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03040092 & 03070176 & 03080180CITY OF CUPERTINO R TRACTOINFQRMATION BUILDING DIVISION PI✓RMITCON _ """DING ADDRESS: CHARVEZ CONSTRUCTION PERMITND03040092 ER'S NAME: 360 W STH ST PERMIT ISSUE DATE(408)893-7693 E: IN -SANITARY NO. CONTROL N0. ARCHITEC (ENGINEER; BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I em licenced under provisions of Chapter Y (commencing P with georoin f Division3of Ne Busingaand Professions Code, end mylicense is Licevce and Classsn id-d effect Us.a ADDITION 822'/REMODEL FINAI_EO Date Contractor ARCHITECTS DECLARATION , I andcrsland is, pla ardoill he used as pahlicrccmd, FEB 0 4 2004 Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the BUILDING following reason. (Section 7031.5, Business and Professions Cade: Any city or county whab sequins it permit m ennatrvct, alma improve, demolish, or repair any structure prior to its issuance, also mquircs the applicant forsuch permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7") of Division 3 of the Business and Professions Code) to that he is exempt therefrom and the basis for the alleged exemption. Any violation of 3 5914002.00 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Pane Y Type not more than rive hundred dollars (S500). ❑ Les owner aides property, ormy employees with wages as theirsdecompcnsatlon. will do the work end thedWcture is nm imm�dcJ or offered tousle (Sec.7094, Husinud D �tl Protections Code: The Contractor's License Law does not apply to an owner of builds improves doessuch his 102 Inspections - PIERS property who or thereon, and who workhimselfor through own employees, providedthatauch improvements are not intended oreached for sale. If. 103 — UFER however, the building or improvement is sold within one year of completion, the owned builder will have the burden of proving that he did not mild or improw for purpose of 104 - REBAR alt.). 10 5 - ANCHOR BOLTS 1, as owner of the property, am exclusively connoting with licensed contractors to 0 Dractthe project (Sec.7044, Business and Professions Code:) The Contractor's Li. 106 — SEWER & WATER cense taw does not apply to an owner of propcny who builds or improves thereon.and who contracts for such projects with a contncmr(q licensed pursuant to floe Contractor's 202 - UNDERFLOOR PLUMBING Liee.se Law. 203 - UNDERFLOOR MECHANICAL slam excmpwNndWe�r Sir.��` ,B& P C for this naso. 204 - UNDERFLOOR FRAME `r KER'S A�y�3 03 205 - UNDERFLOOR INSULATION COMPENSATION DECLARATION WOR I hereby allitm under penalty of pajmY one of the following declantmns: 301 - ROUGH PLUMBING l have and will maintain a Certificate of Consent to sal f-insure for worker's Comped. 302 — TUB & OR SHOWER saran, as provided for by Section 37M of the labor Code. for the performance of the 303 — ROUGH MECHANICAL work (or which Nig .it is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 304 - ROUGH ELECTRICAL 3700 of the Labor Code, for the performance of the work for which this permit is issued. 305 — FRAME My Worker's Compensation Insurance carrier and Policy number am: 306 — HOLDOWNS Cartier. Policy No.: _ CERTIFICATE OF EXEM MON FROM WORK ERS' 307 — INSULATION - COMPENSATION INSURANCE 308 — S+HEETROCK need nodbecompleted lithe permitisfuranc hundmldollars(SIM) 309 - EXTERIOR LATH jess.(Thissection I ecailj certify Nate the mraneo of the work for which this permit is ictucd. I shall not 310 - INTERIOR LATH employ n an soninanymannersnasmbecome suhjccnnthe Work.riCompensation 311 — COAT Laws of California. Date Lawso Calif Applicant 313 501 .SCRATCH - ROOF NAIL - FINAL ELECTRICAL ENERGY NOTICE TO APPLICANT. If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Codr, you must forthwith comply with such provisions or this Permit shall he deemed revoked. 502 — FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY I hereby affirm that there is a construction lending agency for the performance of 504 - FINAL BUILDING ENERGY for which this permit is issued (Sec. 3097, Civ. C.) Leaders Nene Lender's 505 506 - FINAL ELECTRICAL - GAS TEST Lender's Addreaa 1 certify that 1 have read this application and dude that the above cos telatinn is building I agree to comply with all city and county ordinances and state laws relating to 507 - FINAL PLUMBING of building conswcdion. and hereby authorize mpresenutivca of this city to enter upon the FIN MEBC CAL ahovo-mentioned property for inspccdon purposes. (We) agree to use, indemnify and keep harmless the City of Cupertino against 0 9 FI liabilities, judgmenu, coats and expenses which may in any way accrue againstaaid Ci ty in 5 NG consequence of the gaming of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 5 C WORKS Date SOURCE WULATIONS. Re-roofs Type of Roof 1A Ld��-713/0-3 igna the of ppliteant/Codowen Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant ser future building oecupand ambe or handle haamdous material u dented by the Cupertino -MoniGlad Code, Chapter 9.12. and the Health and Safety de, Section \ph'(`/ 25532(.)