08020031 BUILDING DIVISION• PERMITCON�CR:ACTORII ATIO- : • -
nu:. s �s mid -_
PERMR NO.
"R1 'MT§'bTEVEIVS CREEK BLVD TBD - TO BE DETERMINED 08020031
ER'S NAME: - PERhUT ISSUE DATE
SHELL OIL CO. U. S. 02/05/2008
PHONE: SANITARY NO, CONTROL NO.
ARCHITECf7ENGINEER: BUILDING PERMIT INFO
BLDG O EMECH
O �� O
Sop LICENSED CONTRACTOR'S DECLARATION Il)DesCrDescription
1 hemby affirm JO
that 1 am licensed under provisions or Chapter 9(oushomming lp
whim Section 7")o(Didaion 7 orme Business and Pmmaions Code,am on,Neve is RMV & REPLC CONDUIT & WIRING TO 4 SUBMERGBL
I n full fume and e
UcemucClau /D t7c.g 'P PUMPS, LIKE4LIKE(NO NEW CIRCUITS) .UPN FRTHR
`3`q Dau ARCHTIECTS DEC INSPCTN,
Y•uu.�22 1 undewnd my plans mall he used u pubrtco
g u� Licensed Professional
y7 OWNER-BUILDER DECLARATION
ConumON
4 Q 73 I Maso .(Tiro that I oro.amps from Jw GontraclCc License city
o fou IW
OO following moon: emit t 7D71G.Business and Professions Code:My city ar county
$ which requires r permit to.Im$ft alum impmnw,h PCMiLb,of repair ay suttcture
prior teisscensed ,abu mquim lhc&pplieulfor such pemitw file assigned wwmcm
< (mermc ingwidputrvuUamcproviviouMof ftBuuwrYUcmvseaw(Chapur9 Sq.Ft. Floor Area Valuation
that he sexem t Section 7000)Ad)MOiasis for
th me Business endon.myons Cme)of $1000
—
that io b exempt dumfwm And me bub far use alleged exemption.to Any l penalty
of
Section 7031.5 by e soy hundred dollars
permit rvbKets Ne Applicant to•civil penalty of Number Occupancy•Type
Am mart man five hundred dollen(5500).' 3 2 6 31 0 21:Y/V'
I,umnaofthepmpmty,mmycmploycuwimma uJ kwidcompenudm.
will do the work,and R eswctum 6 notinwnded oruRemed Instal.(Sec.7044,Bum.
And Pour..Ins Code:Ted Commuter's Liaise Law don not apply be a ownsr of Required Inspections
property who builds oimprows themon,and whodoestuchworkhimulfor through his
awn employee,provided mat such impmwmem,an,not intended mortared for sale.IL
however.the Wilding or improvement is sold within one yem Mwmpletian.me awmur-
milder will haw the boron of proving that ha did out held Or improve far purpose of
ole.).
❑1,as mrner M the pmpcny,am=elusively contracting with licensed mntramma to
conarmct the project(Sec.7004,Bu moo,And Net.sloe Come:)Tu Conuamer'a Li-
cense law dome not apply to A.owner of pmpenY who Wilda ons lopes.thereon.And,
who cMnacb for such prejeN with AconJemr(t)licensed pmmennl to the Cummemm't
License Law.
❑IsmuammunderSm. ,Bk PCrormm.m
Dau
WORKER'S COMPENSATION DECLARATION
1 amby&flim under penalty of perjury Our of the following decimations:
❑I haw and will maintain aC&Nrima wfComent to self-inaum for Worker's Compen-
adon,As provided for by Section 370D of me Labor Code.for the performance of ties
work for which this pcmit is issued.
❑1 haw And will maintain Wodu's Compensation Insurace.As required by Section
77M Mme L4mr Code,to,the Wrlo mence of the work for which this permit is issued.
My Workaes Compenution 4Pu�¢,ardc sod Policy number am:
Cardera.cT+'a-r." isH� Policy No.Alal CgDg'
CERTIFICATE OF EXEMPTION FROM ORKERS'
COMPENSATION INSURANCE
(This section need notheconpleu t If tins permit is formic hundred dollars(SIM)
or less.)
I certify that in the performance of the work fos which this Icmis is issued,I shall.1
employ any Motor in try manner an As to become subject in tic Workers'Compensation
Laws of Califomia.Dau
Applicant
NOTICE TO APPUCAND If,&fuer malting rob Cendiiau of Exemption.you should
become subject in to Waheh Compensation provisions of the Labor Cmc,you mum
O Forthwith comply with such provisions or this permit shall W doomed revoked.
Z^! CONSTRUCTIONLENDINGAOENCY
.N. I humby a111m flu thea In ronstractinn funding.gamy,forme perfomuceof
t>; .fin
the work for which this permit is issued(Sec.7097,Civ.C.)
Q Lender's Name
n7- Z Lender's Adduce
U O 1 certify that I ate mud this application And sou this the aWw infomation Is
um ^". coma I agree te comply with all city and county mulnances and some laws mining to
-p`rJ' Wildingconstruction,and hereby sumorise representatives of this city in men upon me
W above-mentioned property for inspection p opines.
