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CITY OF CUPERTINO 3
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BUILDING DIVISION
PERMIT z
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PERMITNO.
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WILKEY'S CONSTRUCTION, INC. 0
08040014
A'S NAME: P
PERMIT ISSUE DATE
CONOCO PHILLIPS 4
4827 PACIFIC AVE 0
09/19/2008
PHONE: S
SANITARY NO, CONTROLNO. I
ARCxITECT/ENC3NEER: B
INFO
INSTALL ENCHANCED VAPOR B
BLDG LECTT P
0 0 0 0
LICENSED CONTRACTOR'S p
IOb Description
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License ❑W e
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ARCHITECTS DECL wcAT1ON
1 uMcwnJ my pWt shall W used u Public records
Licensed Professional
OWNER - BUILDER DECLARATION
I botoby M. Watt 1 am eumpt from the Curbstone, license Law far the
following mason. (Section 7071.5, Business and Professions Code: Any city ar county
which acquires A permit w esmwmv, shot, improve, lemulih. or repair soy -,to.
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BUILDING DIVISION PERNHT
BUILDING ADDRESS: PERMIT NO.
21530 STEVENS.CREEK BLVD 08040014
OWNER'S NAME: S� PERMIT ISSUE DATE
CONOCO PHILLIPS 09/19/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHIIECrfENGINEER: BUILDING PERMITINFO
INSTALL ENCHANCED VAPOR BLDG ELECT PLUMB MECH
LICENSED CONII KACIVR S uCULAKA1 LUN
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 5 sdo .7
License Clads Lle- N
Date a 1G9 Contractor tLIi7'py. Kra+cam
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 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, after, 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 Contractur's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) ser
that he is exempt thcmfrom 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 penally of
not more than five hundred dollars (5500).
❑ 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 Contractors License Law does 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 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 burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the pmjeci (Sec. 7044, Business and Professions Code:) The Contractors U.
cense Law does not apply to an owner of property who builds or improves thereon, and ,
who contracts for such projects with a conuacur(s) licensed pursuant to ase Contractors
License Law.
❑ 1 am exempt under Sec , B & P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compcn-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I 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 CamperuA�ti_o-n lnsuranee artier and Polity number am:
Carrier.Z`Ul.:11 [Y'r- ,1)5' �ri Policy No.: IsChC r I 1 I ly0I
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(this section need not be completed if the permit is for ane hundred dollars ($100)
or less)
1 certify that in the performance of the work for which this permit is issued. I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT. If, after making this Certificate of Exemption, you ihould
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be dcc=d revoked.
CONSTRUCTION LENDING AGENCY
1 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 1 have read this application and state 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 aothorim representatives of this city to enter upon the
above-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 UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS. 0171-9
Si Applicant/Comractor Date
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)?
❑ Yes _r(No
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 %aRo
I have mad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand due if the building
does not currently have a tenant. that it is my responsibility to notify the occupant of the
requi is which must be met prior to issuance of a Certificate of Occupancy.
agent
Sq. Ft. Floor Area
Required Inspections
Issued by:
Re -roofs
Type of Roof
Occupancy Type
Date I--?— J
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'}" or better
CITY OF
CUPEVI INO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
APN # 2, 7A 6) 0,) -7 v
Date: o46-0
4 U- Q b
Building Address:
Mailing Address (if di ferent from building address):
.,-Ila ,tA
Owner's Name:Phone
OC/0q4.
#:
Contractor:
Ph e: FM • �i2- G (kZ•
/ j (
Vv`W-�S �� (/1 ► l�l� �'
Fax: j �• �d
Contractor License #:
Cupertino Business License #:
Contact: j
Phone: , . b,:;l(,g
Fax:
Residential ❑ Commercial
Job Description:
Building Permit Info:
Bldg Elect E�-- Plumb [J--" Mech
Type of Construction (Usage Class):
Occupancy Type:
1 FR, IIFR ❑ 11, 111, V -IHR ❑ 11, 111, 1V V-N)A,.
[A
Valuation: Square Footage:
Project Size: Standard Large 11 Major ❑
3
cm OF
CUPEVINO
CITY OF CUPERTINO
GENERAL ]BUILDING
PERMIT APPLICATION FORM
Quantity/Sf
Fee ID
Fee Description
Fee
Permit Type
Group
WIENRES or
1GENCOM
113TEMPPER
Temporaryy, Building Permit (good for
B
30 days)
113130ILERI
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)
113130ILER2
Installation /relocation of ea
M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1BBOILER3
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
NI
_
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
1B80ILER5:
Insiallation/relocation of ea boiler or
M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH
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.
node.
1ELECINSP
Other Electrical Inspections (per hour)
E
1MECHINSP
Other Mechanical Inspections (per
M
hour)
1PLMBINSP
Other Plumbing & Gas Inspections
P
(per hour)
l MEETING I HR
Application Meeting
B
_
CITY OF
CUPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
I am not using any subcontractors:
S' a a
Please check applicable subcontractors and c ete the following information:
SUBCONTRACTOR
• • �g,t p Ellen -"
•
�r i
Cabinets & Millwork
I am not using any subcontractors:
S' a a
Please check applicable subcontractors and c ete the following information:
3
O e /Co for Signature ate
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 R
Til
3
O e /Co for Signature ate