? ❑Y., Na All roofs shall be inspected nor to an roofing material bei. P P Y g g installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or dcdma which It handiness air contaminants as donned by the Bay Area Air Quality Management all new materials for inspection. istrict? D Yes a 1 have mad the licentious materials requirements under Chapter 6.95 of the Califor. nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant, that it is my responsibility, to and l'y the execution of the rcyuircmcn which mu� sxWprow ppd., m issuance of a C.mrmate of Overmy. Signature of Applicant Date ?�3/3 All roof coverings to be Class "B" or better Owner or dharircJ .gem Dam eu joZ COC as � rn �rtz�Z 3r m U ttyt- �Orn _ a y� pa0 < tm u_y — Z > EFo 0z z� a� �z UC Oc_ �. 0. Uz I CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRA CTORAN",ATIt BUILDING ADDRESS: 40_22:7 TONITA WY CHARVE Z CONSTRUCTION PERMIT "03040092 OWNER'S NAME: KRISHNA KISHORTE 360 W 8TH ST PERMIT ISSUE DATE PHONE: (408)893-7693 SANITARY NO. CONTROL N0. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I 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. License Class Lic.9 ADDITION 822' /REMODEL Date Contractor ARCHITECT'S DECLARATION I understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, 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 o the provisions of thc Con(ractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of 35914002.00 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number OCCU anC Occupancy Type not more than five hundred dollars ($500). ❑ 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 forsale(Sec. 7044, Business 101— UNDAi�Jlggd and Professions Code: The Contractor's License Law docs not apply to an owner of Inspections property who builds or improves thereon, and who does such work himselfor through his 10 2 — PIERS own employees, provided that such improvements are not intended or offered for sale. if, 1 0 3 — UFER however, the building or improvement is sold within one year of completion, the owner - builder will have the burden or proving that he did not build or improve for purpose of 104 — RE BAR sale.).105 — ANCHOR BOLTS I,.as owner of the properly, am exclusively contracting with licensed contractors to onstrvct the project (Sec. 704.4, Business and Professions Coded The Contractor's Li. 106 — SEWER & WATER cense Law docs not apply to an owner of property who builds or improves thereon, and . 202 — UNDERFLOOR PLUMBING who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. 203 — UNDERFLOOR MECHANICAL ❑ 1 am exempt under Sec. . B & P C for this reason VAiI 204 — UNDERFLOOR FRAME owner Il,..�-� Date 1/3/1)3 WOR CER'S COMPENSATION DECLARATION 205 — UNDERFLOOR INSULATION I hereby affirm under penalty of perjury one of the following declarations: 301 — ROUGH PLUMBING ❑ 1have and will maintain aCertificate ofConsent toself-insure forWorkcescompen- 302 — TUB & OR SHOWER cation, as provided for by Section 3700 of. the Labor Code, for the performance of the 303 — ROUGH MECHANICAL work for which this permit is issued. 304 — ROUGH ELECTRICAL ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 ordie Labor Code, for the performance of the work for which this permit is issued. 3 05 — FRAME My workers Compensation Insurance carrier and Policy number are: 306 — HOLDOWNS Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 307 — INSULATION COMPENSATION INSURANCE 308 — SHEETROCK (ntis section need not be completed if the permit is for one hundred dollars ($100) 309 — EXTERIOR LATH or less.) 310 — INTERIOR LATH I certify that in the performance of the work for which this permit is issued, I Shall net employ any person in any mannerso as to become subject to the Workeri Compensation 311 — SCRATCH COAT Laws of California. Date Applicant 313 S01 — ROOF NAIL — F I NAL ELECTRICAL ENERGY NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you should become subject to the Worker's Compensation provisions of the tabor Code, you most forthwith comply with such provisions or this permit Shall be deemed revoked. 