04060052CITY OF CUPERTINO
rid { "'
BUILDING DIVISION PERMIT
CONTRAC�T�T�OR INT'®'
BUILDING ADDRESS: _
MADLEM MECHANCIAL INC
PERMIT"°'04060052
OWNER'S NAME:
PERMIT ISSUE DATE,
OAKVILLE MARKET
1990 OLD MTnnT.RPTFTn WA
nr�10-712004
E;
SANITARY NO. CONTROL NO.
(650)934-9485
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
SDECons or CON
LICENSEDCONTRACTOR'S
1 affirm that I am underprovisions of Chapter 9 (commencing
Job Des Ip 6p,❑�
Division BusncagwM ProfcWuns Code,ser my license is
ion 7 lithe Bu iscon
Section
U �l f�
with
of off=
un fork, dcrcuc o
INSTALL SEWER C/O (� e
Lia c tea. Irw
Da¢ Con
UN 9:
ARCNIIECS DELLPWJLW
2404
recovered my plans shall W used As pd ¢ recmds
sp��y
a 1J1zAD to
Licensed Professional
OWNER -BUILDER DECLARATION
I em exempt from Nr Contractor's License Law for the
1 hereby Anion food,
moon. suet.. RI31.5. Businessland lues Code: MY city or county
emit t Approve, de or repair any
Which requires permit re cnreuuel, spree imProw,
Which ex
um ant
h Perlia
prior m its licensed issuance, also re1. the N. applicant the Com Pmune to fit. s sign.(su¢mcm
n
(commiscngwiPunuant of Nc Communes (Chapter
N)
Sq. Ft. Floor Area
Valuation
Code) or
7 of Division nd Prorlaons Cock)
(commencing with Section Tern) of Divixiof the Business and
r de rm. Any
Nal W u exempt Nertfmm an0 (re bus for IW JI.gW eumpdon. My vlola(on or
pnsstn ��nnyN,,�
3LP1a M W Ota 0 0
�1
Occupancy e
p y •7 p
Sudan 7031.5 by airy applicant for a permit subjecu one applicant m a civil penally or
not mom Nan Eve hundred dollen (5500),
❑ I,00wner of Ne proprny,mmy employes with wegesuNe'u colt compenutim,
Required Inspections
will do tcwort. and due sutrctum is not intended monered for We (See. 7044, Business
and Pmfassiom Cade The Conmctr's License Law does not apply N an owner of
property who builds m Improves thereon, and who docs amh .,it himself or Nmugh his
own employees. provided that such impmvemenu are mtinundW cronarW fm We. If.
however. Ne building or W pmwmsnl is cold within one your of comple(on. are owner.
builder will have the burden of proving dual W did not Wild or improve for purpose of
sake.).
❑ 1, As owner or L u property, am exclusively contracting with licemed contractors to
construct Ne project (Sec. 7°14, Business and Pmfesdons Code:) The Com acmes Li -
caress taw does not apply to an owner of partially who Wilds or improves thereon, and
who contracts for such projects and, a canaaclor(,) Recalled pursuant to the commucoes
License law.
❑ I am exempl under See. . B k P C fm ND moon
Owner Dau
WORKERS COMPENSATION DECLARATION
I thereby aRrm under penalty of perjury arc of due following deelm(om:
haw and will maintain aCeolftcate of Content m self-imum for Wmke'sCompen-
sadon, se pcovidN to, by Section 37M of tk IoW, Cade. for Ne per(oors. of Me
work for which this pane is issued.
❑ 1 h d will maintain Workers Compensation Iourana, o rryuised by Section
3, o N labor Code. for the performance fm which this permit is tum
m W Ye Coonlnsunme nise and Paliry num tee:
Ycarrier And
en Pali
CERTIFICATE OF EXEMP ION FROM WORKER
COMPENSATION INSURANCE
('Nis auction sued not W completed if la, permit Isforonc hundred dollar (5100)
or less)
1 coolly that in Ne performance of the work for which this permit 4 bused, ) shell not
employ any person in my mmnerso As to become subject o the WMIteri Compernadon
'
Laws of California. Date
Applicant
NOTICE TO APPLICANT`. If, after making this Certificate of Escmption. you should
become subject is the Workers Compensation provisions of Ne Labor Code, you must
forthwith comply with such provisions or Nis permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 thereby afrm that Vert is a construction lending agency for Me Performance of
Ne work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Add.
I certify that 1 have mad this application and more that to allow information is
correct.) agree to comply with all city and county ordinances and slide lain relating to
Wilding construction, and hereby authorize representatives of this city to enter upon the
aWw-encnuoned property for' do mrsses
(We) egrte m save,' demo' y c harmlru (re City of Cupcnino against
;0
IiabiWles,judgmenss.cm ands rases is MAY in any waYsecme against said City
is. sequenccafteg a this pe it
APP CANT UNDER DS AND COMPLY WITH A -POINT
Issued by: Date
SOU ED "n S.