(We)agree to saw,indemnify sed keep harmless the City of Cupertino against
t:�y liabilities,judgments,coms and expenses which may in any way Accrue Against said City
U z inconse on
of the 1X.R.
w' APP UND N AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S U
CC Re-roofs
SI n Appli C6. Iyy Data
HAZARD0UST3ATPRIALS DISCLOSURE Type of Roof
Will tinsapplicantmfutum Wildingwnpanlmamoranilehs oamawdd
de nod by the Cupertino Municipal Cade.Chapter 9.11,and me Health and Safety
semen 15572(a)7 'J All roofs shall be inspected prior to any roofing material being installed.
❑Yes {p No
Win the applicsot or uu'U1m Wilding occupant use equipmam os devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit Wardens air commmiunu As J fl sed by the Bay Arta Air Quality Management all new materials for inspection.
m3uict7
Dyes
u
I have mm me us materials requirements underChapter 6.95 or me Califor.
".hi.h
0.5,25577 ud23571.1uodorsund mmllthc Willing
t is my responsibility w nodfy the occupant of me
teiatrsumnr.cenir¢Atear2capaueY. Signature of Applicant Date
Dam All roof coverings to be Class"B"or better
• CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ' 32631021. 00
DATE ISSUED. . . . . . . : 02/05/2008
RECEIPT #. . . . . . . . . : BS000003859
REFERENCE ID # . . . : 08020031
SITE ADDRESS . . . . . : 20999 STEVENS CREEK BLVD
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SHELL OIL CO. U.S.
ADDRESS . . . . . . . . . . : 20999 STEVENS CREEK BLVD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : WAYNE PERRY, INC.
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
• TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICO VALUATION 10, 000. 00 2 . 10 0. 00 2 .10 0. 00
IELECINSP HOUR 1. 00 122 . 38 0. 00 122 .38 0. 00
lEPERMITFE FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00
1TRAVDOC FLAT RATE 1. 00 40 .79 0. 00 40 .79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 206. 06 0. 00 206.06 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 206 . 06 #19971
---------------
TOTAL RECEIPT 206. 06
•
'ROa 003
i Y
an CITY OF CUPERTINO
• CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# Date: J _r —c)r`�
Building Address:
-,,, - �v
Mailing Address (if different from building address):
Owner's Name: Pho #:
l
Contractor: Phone: Q// / / ,oma
on
0t4o�-7- Fax:
Contractor Ilicense#:
• Cupertino Business License
l �
Contact:: y ,� Phon �((P 717 r 3
,;�V'0� �
Residential Commercial
Job Description:
ram
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Cla s): Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-IHR ❑ 11, 111, 1V V-N
Valuation: Square Footage:
• Project Size: Standard ❑ Large ❑ Major ❑
CITY OF CUPERTINO
CUPEI,TINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1BTEMPPER Temporary Building Permit(good for B
30 days)
IBBOILERI For the installation or relocation of ea M
boiler/compressor to &including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h 29.3kw
1BBOILER2 Installation/relocation of ca M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
IBB0ILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea •
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1BBOILER4 Installation/relocation of ea M
boiler/compressor over 30 hosepower
to &incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
IBAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
1ELECINSP Other Electrical Inspections (per hour) E
IMECHINSP Other Mechanical Inspections (per M
hour) •
IPLMBINSP Other Plumbing& Gas Inspections P
per hour
1MEETINGIHR Application Meeting B
alF
CITY OF CUPERTINO
CUPEI� GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWL/Duplex New B
IACOUSRESAD SFDWL/Duplex-Addition/Alteration B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1 CHIMNEY Chimney B
1CHIMNEYR Chimney Repair B
FENCES
1FENCE>6FT Non-masonry, over 6 ft in height B
1FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FH?EPLMAS Fireplace Masonry B
1FIREPLFAB Fireplace Pre-Fabricated/Metal B
1FLAGPOL>20 Flag pole (over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1FOUNDREP Foundation Repair B
1PILECAST Pile Foundation Cast in place concrete B
1PILEDRIV Pile Foundation Driven (steel, pre- B
stressed concrete
3 of 5
CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING APPLICATION .
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
RETAINING
WALUCONCRETE
OR MASONRY
1RETSTN Standard (up to 50 ft) B
IRETSP310 Special Design, 3-10' high (up to 50 `) B
1RETSPIO Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft
SIDING
1 SIDESTBK Siding, Stone &Brick Veneer B •
interior/exterior
1 SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf. B
1 SKYL>1 OSF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
•
4of5
ZCIF CITY OF CUPERTINO
• CUPEf�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee.Description Fee Permit Type
Group 1GENRES or
1 GENCOM
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1WINMEWSTR New Window-structural shear B
wall/masonry includes plan ck fee)
IEPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1 PLMPLNCK Stand Alone Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
iBSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
/ 1TRAVDOC Travel &Documentation B
1BUSLIC Business License B
•
5 of 5
F Community Development
10300 Torre Avenue
j ' ✓ Cupertino CA 95014
Telephone(408) 777-3228
tCITY OF Fax(408)777-3333
PEkTINO
Building De artment
JOB ADDRESS: PERMIT#
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Si tore Date
Please check applicable subcontractors and complete the following information:
60 SUBCONTRACTOR BUSINESS 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