04010022 CITY OF CUPERTINO - a `- ft a
BUILDING DIVISION PERMIT cO�I�AGTOIi I1VP�1RMtS.e 81N,
BUILDING ADDRESS: PERMITNOO 4010022
OWNER'S NAME: PERMIT SUE DATE
CPAA ART CE
IE: SANITARY NO. CONTROL N0.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
Ydi LICENSEDCONTRACTORS Job Description A ,�
u 1 ion? affirm Nn 1 am limned under nd lirmons of Chapter 9(commencing I yam
O� with geetiea7id.fof DlW,lon3a(Nn Bunneasand Rofessiom Cock.and mylicent is
L License
TI--ART SCHOOL //®�■
E g Licence Clan Lie.«
na^p Dao: Convector /�/
Y ARCHITECTSDECLARATION AN �,aaaw
Y I undersand my plana¢hall M used u public mmol, 00
V
c� Liccntd Professional
OWNER-BUILDER DECLARATION -PING
I hereby offmm that 1 1. exempt fire dk COn ores Co License Law for the
�p0 following tasaa(Smtiun](1]LS,Basineaa end Profes¢inm Cole:Anycity or county
ate$� which requires a Permit to convect.also,improve,demolish.m repair.ray ametum
W�'^ prior us its issuance.also requires she applicant for such Permit to file a signed sukmens
£!-im< that he is licensed purment to she provisiaasaf the Contractor.License Uw(Chapter9 Sq.FL Floor Area Valuation
yF� (commencing with Section 70W)of Division of the Business and Professions Code)or
y $ that W 1,exempt themfrom and the basis for
the alleged exemption.Any,vioiatlon of $100000
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than five hundred dollars(M).
❑1,as Owner of the property,or my employee with wage,a Weir sole eompi nudon,
will do Ne work and Ne swctum is not intended orortetd for sale(Sec.9044,Business
and Professions Code:The Connector.License law does not apply to on Owner of Required IDSpeCt10HS
properly who builds Or improves thereon,and who does such work himself or through his
awn employees.provided that such improvements are notimended Oroffetd forsale IL
however,the building or Improvement is sold within can year of completion,the owner.
builder will haw she burden of proving that he did not build Or improve for purpose of
as .).
1,as Owner of the propeny,am exclusively contracting with licensed contractors to
c met the project(Sec.7044.Business and Professions Code:)The Contractor's U.
seem,law does not apply to an owner of property who builds or improves demon.and,
who contracts for such projects wit a com actor(,)licensed pursuant to the Commit
Lkenw Law. /1c. B&PCrm Is mu n
❑I am exempt u J � � p
race � / �) Data (/
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of Ne fall Hi l—lions:
have and will maintain aCenilmatof Consent to self-usure for Workei&Compen-
sation.as provided for by Section 3700 of the labor Code,for the performance of the
work for which this pmmil is issued.
❑I haw and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Cuda,far the peRmmmor of the work for which Nis ponnit is issued.
MyW rketa Compemadmit].a....carrier and Policy number am:
Policy No.:
CERTIblCAl50F EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('ITB,retire need notbocomplektl if she permit is fnronehundtd tlallea(S1IX8
or kss.)
I certify that in the performance of the work for which this permit It issued.l shall not
employ any person in any manner so as in become subject o the Workers'Com remation
Laws of California.On
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificam of Exemption,you should
become subject in the Worker's Comte emkin provisions of Ne Labor Cock,you must
.JZ forthwith comply with such provisinnr or this permit shall be deemed mvaked.
OCONSTRUCTION LENDING AGENCY
'Ta I hereby alarm that there is a convection lending agency for to performance of
CL 7 the work fur which this permit is issued(Sec.3097,Ci,C.)
W A Lender's Name
G Lender's Address
U 1 certify that I have read this application and sate that the show information is
W cannot.I agree to comply with all city and county ordinances and sum laws testing to
building construction,and herebyaudorim repicsenutiws Or this city to enter upon dk
C17 above-mentioned property for inspection purposes.
G (We)acme to saw,indemnify and keep harmless the City of Cupimmaygainst _
,a rq IlaMhhea,judgments,costs and expenses which may in anyway amnio against did Cily
C) APPLLIICgAeNT UftheBSTANDS ANDof WILLWILL COMPLY WITH ALL NON-POINT Issued by: Date
R E RE A�S. )
e-roofs
eat of ApplicantlConoacmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant stat or handle hanNou,material
as ckfmcd by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,S stiezsmz(ar
Yes No
All roofs shall be inspected prior to any roofing material being installed.
