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04080002CITY OF CUPERTINO �g}�a ��aaT�tt.g..'aa . y ya 'y�a,Ia'�'� tc7a� T191�. - BUILDING DIVISION PERMIT �l.s.Odvl,aL 'OkiINFORI BUIL DING ADDRESS: SOUTH BAY CONSTRUCTION CO PERMIT NO. INC 04080002 OWNER'S NAME: - AWL PERMrf ISSUEDATE E: SANITARY qA*OL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby i fffrm Nn 1 an licensed under previsions of Claque, 9 (commencing with Section 70110) of Division 3 of the Business and Prof sidons Code, and my licamer is I. full fare. ond.fret. – REVISION—FLOATING SHEETROCK Licenac Lk.x Dam Camfecmr 0 NEW PERMIT ISSUED/ORIG. #04010076 RCH l DEC ibe... I un crsu my p ata shall be reed as public records Licensed Prefessio al OWNER-BUILDER DECLARATION 1 hereby alum that 11. exempt from Nc Contractors Liccne Law for the maso Code: Any city or county following mason. Tont Business and doiana which requires a earnit1 improve. or repair any sacrum alma Improv., tlpermit the the applicant f t asigned smtemcm e. aim recons; the prior to its issumcp,alsont Sq. Ft. Floor Area ValuatiG$350 Cohpermitl0im to be is wit pursuanUO the prevision of III. mess License law (C Bu oda) or (co cing of the exempt unit Profusions Collo) or (commencing Section70M)and )th basis for alleged Net he u exempt therefrom and Ju breis for the alleged exemption. Any violation of that he APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant he a civil penalty of not mart Nan five hundred doll. (5500). 32410047.00 C] 1, as owner of the property or my employees with wage as their sole campenssdon, Required Inspections will do he work, and the machine is not Intended or offerod foraale (sec. 7014, Business and Professions Cade: The Contractor's License Law dace not apply to an owner of property w ho builds of im prow Nerean, and who does such work himself or through his awn employees, provided Nal such improvements an not intended oroffered fur sale. If. however, be building or improvement is sold within one year of completion. the owner. builder will have the burden of proving Nal he did not build a Improve for purpose of E) 1. as owner of the propeny, am exclusively connoting with licensed conviction to constr the and Professions The Conformers can= not /Sec. . (► ds orfi fmprow Nerean, and owner of property who builds red La es o an weer of cense Law dose not apply to V rs whO contracts for such projeela WlN e.OnVacttlr([) licensed pursuant to the COnVKlofs % Law. Licata. Law. \ ❑lam exempt antler Sec, .B&PCfor this mason Owner - Dem l WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following dechre0on: have and will maintain a Certificate of Consent to self-insum for Worker's Compen- sation, as provided for by SeNan 3700 of the labor Code, for the performance of the work for which this permit is issued. I haw and Will maintain Wafkcf'f Compensation linuarm, as required by Section 3700 of the labor Cede, for the performance of the work for which this ismmit is Issued. My Workeri�pmpana'gn lnunnmc ter and Policy numberam: Carier:�p /G /1�/ Poli D� No.; / - • $ERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he completed lithe permit Is foranc hundred dollars (SIM) or leas.) I etJfy than In the pC,fomnnC of NC Work far which this permit IS Issued. I shall nut employ any person in any manner an as m become subject to the Workeri Compensation Laws of Califomie. Data Applicant NOTICE TO APPLICANT. If. after making this Certificate of Exemption, you should become subject to the Worker's Compensation provision of the Labor Code, you must foMwith comply with such prnvishms; or this Permit bull be carried revoked. CONSTRUCTION LENDING AGENCY 1 hereby M. that there is a construction Iendin5 agency for the perfammunce of the work for which this permit is issued (Sec. 3099. Civ. C.) Lender's Name Lender's Address 1 certify Nat 1 have mad Nis application and sum that the above information if ' correct. I agora to comply with all city and county ordinances and auk laws relating to - building construction, and hereby authorim representatives of this city to enter upon the abevn (We) nedare 1...mpony for inspection purposes. and kith harmless Jet City of Cupertino against (We) agree to save, ande expenses liabilities. judgments. coon ntl expenses which may in any way .etre. egeint said City in consequence of the gran' this p.rmi APPLICANT U RS N S AN L COMPLY WITH ALL N POI , Issued by: Date SOURCE REG a-roofs •TI CK Signor ofA plican onlru or "De HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building rempant stare or handle he oudous material as defined by fee Cupertino Municipal Code. Chapter 9.13. and the Health and Safety Cade, Section 15532(a)? All roofs shall be inspected prior to any roofing material being installed/ve 0y.u If a roof is installed without first obtaining an inspection, I agree to rem WIII the applicant or future building occupant use equipment or devices which II harm ons air maturirnnm b rat by the Bay Area Air Quality Management all new materials for inspection. let? Yes I have mail Ne llvannus materials requirements under Chapwr 6.95 of the Califon , nia Health&Safety Cod Secdou2 M5,25533nd35534.lumlemamdthatifthe Wilding doer mol cane Was al IS my re n5 ity tenmuly Nc ceeupaml of Ne requircmcn al he uam"of mrtihcamooccupancy. Signature of Applicant Date All roof coverings to be Class "B" or better anc,mlmdlmr,,1Date w 0aa 3yt: 4 �O? yqC x�� •yI ", V FFC aaacc 5 `a - C)2 Z C CITY OF CUPERTINO BUILDING DIVISION PLi' BUILDING ADDRESS: SOUTH BAY CONSTRUCTION CO NCS ND64080002 OWNER'S NAME: PERMIT ISSUE DATE PHONE: (40R) -17q-n4OO SANITARY OL NO. 