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04070078CITY F CUPEf�T1NO 5 CITY OF CUPERTINO U o PERMIT APPLICATION FOR �4- "N # v Fee Description Fee Group Date:7 + 1 , Build' n Address MECHANICAL Mailing Ad ssif ent from building address): Boiler <= 100,000 Btu MECHANICAL BBOILER2 Owner's Name: MECHANICAL BBOILER3 Phone #: kv �T�33T S, BBOILER4 Boiler > 1M to 1.75 M'Btu -16 Contra to : Boiler > 1.75M Btu MECHANICAL License #: LAN l v/- BUILDING BCONSTAX Ind/Off/Comm/Quasi Contact: Phone: Con. Tax for BQ Zone Cupertino Business License#: BCONSTAXH Fax: BUILDING BCONSTAXR Building Permit Info: BUILDING BELEC 1000 Elec 600V <=1000A ELECTRICAL BELEC1001 Bldg � Elect ❑ Plumb ❑ Mech ❑ Job Description:: A ELECTRICAL Residential C"Ovtiv 6 y FI6 Commercial ❑ Sq.Ft. Floor Area: Energy Add Multi $/Sq.Ft.: Cost of Project: Investigation fee Occupancy Group: Type of Constructio lease ck this box if.th roject is a -sto 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 > 10 OK to 50OK 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 BELEC 1000 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 �` Z, 17�12 1 of 3 CITY OF CUPERTINO CITY OF CUPERTING PERMIT APPLICATION FORM Quanti Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 13NUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL 13NUCOMMP New Comm Plumb PLUMBING 13OVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cess ool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind. Waste Interc tax 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 r nkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER InstaWAlter Water Pie PLUMBING BPWSEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER AIC Unit > 10,000 cfm MECHANICAL BREMAiRHAN A/C Units c= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL . BREMFURNOV Relo Fumace > l OK btu MECHANICAL BREMHEAT Heater installation MECHANICAL BRENIINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platforin Fixture ELECTRICAL BREMPOWER Power De-dce/Apparatys ELECTRICAL BREMRECEPT Rc tl, Switch & .Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL 13REUREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 �:ITY OF CUPERTING CUP�f�F PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 BSEISNIICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bld Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERNIITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERNUTFEE Mech Permit Issuance MECHANICAL PPERNIITFLE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Change BUILDING 3 of 3 oUILDiNG 01WSION PERS SILVERIE III INC, DALNif;L IPERMIFTNDD4070078 OWNER'S NAM]« PERNM 15SVE DATE STEVENS CREEK APARTM'RNT.R T, 91�'� n T) T. MfliJ'Tla a17_1`� crrI. n I , n 1r%0 In n n n ARCHCCECrfENGINEER: a p LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm !tat 1 am licensed under provisions of Chapter 9 (commencing z with Sectioni6m)ofDivimon36rtheBusinrssandProfcssionsCD&.andmyrmcnscis in full face and effect. '+� X License esus Lie. n p Date Contractor .a ARCHITECTS DECLARATION I understand my plans shall be used as public records aV M h Licensed Professional y OWNER -BUILDER DECLARATION e I hereby affirm that I am exempt from the Contractor's License Law for the A h5 following reason. (Section 7031.5. B usincss and Professions Code: Any city or county $ which requires a permit m CM-,q=L alter, improve, dmmulbLh, ar repair any structure z } prior to its issoanx, aLw requires the appricanl for such permit to file a signedstalcmcnt e that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7W0)ofDivision3or the Business and ProressionsCadc)or that he is exempL thcrrtrom and the basis for the alleged exemption- Any violation of Section 7031.5 by arty appliCantfor a permit subjects the applicant to a civil penalty of not more thaw five hundred dollars (5500). I. as owner of tfie property, or my empiayces with wages as their sole easrpensatlon, will do the work. and the structure is not intended or offered for sale (Sec. 704-4. Business and Professions Code; The Contractur's Lie== Law does not apply to an owner or Property who bunds or improves therwn. and who dors such workhimself or through his own employers, provided that such improvements arenotintended aroffered for sale, [f, 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 pwpase of W. as owner of the property, am exclusively Contracting with licensed contranors to �6w—U= the project (Ser. 7044, Bueinat and Professions CodC.-) The Contractor's La- ccase Law does not apply to an owner or property who builds or improm thereon, and who eantractsfar such pmjecLs with a eonLractorfs) liCC.=d pursuant to the Cantrutoe's License Law, ❑ 1 am exempt a J» , B & P C for tld5 reason Date L' I berc'VlaTsrm under penalty of perjury one of rhe following dcrlarations: 1 have an�Jill maintain a CenlGetrn of Consent to self -insure for WorkersCompcn. saden, as provided for by Section 3700 of the Labor Code, for the performance of the weak forwhich this permit is Issued. C] I have and will maintain Workers Compensation Insrumee, as required by Srs[ion 3700 or the Labor Code, for the performance or Ne work for wbkch this permit is imed, My Worker's Compensation insurance carrier and Policy number we: Carrier Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This seeton recd not be Completed If the rem it is Cor otic hundred do0as (S 100) M less.) I cusify that in the performance of the work for which this permit is issued. I shall not employ any person In any manner so as w become subject to the Workers' Compensation Laws of California Date Applicant NOTICE TO APPLICANT_ if, after making this CcrlfOcate of Exemption, you should biome subject to the Workers Compensation provisiom of the Labor Cod- you muss roahwith comply with such provisions or this permit shall be deemed revoked. CONMTjCT10N LENDING AGENCY I hereby of inn Char there is a construction lending agency farehe perrmnareo or the work for which this permit is issued (Sec. 3097. Civ. C.) Lenders Name Ltnder'sAddrrss _ 1 SANITARY NO. ' - ' CONTROL NO. Job Description REVISION --10 FOR RETAIL IMPROVE NO NEW PERMIT ISSUED/ ORIG. ##02040076 Sq. Ft. Floor Area 36901029.00 Required Inspections I certify that 1 have read Otis application and state that the above information is carreeL 1 agree to comply with all city and county ordinances and state laws relating to building eonsauction, and hxeby authorin representatives of chis city in enter upon the above-mentioned property for Inspection purposes (we) agree to save, indemnify and keep harmless the City of Cupertino against Ifabkbtiu. jcdgmcats 6?ts and expenses which may in any way aceme against said City in consequenceof a ranting of this permit, AP i ] DF STANDS AND WJLL COMPLY WITH ALL NON-PO1PT ISSUed by: HAZARDOUS MATERIALS DISCLOSURE ' ] e applicant or future building occupant store or handle hazardous material de b the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety otic, 'on 25532(a)7 ❑Yes Will the applicant or future building o=partt use cquipmeal or devices which cmic hawdous air contaminants as defined by the Bay Arra Air Quality Management District? ❑Yrs (�No I have mad the haranfouuss materials requirements under Chapter 6.95 of the Califor- nia Health &SafetyC,Secdons25505,25533and25534.Iunderstandthildrhhe building does not cutrea y v� a tenant, that it is my responsibility to notify the occupant or the rcgyiremerttss I must be mel prior to issuance of a Certificate of Oecupancyfk I f Re -roofs Type of Roof Date PERMLTINFO uatl Q$ 10 2 Type o� 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 ofApplicant Date All roof coverings to be Class "Br' or better C1TY �OF CUPEKrINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department WN Rx, I �t I WAS 1 513' BLIkNESS NAME BUSINESS LICENSE # I am not using any subcontractors: a e Date Please check applicable subcontractors and c . Iete the following information Owner/ Contractor Signature Date SUBCONTRACTOR BLIkNESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum. / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date