502 — F I NAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 503 — FINAL MECHANICAL ENERGY I hereby affirm that there is a construction lending agency for the performance of 5 0 4 — FINAL BUILDING ENERGY the work for which this permit is issued (set. 3097, civ. c.) Lender's Name 505 506 — F I NAL ELECTRICAL — GAS TEST Lender's Address I certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to 507 — FINAL PLUMBING building construction. and hereby authorize representatives of this city to enter upon (he CAL ahove-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against 0 9 liabilities. judgments. costs and expenses which may in any way accrue against said City 5 ZINMEVNG� in consequence of the granting of this permit.APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: 5 WRKS Date SOURCERE ULATIONS. -713/c,3 Re -roofs Type of Roof ignature of ApplicanUConimctor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as dcrrned by the Cupertino Mont pal Code, Chapter 9.12, and the Health and Safety G Code, Section 25532(a)? ❑Yes rd.^u 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 Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes o I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safc(yCodc, Sections 25505.25533 and 25534, l understand that if the building docs not currently have a tenant, that it is my responsibility to notily the occupant of the requircmcn whichmustbemet poor toissuance ofaCcrtificteofOccu ancy. Signature of Applicant Date ? f 3(Z),3 hQizedag All roof coverings to be Class "B" or better Owner authorized agent agent or Datc -,TY OF CUPERTINO CITY Of PERMIT APPLICATION FORM CUPEI�TINO APN # J-�5 14 - o Fee Group Date: Other Appliances MECHANICAL BBLDGFEE Bldg Permit sq. foot Building Address: BBOILERI Boiler <= 100,000 Btu d J2 fewlTA- 1 Boiler > 100K to 500K Btu Owner's Name: BBOILER3 Boiler > 500K to 1 M Btu Phone #: r c I 4Z26,01 r> Ate` D ti% A D WA- A A- J -4 t Contractor: Boiler > 1.75M Btu MECHANICAL License #: o � BCONSTAX Ind/Off/Comm/Quasi Contact: BCONSTAXBQ Con. Tax for BQ Zone Cupertino Business License#: Building Permit Info: Hotel and Motel BUILDING Bldg E�/ Elect ETZ Plumb Cr Mech E Job Description: Elec 600V <= 1000A ELECTRICAL Residential Commercial ❑ Sq.Ft. Floor Area - ELECTRICAL $/Sq.Ft..r Occupancy Group: Cost of Project ' -I BUILDING Type of Constru ton: Energy Add Multi BUILDING BINVESTIGA Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permit sq. foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1 M 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 BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC 1001 Elec 600V > l OOOA ELECTRICAL o BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 CITY OF CUPEVINO �iTY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor 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 J ° BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn SprinlclerBackflo PLUMBING BPSTORM StomVRain Water PLUMBING BPTRAP Kitchen Trap PLUMBING 4 BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING _....... BREMACOVER A/C Unit > 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL s BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > IOK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 CITY OF CUPERTIN O CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL ` BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res A liance ELECTRICAL 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 BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING µ° BSPECIAL Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE EIec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL ... MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 CITY OF CUPERTINO BUILDING DIVISION PERMIT 'T'_ CHARVEZ CONSTRUCTION BUILDING ADDRESS: PERMIT Nob 3 0 7 017 6 OWNER'S NAME: 360 W 8TH ST PERMIT ISSUE DATE PHONE: (408) 893-7693 SANITARY 0. