLucnc °NUERSTANDStANU WILL COMPLY WITH ALL ONPOI Issued by: Date 4'
SOURC RE ULATIONS.
GC 'A'ae Re-roofs
.t6 at of ApplianUConuactor at
HAYARDOUS MATERIALS DISCLOSURE Type of Roof
Will the Applieant me future building isomminr sono,handle ha res material
az defined by the Cupertino M�I Chile,Chapter 9.12,and the Health and Safety
gide,station 255320)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
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 harardous air contaminants as darned by dm Bay Arca Air Quality Management all new materials for inspection.
District,
❑Yes o
1 have reW the haanrdnus mamriaLs reyuiremcnu under Chapter 695 of the Cali(nr-
niaf(ealth& .fitly , Sccdbns25N)5,255JJ.d25534.1..&amndmatifd.building
docs not rte dy ham A¢nano,that it is my responsibility Io notify IM occupant of the
require ns hichmuuM eIngy a,iafamm�ractnint roetapaney. Signature of Applicant Date
n ramhorixcd agentDam
tI °L All roof coverings to be Class "B"or better
CITY OF CUPERTINO
CONTRACTORIN TION-'
BUILDING DIVISION PE10-i"r
Bugig&"":2 STEVENS CRK BLV PERMIT to.2110067
OwEMBR?FIELD REALTY APPLICAIJCY�bl)'& 2002
PHONE: SANITARY NO. CONTROL NO.
ARCHITECTrENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I thereby Affirm Oat I am licensed under provision of Chapter 9(commencin, Job Description
Ey whin Section 7")of Division 3 of the But,Business.4pri,fessim.Couls.,ral my tic
is
SIGN
in full. Are".
licensec __ Lu,.. 4 69,7347
0 "'ne-coal 7, 91AIDAW �� FINALED
EC
ARCHITECTS DEC TION
it,,tend it as A, c Curtis
JAN 13 2003
wcrd Von....one
'0'�u
tl6:t OWNER-BUILDER DECLARATION
C u!:R I hereby AMM that I Am exempt from the Conorschor's License Law for the
w3:00 following moon.(Scetion 7031.5,Buaricas and Purfassions,Code:Any city or County $2000
BUILDING
a�2� which rePtims a permit to construct after,improve,demolish,or repair any structure,
H;< Prior in its Issuance,also requires de,applicant for such permit to rile a signed statement
Nat he is licensed pursuant to the,provision of the Contractor's License Law(Chapter 9 3&P6L300caA&a Valuation
(commencing wish Section 7(=)of Division 3 of On,Business and Profession Codaor
Nat Its,b exempt thenamut and On Imas,for He Alleged exemption,Any violation of
Section 7031.3 by any applicant for a Permit subjects use applicant to a civil Penalty of10 APN jqEgR4=I I UN
.or more than five hundred dollars Occupancy Type
0 l.ummrofftpmptay.ormyempl�with�&uuftkwtewmN= on. 103 - UFER
104 REBAR
And Proft"On.1 Code;The Contractor's License Law does not apply M an owner of
propenywho Wilds in improves Hereon,and who doessuch work hinuselfor through his 105 - ANCHOR T�Inspections
Avon employsuns.provided that such improvements are not intended oroffered forests.If, 304 - ROUGH ELECTRICAL
however.the Wilding or improvement is sold within One year ofcompleflon,the owner.
builder Anti have On,tarman of prIving ths,he did not Wild or improve for purpose of 505 - FINAL ELECTRICAL
alk.). 514 - FINAL PUBLIC WORKS
C]1,as owner of the property,am exclusively contracting with licensed contractors in
construct On project(Sec.7040.Business and Professions Code:)Tim Contractor's U.
cense Law does not apply to an Owner of property who Wilds or improv duction,and
who coniouct.,for such projects with a contrulor(s)licensed pursuant to the Contramor's
Lice=Law.