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 s with Section 7000) of Division 3 of the Business and Professions Code, and my license iin full force License and effect.Lic s _ REVISION --FLOATING SHEETROCK Date Contractor 0 NEW PERMIT ISSUED/ORIG. #04010076 ARCHITECTS DEC / I un a my p arts shall he 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 convect, 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 (Chaptcr 9 Sq. Ft. Floor Area Valuat4 3 5 0 (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 APN Number Occupancy Type Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 32410047.00 ❑ 1, as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work, and the structure is not intended oroRered forsale (Sec. 7044, Business and Professions Code: The Contractor's License Law doers 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 ate 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 convect the project (Sec. 7044, Business and Professions Code:) The Contractors Li- cense Law docs not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's . License Law. ❑ I am exempt under Sec. . B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penally of perjury one of the following declarations: ❑ i have and will maintain a Certificate of Consent to self -insure for Workers Compen- 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 Workerspensee n Insurance c er and Polity number arc: Carrier. a G /:�7 Polity No.: ERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one 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' Compensadon Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. I ' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a convection lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lenders Name Lenders Address j 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 authorize 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 ' inconsequence of the gran ' this permi RS N S AN L COMPLY WITH ALL NO -POI ' APPLICANT Ur1V i Issued by: Date SOURCE REG TI e -roofs Type of Roof - SA�l ignat of A lican ontractorDa HAZARDOUS MATERIALS DISCLOSURE Will the applicant or rut " building occupant store or handle haaardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safcty Code. Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed/ve ❑Ycs u If a roof is installed without first obtaining an inspection, I agree to rem Will thea applicant or future building occupant use pp g p equipment or devices which emit hazardous air contaminants as cftned by the Bay Area Air Quality Management all new materials for inspection. District? ❑ Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- niaHcalth&SafclyCod Seed ons25505,25533and 25534.1unekrstsndthat iftlrc building " docs not curie tens au' is my ns' lity to nodfy the occupant of the is requircmcn sex enificalcofOccupancy. Signature ofApplieant Date 'zc All roof coverings to be Class "B" or better nerd auth Date Community Development 0 Torre Avenue CupOertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 CUPEkTINO Building Department I am not using any subcontractors: 1� Signature Date Please check applicable subcontractors and complete the following information: .: ,•: i-, •. - BUSINESS NAME mfl Cabinets & Millwork I am not using any subcontractors: 1� Signature Date Please check applicable subcontractors and complete the following information: / 1 r/Contractor Signature Nr- - W-1- 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 / 1 r/Contractor Signature Nr- - W-1- Ti 76 `Cts - CITY OF CUPERTIN d o S- 0 Z 0 2-- 7 CITY OF PERMIT APPLICATION FORM CUPEVINO APN #, 7z6 ` q, Quantity Fee Description Date: BAPPLOTHER Other Appliances MECHANICAL Building Address: Bldg Permits . foot Owner's Name• BBOILERI Phone #: Contractor: � � BBOILER2 License #: —,; �,' ----: 561 -4 Contact: � �) BBOILER3 Cupertino BusineLfice�r ,s�: MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu Building Permit Info: BBOILER5 Boiler > 1.75M Btu MECHANICAL Bldg,Ind' Elect ❑ Plumb ❑ Mech ❑ Job Descriptio BCONSTAX Residential Commercial ❑ Sq.Ft. Flo r Area: $/Sq.Ft.: Cost of roject- Occupancy Group: Hotel and Motel BUILDING Type ofonstruction: f —y, ° D GtF 5;0 G tti 1 11W— Quanti Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDG FEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K 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 <= l OOOA ELECTRICAL BELEC 1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY BUILDING BENERGYADD -Energy Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 �6 q2- l CITY OF CUPEKrINO WITY 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 BNUCONDAM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI 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 Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Repipe 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 cfin MECHANICAL BRENIAIRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Apphance 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 (mnl I CITY of CUPEI�JINO CITY OF CUPERTIN(O PERMIT APPLICATION FORM 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 Sips, 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 BSVV M 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 Chane BUILDING BMISCELL Building Misc Fees BUILDING 3 of 3