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 9 Job Description p 1 hereby affirm that 1 am licensed under provisions of Chapter (commencing with Section 70W) of Division 3 of the Business and Profession Code, and my license is in full force and effect License ClassLie. a REVISION--BEAMS/CRICKET Date Contractor - NO NEW PERMIT ISSUEDr ORIG. #03040092 ARCHITECT'S DECLARATION 1 understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, 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 Contractor's License law (Chapter 9 Sq. Ft. Floor Area Valuation so (commencing with Section 7000) of Division 3 of the Business and Professions Code) ser that he is exempt therefrom and the basis for the alleged exemption. Any violation of 3t��1lpT�erO 0 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars (S-%% 1, as owner of the properly, or my employees with wages as their sole compensalion, will do the work. and the suucture is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of Re aired Inspections property who builds or improves thereon, and who does such work himself or through his 101 - FOUNDATION own employees, provided that such improvements are not intended or offered for sale. If, 102 — PIERS 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 10 3 - UFER sale.). 10 4 — REBAR I, as owner of the property, am exclusively contracting with licensed contractors to V construct the project (sec. 7044. Business and Professions Code:)The Contractors Li- 105 - ANCHOR BOLTS Cense Law does not apply to an owner of property who builds or improves thereon, and 10 6 — SEWER & WATER who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's 202 — UNDERFLOOR PLUMBING ❑) am exem t ° �der�Slec�p B�& PC for this reason r-1Iaeexe x/23 p3 203 — UNDERFLOOR MECHANICAL te WORKER'S C PENSATIONDEEt; ATION 204 - UNDERFLOOR FRAME Jv ) hereby affirm under penalty of perjury one of the following declarations: 205 - UNDERFLOOR INSULATION F1 I have and will maintain a Certificate of Consent to self-insurc for Worker's Compen- 301 — ROUGH PLUMBING sation, as provided for by Section 3700 of the Labor Code, for the performance of the 302 — TUB & OR SHOWER work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 303 — ROUGH MECHAN I CAL 3700 of the Labor Code, for the performance of the work for which this permit is issued. 304 — ROUGH ELECTRICAL My workers compensation Insurance carrier and Policy number arc: 305 — FRAME Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 306 — HOLDOWNS COMPENSATION INSURANCE 307 - INSULATION (this section need not be completed if the permit is for one hundred dollars (SI00) 308 — S H E E TROC K or less.) I certify that in the performance of the work for which this permit is issued. I shall not 309 — EXTERIOR LATH employ any person in any manner so as to become subject to the Workers' Compensation 310 — INTERIOR LATH Laws of California. Date Applicant 311 313 - SCRATCH COAT — ROOF NAIL NOTICE TO APPLICANT: If, after making this Cenificatc of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code. you must forthwith Comply with such provisions or this Permit shall be deemed revoked. 501 - F I NAL ELECTRICAL ENERGY CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY I hereby affirm that there is a construction lending agency for the performance of 503 - FINAL MECHANICAL ENERGY the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name 504 505 - FINAL BUILDING ENERGY - FINAL ELECTRICAL L°ndeis Address I certify that I 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 506 - GAS TEST building concoction, and hereby authorixo representatives of this city to enter upon the IFFIN PLUMB G above-mentioned properly for inspection purposes. grn� (We) agree to save, indemnify and keep harmless the City of Cupertino against 0 8 F I L liabilities, judgments, costs and expenses which may in anyway accrue against said City 5 in consequence of the granting of this permit. Gaiv� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: 5 ING Date o SOURCE REGULATIONS. Re -roofs 514 Type of Roof NAL PUBLIC WORKS 7 23 Yuri: Yuri: 0 of Applicant/Contractor 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 No iGi 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 Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑ Yes �xNu I have read the hazardous materials requirements undcrChapter 6.95 of the Califor- nia Health & Safety Code. Sections25505, 25533 and 25534.1 understand that if the building does not currently have a tenant. that it is my responsibility to nodf)� occupant of the rcquircmcn�cny%s which must be met prior set issuance of a Certificate of Oc 