[3 1 son exempt under Sec. ,B&P C for this manum
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury can of the following Itemization:
0 1 have and will maintain.Certificate,ofCDnwnt to self-insum forWarlit,r's Com,xm.
pation,As provided for by Section 3700 of she Labor Coca,for ft Performance of He
Fork to,which IN, .it a Issued,
❑I loon and will maintain Worker's Compepastion Immusurce,as required by Section
3700 of On Later Code.to,the,Muniorn.of 0,woric to,which this Permit is issued
My Workers Comptoustion insurance carrier And Policy number art:
C.je'.=_.yjr_TRRD pplicylj�EC�CZ9.5jy
CEIMNEATEGFEXEMPTI36 ( 4 WORKERS'COMPENSATION 12RADNICE
(rhissumon need not Wcomplened ifthe permit is torch hundred dollars($LWI
or less.)
'I unify that in the Performance of ft work for which this Permit is issued.I A&[]not
Employ any pereen in any manner so As 10 become subject to the Woulams'Compentation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Cerfificau,of Exemption,you should
become Subject to the Worker's Compensation previsions of the,Labor Code,you mot
z forthwith comply with such provisions or this Permit shall be deemed revoked.
0 4 CONSTRUCTION LENDING AGENCY
I hemby affirm that there is a contraction lending agency for the,performance of
as > the work for which this Permit is issued(Sec.3097.Cu.C.)
Lender.Name
z LCmRe.Add"
U 0 1 candify Had I have mad this Application and State OIL the almn information is
PcoureCt.I.,me 1.comply with all city And county ordinances And state law.rchidn&in
U Wilding construction,and kneby authorim representatives Of this City th enter upon she
C4 Onve-mentioned property(andnspection purposes.
CL. (we)a&=to a",inemnify and keep harroass;the City of Cupertino Against
,, timilithes,judgments.Costs expenses which may in my way accrue,against=it City
U Z in,preacque. 9MOnS Of this Permit.
APPLIC PIDERSTANDS AND WILL COMPLY WITH ALL 1,)N PO
SOURC RE ULATIONS. Z�La Issued by: Dat
tt I
j'jZ
1 19 I'AppticamitCmuseacm, A OZ Re-roofs
HAZARDOUS MATERIALS DISCLOSURE 7),,pe of Roof
4W'llft;.PP1i=tmfuture
Wilding Occupant store or handle heteardous material
asdefined thythe CupenumMusuc ICAAJ Chapter ll.12.arelibeefleaddiand S.Oly
Codes,Section 25532(a)? ;Z
0 yk. All roofs shall be inspected prior to any roofing material being installed.
Will the Applicant of 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 all new materials for inspection.
tDisvmt?
0 Yon
I have peal the haoxhl materials requirements under Chapter 6.93 ofthe Cali(or,
Cook,
niaHcalth& ty Cook.Sections�159)5,25533 it Z!i!iM.I ituderearst Inn if dic Wilding
xf� �A U
J.Out tly have umara.Oat it I.my ra,mathdity in purify the oeetrotnt of the
he
require A hich must
W At In'
c,: of Applicant Date
'authorised
so agent
All roof coverings to be Class "B" or better
r
TEST, ADJUST AND BALANCE REPORT
Date: September 6, 2002
Project: Chicago Title
Address: 20100 Stevens,Creek Blvd.
Cupertino, Ca.
HVAC Contractor: SILICON VALLEY MECHANICAL .
980 N. ITh Street
San Jose, Ca 95112
yr
PROJECT NAME: ICHICAGO TITLE
ADDRESS: 120100 STEVENS CREEK BLVD. CUPERTINO
SYSTEM: JAIR BALANCE REPORT .