Re -roofs
C
Si lure fApplicara Comlaelar V (weal I
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Wil Ne applicant or future building occupant ame, or handle hvndms material
defined to Cupertino Municipal Code. Chapter 9.13. and is Health and Safety
sucn 7
C] A ()T.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
Ill the applicant or future Wilding occupant use equipment or devices which
]axardnus airconumimmur as dcr.h.d by IW Bay Arca Air Quality Management
all new materials for inspection.
District?
' Dyes �CNJu
l hew mad Nc hmarda naps myulmmcnu cars(crChaprerh95of(teGlifm-
niaHcalN SafclyCode,See ons .35533and2553d. lundcamnd tui!to Wilding
dean not cntly hose a u al is y rcaponsihility t nntily the mcupens of Nc
requircmc aahichmou etpnor aaan.eoracenifia a rain y.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner car Mah ri.cd eg.nl ,te
BUILDING DIVISION PERMI
RCONTRACTORTNF'ORMAT
$n,,. i
BUILDING ADDRESS:
MADLEM MECHANCIAL INC
PERMIT NO. 04060052
ER'S NAME:
PERMIT ISSUE DATE
OAKVILLE MARKET
1990 OLD
PHONE:
SANITARY NO, CONTROL NO.
650)934-9485
ARCHITEC (ENGINEER;
BUILDING PERMIT INFO
BLDG ELECT PLUM0B MECH
f
o 0 0
LICENSED CONTRACTOR'S DECLARATION
hapten 9(com
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
ft, that
Job Desert
on3aftheednc nd PefcssiOf
with Sectionb,
Cenci is
FINAL
imm�m a dermm O
INSTALL SEWER C/O ED
License C, Lk. _
'
Da¢\ Conus
I'
`fWndcmmd my plan he usedaspoh TIUIT
a:retards
`,J '(
JUN 012004
Licensed Pefcssional
OWNER -BUILDER DECLARATION
I hereby Mfom Nat I am exempt room the Contractor's License Law for the
following reason. (Stettin IID L5. Business and Professions Calc: Any city nr county
��I DI NGn
eana, also, impron
which requires a pemnit m wu ve, demolish, m repair any nre cs
prior to its issuance, alsu xquires Ne applicant attach permilto flea signed smtement
mal he is licensed larmanl to Ne revisions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(com,Bencing with Section 1000) of Division 3 of the Business and N.Ral inti Code) or
that hs is exempt therefrom and be basis for Ne alleged exemption. Any violadon of
3 �BMI �1Gldr�er 0 0
Occupancy
P y TYPe
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty or
not mom than fisc hundred dollars (g500).
❑ la as owner of the property, m my employees with wages u their sole compensation,
will do be work cad the swnurt rs at imemtied or offered forsal. (See 1004, Business
Required Inspections
and Pelcoul Code: The Conuzctort License Law dors tot apply in an owner of
property who builds or improves thereon, and who does such work himself or through his
awn employees. provided that such improvements are 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 Wrden of proving that he did not Wild or improve for propose of
sale.).
❑ I. as owner of the property, am exclusively contracting with licensed contractors to
construct she prolan (Sec. 1044, Business and Profeuioas Codk:) To, Communes Li.
cense law does not apply to an owner or property who builds or improves Merton, and
who contracts for such projects with a conwctor(s) (leaved pursuant to use Contractor's
Liter's law,
❑ l am exempt under Sec ,B&PC far 01. ..ad
ir Data
,
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of The following decimations:
❑ I have and will maintain a CCITHIMm of Comem to xl6iasum for Worker'sCompen-
sodium, u provided for by Section 3700 of the labor Cade, for the performance of the
work for which this permit is issued.
❑ 1 h c Ind will maintain Workers Compensation lasuranm, as tequimd by Section
7�a th Latin Code.for the performance of the�for which this permit is issue
is Compe oto lntnncecamicrand Puiigmmn ram:
C ev Poli
VC
CERTIFICATE OF EXEMPTION FROM W ORKER
COMPENSATION INSURANCE
(This section need not W completed lite e permit Is Amore hundred dollars ($1000
or less)
1 tardily that in the performance of Ne work for which this permit is issued, I shall not
employ any person in any manner x as to bacome subject I. Waritesf Comrcwumi
Laws of California. Data
Applicant
NOTICE TO APPLICANT: Ir, after making this Certificate of Exemption, you should
become subject to the Worker's Consternation provisions of IW Ichor Code, you must
.
forthwith comply with such provisions or this Permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby, affum than Nem is a conxwuinn lending agency for the Performance of
Nc Wark fur which this permit is issued (Sec. 3091. Civ. C.)