4Vr. Signature of Applicant Date i(� 7/2310 All roof coverings to be Class "B" or better Owner or authorircd agent Date CITY Of CUPEI�TINO ?... Ci i Y OF CUPERTINO PERMIT APPLICATION FORMS <° APN # � r ff e,, b Ci—L,,,- Date: 7 �) _Y S�7 Building Address: ! Mailing Address if d ff -rent frm building address): 3;c1 i on)iA wAY Owner's Name: ry A JCI I S i -t K� � h ni � �! � Phone #: Contractor: C_" 7 C— , 71 T/ k �— u � 0 � License #: Contact: Phone: Cupertino Business License#: Boiler > 100K to 500K Btu Fax: BBOILER3 ,mit Info: MECHANICAL BBOILER4 /Plildin Bld Elect, ❑ Plumb ❑ Mech ❑ cri tion: Job D p MECHANICAL BCONSTAX idential❑ BUILDING ercia� I Sq.Ft. Floor Area: BUILDING /Sq.Ft.: Cost of Project: BUILDING Occupancy Group: Hotel and Motel BUILDING BCONSTAXR Type of Construction: BUILDING Please check this box if the project is a Elec 600V <= 1000A ELECTRICAL second -story addition: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1 M Btu MECHANICAL BBOILER4 Boiler > 1 M 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 BELEC1000 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 BMITIGATC Comm. HousingMit. Fee BUILDING 1 of 3 sl�l C Y OF CUPERTINO CITY of PERMIT APPLICATION FORM CUPEKrINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMLTLTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMLTLTI New Multifamily Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Cbeck 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 rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL 2 of 3 CITY OF CUPERTIl` CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 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 BU LDING BSEISMICOM Seismic Commercial Seismic Fee Res BUILDING BUILDING BSEISMICRE BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Change BUILDING 3 of 3 sedZ 10O cWp CZU a<c�. .�N �rz�Z �fa K >yU W I— o aN Lp0 <m� =za EEC i 5 CITY OF CUPERTINO BUILDING DIVISION PERMIT C�7NTRACTOIt TN]FC}RMATIQ BUILDING ADDRESS: TONITA WY CHARVE Z CONSTRUCTION PERMIT N'03080180 OO3080180 ,-10227 OWNER'S NAME: 360 W 8TH ST PERMITISSUEDATE PHONE: (408)893-7693 SANITARY NO. CONTROL NO. ARCHI7ECTIENGINEER: BUILDING PERMIT INFO BLD ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description Ihereby affirm that I 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 fall force and effect. REVISION--INLicense HOUSE USE ONLY Class Lic. N Date Contractor NO NEW PERMIT ISSUED/ORIG. #03040092/03070176 ARCHITECT'S DECLARATION 1 understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish. or repair any structure prior to its issuance, also requires the applicant for such permit to Glc a signed statement that he is licensed pursuant to the provisions of the Contractor's Licensc Law (Chaptcr 9 Sq. Ft. Floor Area Valu atiop 10 7 (commencing with Section 70)0) of Division 3 of the Business and Professions Code) or that he is exempt therefrom 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 3 �1N4`Zl3�er0 0 Occupancy P Y Type not more than five hundred dollars ($500). ❑ 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 Professions Code: The Contractor's License Law Required Inspections p and does not apply to an owner of FOUNDATION property who builds or improves thereon, and who does such work himself or through his 101 - own employees, provided that such improvements are not intended or offered for sale. If, 10 2 — PIERS however, the building or improvement is sold within one year of complcuon, the owner - builder will have the burden of proving that he did not build or improve for purpose of 103 - UFER sal`.). 104 - REBAR coI, as owner of the property, am exclusively contracting with licensed contractors to nstruct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li- 105 — ANCHOR BOLTS cense Law does not apply to an owner of property who builds or improves thereon, and . 106 - SEWER & WATER ,who contracts for such projects with a contracior(s) licensed pursuant to the Contractor's icense Law. 202 - UNDERFLOOR PLUMBING ❑ I am exem t under Sec. B & P C for this reason Date C Io3 203 - UNDERFLOOR MECHANICAL Z_ WORKER'S COMPENSATION D��ATION ATION Zl 204 - UNDERFLOOR FRAME hereby affirm under penalty of per jury onto a following declarations: 205 - UNDERFLOOR INSULATION ❑ I have and will maintain a Certificate of Conscnt to self -insure for Workers Compcn- 301 — ROUGH PLUMBING sation, as provided for by Section 3700 of the Labor Code, for the performance of the 302 - TUB & OR SHOWER work for which this permit is issued. 