I
AREA SERVED NO. MODEL DIFF NOMINAL ACTUAL % OF
UNIT NO. CFM CFM DESIGN
OFFICE SPACE AC-1 YORK SIA-1 200 250 1.25
S/A-2 300 285 0.95
_ SIA-3 100 110 1.10
S/A-4 300 300 1.00
S/A-5 200 195 0.97
S/A-6 200 175 0.87
S/A-7 200 200 1.00
S/A-8 200 200 1.00
TOTAL 1700 1715 1.01
OFFICE SPACE AC-2 YORK S/A-1 200 200 1.00
S/A-2, 250 250 1.00
S/A-3 300 125 0.42
_ S/A-4 150 150 1.00
_ S/A-5 150 , 150 1.00
TOTAL 1050 875 0.83
y
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o
. o a4
y 10I �. PLOT PLANS
1 DATE 1L q I b2
% ' +C I• `•. ��\ I }—. PLANNG - —
KE
\`•�; \ I DATE
N
I � ;; ,nr.. riFn�•.
FIrI I b •i vhu� I Tpo�t 1^g _
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� o q� � �o � RIECEXVED
Nov
M
loom � in
+ IN I [I)RDANCE IA)1-4 THC' CITY C7
Cum 5 r ND C(r/'DEG
DATEIII
SIGNET
This sm plans r cqtiens MUST
I'+ 1 D be kep n the { -cs rnc: it is un
�j� lawful o i lake a�terations
on sane iih:c sei:a from
1 the hu,0 r; C•
1 1 I'he str t ng a''.2tio-s
• "y;pioaei et .•
of ATIN C� b
ZO �ao-22
J-71
156" '
1 "
36"
46
1611
51 "
12"
21 "
Grade
Concrete Pad -;,
6 sac mix , #4 Rebar „
^' Existing Footings
Ca
Existing Footings i ^'
Refurbish Monument Sign: Remove all Wood, replace with Sign Foam
accents( weather Proof) Tex coat entire sign, Add concrete
pe, fdestal, clean and paint inside and replace lamps if required.
4 #4 Rebar Drilled and Epoxy to
each existing footing.
156"
36 11 • • Existing Poles Top View
156"
36 4 '<
z
146 <
o,
an
N
O =�
N
51 .. � 7Z75!:j •
12..
21 „
Grade n
-- _ - – —
17-
4
Concrete Pad —
6 sac mix , #4 Rebar
;Existing Footings
Existing Footings
11
dVbye I tr -,
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o
L 4 K A� � ;{h' �
r
,fav`, � mad ,�'•� bt��'� �]tg�t�4;��:;9� -��;�•' � ,�
+�'i.•I f r, ^ •,•Ale ,� ni t Lt 5tkr n X1`111 "se t7,•' (� 1
', , }' v rj tt rrw ri,.yK^w1{Yf�`al �i���y � i 1' �+t�'.h '".1�'�, � '4'-•
, i o- ° ... } r, rel r . •8. :.. �, I,1 :rf< � 1 .
1 1 1. S itr 4 s .� �•. }� .a � ? t I 4
y�n
-r CHIPAG a F
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TITLE
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.tY• b0 „'1 � +hw ytJSi A � r p
• r' ` 1. .G $�."CI ly'LY'�',3'�YC $r ,tiw!r�a-�" "14+F�
CITY OF CUPERTINO 0� r
SIGN ,
ll o a
CUPE�FINO PERMIT APPLICATION FORM
APN# D
30-03- 009 Date: I- yo, oY
Building Address: Gv /+` A
C14- 8�✓D, l/rY` �
Owner's Name:� ��Y Phone#: +c 6s rb1 -9391
Contractor: i License#:
W k—C tow bl AP vb is S c(_ --I C-13, h4�7'1 3"
Contact: Phone#:
C4 OF-
Applicant/Contractor:
uil g Pe
Bld
Job D crip
ential:rmit Info:
Elect Plumb Mech
don: FuR B/SH EX�sTING t/j / ING coNC1EE s�hB
Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuatio • , r \
Type of Construction: Occupanc Gro p / 7J
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILIDNG
BPERMFEE Bldg Permit Fees BUILIDNG
PLANCHK Plan Check Fee BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
EPERMITFEE Elect Permit Issuance ELECTRICAL
BREMSIGNAD Rmd] Signs Add Branch ELECTRICAL
BREMSIGNS Rmdl Sings, Marquee ELECTRICAL
BUSLIC Business License BUILIDNG
•
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