Lenders Name
Lenders Address
1 certify that I have read this application and sum 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 authorise mpruenutiws of this city to enter upon me
shove-memiancd propcny furyy' Ius cur Eorpous.
(WO) agree to sive, jddcmn" y a d bee harmless the City of Cupertino against
-le
1
11abiliues,judgmcnu,eos ands area mayin any way scene againstsaid City
int nxquencc ofthcg tin "this per it
APP (CANT UNDER DS AND L COMPLY WITH A POINT
Issued by: Dale
SOU REGULATI S.
Re -roofs
Type of Roof
SiApplicanUCamod Des
HAZARDOUS MATERIALS DISCLOSURE
the applicant w future building =upon( store or handle hazardous material
Ne Cupenom Municipal Code, Chapter 9.12. and the Health and Safety
azss32(.)1All
�Nohe
roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree ro remove
applicant or future building oreupam use equipment or dcvicu which
emit hamlous air contaminants as dcfned by the Bay Area Air Quality Management
all new materials for inspection.
Districll
E) Yes �Nu
1havemad Neharalloo wrlalsmquimmenuunder Chmpwr6.95ofNe Califan
nix Health Sa"myCede, Sccl(om2 25533and2534.1undereand Nadifthe building
docsnat cnllyh.ve. 'an at u ymspmuieloy notify thea'eupnnor Na
rcquimmcL hien env strip mncaaf.canlfc rata r.
Signature of Applicant Date
'
All roof coverings to be Class "B" or better
g
Owner or auto riacd sate ]�arrl—r
CI F
• CUPERTINO
•
•
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE �'�U C, S Z
PERMIT APPLICATION FORM
APN # -S5Gf O So 1 A
PPERMITFEE
Date:
Uunc -7, 2o0
Building Address:
BPREPIPE
Re i e of Fixtures
zos58
sq-�v�s ce�c BL -VP
Bldg. Permit Fees
Owner's N e:
BPFIXTURE
Phone #:
Contractor:
Phone:
X12
License #: 20��
MAD� me3A .
5 (44 -1 -
Sewers
Contact:
puss S
Phone:
Cupertino Business License #:
vice.
Res &4LP7 -G(.SS
Business License
Building Permit Info:
Bldg )9 Elect
❑ Plum
Job Description:
51�15TGLL S;#i lrT;a S� )E(L GCEo�S-o�-r
Residential ❑
Commercial 'g
Cost of Project:
#5, 000
Qtyyy��f
Aot>ficable Fee ID
Fee Desrrintion
Far (-rmnn
•
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BPREPIPE
Re i e of Fixtures
PLUMBING
BPERMFEE
Bldg. Permit Fees
BUILDING
BPFIXTURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
PSEWAGE
Sewage Disposal
PLUMBING
BUSLIC
Business License
BUILDING
•
0
0
•
OAKVILLE MARKETPLACE 126558 STEVENS CREEK BLVD. CUPERTINO
(1) M H
PL OTU—
I�E AMU Wt,.
(J) 5W.SEUM LQ.
APNWVIEU
dl@ fl'* 0 et mes end itis un
noes or. alterations
matt wdtten permission from
WAR 9eA. City of Cupertino,
N 890iNpifgg of this plan and specifications
10ALA NOT W held to permit or, to be. ar,
,POMW of the Violation of any provisions
.4ay Oily Ordinance or state law.
DEIVELJ 49
( PRIVATE PROWUT
(E)
LE) 54I. -MM— UO
CUPERiINO SANITARY DISTRICT
w I DISTANCE FROM PROPERTY
LINE TO BE AS CLOSE AS
PRACTICAL AND NOT TO
EXCEED FIVE (5) FEET.
0
rt
a�
PUBLIC RIGHT OF WAY STANDARD CLEANOUT
-REMOVABLE CLEANOUT PLUG
FINISH GRADE ..,
l STY G5
Tt SH
WYE FOR RISER I /G9C _ IA6�TS�WER"�ORAbP'ROVF;D EQUAL
SHORT LENGTH i 1/5" BEND
ADAPTOR, COUPLING
FLOW
STREET LATERAL SEWER I HOUSE LATER L SEWER ' Mln
;;-
NOTES_
1. MINIMUM PIPE SLOPE DETERMINED BY BUILDING DEPARTMENT.
2. LATERAL SEWER CLEANOUT TO BE SAME SIZE AS LATERAL
SEWER.
3. AT LEAST 6 -INCH CLEARANCE BETWEEN VALVE CAP AND
INSIDE OF BOX REQUIRED.
FILE " NO STANDARD CLEANOUT DETAIL J
FILE
DR. BY:HJP DATE: 05/13/03 1 CK. BY. -DMT DATE:05/14/03 I APPROVED. BY• R/hr DATE -,r -/S'.5