303 - ROUGH MECHANICAL ❑ 1 have and will maintain Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 304 - ROUGH ELECTRICAL My workers Compensation Insurance carrier and Policy number arc: 305 — FRAME Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 306 — HOLDOWNS COMPENSATION INSURANCE 307 - INSULATION (This section need not be completed if the permit is for one hundred dollars (S 100) 308 - SHEETROCK or less,) 3 0 9 - EXTERIOR LATH I 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 Workcrs' Compensation 310 - INTERIOR LATH Laws of California. Date Applicant 311 313 - SCRATCH COAT - ROOF NAIL NOTICE TO APPLICANT: If. after making this Ccnificatc of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Codc, you must forthwith comply with such provisions or this permit shall be deemed revoked. 501 - F I NAL ELECTRICAL ENERGY CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY �- I 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.) 503 - FINAL MECHANICAL ENERGY Lendcis Name 504 - FINAL BUILDING ENERGY Lender's Address 505 - FINAL ELECTRICAL 1 certify that I 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 506 - GAS TEST building construction, and hereby authorize representatives of this city to enter upon theFIN PLUMB;VG ahove-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against 08 FI L liabilities, judgments, costs and expenses which may in any way accrue against said City 5 �� /.` _ C;� '7TUNDERSTANDS cc of the graining of this permit. AND WILL COMPLY WITH ALL NON -POINT Issued by:5 ING Date GULATIONS. FN��'�'`� � 'l (C` -3 514 Re -roofs NAL PUBLIC WORKS Signature of Applicant/Comractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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 �hNu 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 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 all new materials for inspection. District? ❑ Yes Nu I have read the hvardnus materials requirements under Chapter 6.95 of the Califor- nia H th & SafctyCode, Sections 25505.25533 and 25534. I understand that if the building doe/not currently have a tenant that it is my responsibility to notify the occupant of the r ❑ircmcnts which must be met prior to issuance of a certificate of Occupancy. Signature of Applicant Date 11lr�d W� I ° All roof coverings to be Class "B" or better Owncr or authorized agent Date CITY OF CUPERTINO r C� _& IV OF CUPERTINO PERMIT APPLICATION FORM�' 1 ` APN # �, � Fee Description � ��-,�,�7 � BAPPLOTHER Date: Building Address: BBLDGFEE 'TON i.T_A way XTir.1r, BBOILERI Boiler <= 100,000 Btu MECHANICAL ,cwpE Owner's Name:Phone KR i S q -I j A t -t PW "I) AJ A- Boiler > 500K to 1 M Btu , ,,., (n 3 Contractor: R L PH C,e MECHANICAL License #: Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING Contact: Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Cupertino Business License#: Buil g Permit Info: BCONSTAXH Hotel and Motel BUILDING BAZ E ct ❑ Plumb ❑ Mec ❑ J b ri ion: ' ELECTRICAL BELEC 1001 (Conhercial R Iden El BELEC200 Elec Svcs 600V <= 200A ❑ Sq.Ft. Floor Area: Energy BUILDING BENERGYADD $/S .Ft.: Cost of Project: BINVESTIGA Investigation fee BUILDING Oc upancy ou , . r Comm. Housing Mit. Fee BUILDING Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > l OOK to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1 M Btu MECHANICAL BBOILER4 Boiler> IM 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 <= 1 OOOA ELECTRICAL BELEC 1001 Elec 600V > l OOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3- �4� C Y OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEKfINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEW1vIULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor 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 Sprinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER InstalVAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 CITY OF CUPERTIl`. CITY of PERMIT APPLICATION FORM CUPEP�HNO Qualatity Fee ID Fee Description Fee Group BREMPOWER Power Devi ce/A aratus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 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 BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERWEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERNIITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Change BUILDING 3 of 3