❑
Will the applicant or tat building occupant ase equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
he'rardnus air contaminants m defined by the Bay Area Air Quality Management all new materials for inspection.
sin?
❑yes Nu
Ihm
aveadthehvardnusm rialsrcquitmcnnundo ChaplI�gr6.95 of the Califon
rale Hmhh&Safcsy Cod',Smuon25o5,25533 enJ255Jd.1undcm no3 if Nc building
does not currently howLNmit ismyres W,,lityunoufy occupant of
requimmems which m t, elprior�issu en.raCWBcauoiggature of Applicant Date
O mh/Ori agent //' Dau y" All roof coverings to be Class"B"or better
CITY OF CUPERTINO
BUILDING DIVISION PERMI -fV0NTRACTOR6INFORMAy
BUILDING ADDRESS: PERMIT NO04010022
NER'S NAME: PERMIT LSSUE DATE
CPAA ART CENTERC'I
HONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u0o
LICENSED CONTRACPOR'SDECLARATION JobDescri [ion
Ym 1 hereby Net 1 am Iimnad antler pmvisiom of Chapter 9(commencing P
SZ with Section 1000)affirmrf Division 3 of dm Rosiness and Professions Code,and my license,is
o« mrmvorceanaerfea TI--ART SCHOOL
5 = License Class Lie.p -
Z F p Dale Contractor .
ARCHITECTS DECLARATION
Ky¢a I understand my plans shall ho used as public records
i;'ua�
LL N LKCmcd Poloist nnal
ion< OWNER-BUILDER DECLARATION
iy 1 hereby affirm that I am exempt from the Conditioner's License Law for one
a O following rtuon.(Section 7031.5.Business and Professions Code:Any city or county
x m which requires a permit I,,construct,setter,improve,demolish,or repair any structure
u"^ prior m am issuance,also rrquirm the applicant for such Permit to rile a signed statement
that he is licensed pursuant to lM pmvisiom of the Contractor's Licence Law(Chapter 9 Sq.Ft. Floor Area Valuation
act- (commeneing with Section 7000)of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of $100000
Section 7031.5 by airy,applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
net mem Nan fin hundred dnllam(5500). P Y YP
I,as owner of the pmperty,or my employees with wages as their sole compensation,
wuldo she work.and she swaure is not intended or offered forsale(Sao A044,Business Required Inspections
and Profession code:The contractor's License law does not apply m e an owner of q P
property who builds or improves thereon,and who docs such work himself or lhmugh his
n employ=,provided thin such improvements arc not intended or offered forsvle.It.
however,the building or improvement is sold within one year or improve
for the owner-
builder will have Ne burden imp of ement i that he did not dull or improve for purme own of
r.
sale;-h.c
).
as owner of the property,am eaelusively committing with licensed commission to Is
law dors not apply m m owner of progeny who builds or improves thereon,and
onlncu for ouch projccu with a mmm�or(s)licensed purmam m Ne Convacmhalaw.m exempt u e B A,PSfes(C/for shuras \,1
f G� Dam Y Lr
WORKER'S COMPENSATION DECLARATION
r I hereby affirm under Penally of perjury due of dm folid eclmaliom:
❑1 naw sed will for by
n a tion 37W of Consent r Code.
Ter Workeh ce of the
stilton, r provided for ri Ss istun 31110 of the lobar Code,for the Performance of the
work for which this permit is issued.
❑1 ban and will maintain Worker's Compensation Insurance,as required by Section
3100 of the tabor Code,for the performance of the work for which this permit is issued.
My W rkcr's Compematian Insurance corrins and Policy number are:
Policy No.:
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Thu amine need Out to completed Bthe Permit is fortune hundred dollars(I100)
or
]car.)
1 ccnify that in the performance of the work for which this permit is issued.I shall not
employ any person in any mander an as to become subject to the Workcri CompeluxGon
Laws of California:Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should -
become subject m Ne Wmkmi Compensation previsions of the Labor Code,you must
.J.7, forthwith comply with such provisions or this permit shall he deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
(-+ I hcrchy affirm that Here is a conswnion lending agency for the performance of
f! Ne work for which this permit is issued(Sec.3091,Civ.C.)
[q Q Iandcr's Name
aZ Lender's Address
U O 1 comfy that 1 have read this application and sum dirt the shove infmrsood n is
U,P correct.l agree In comply with all city and county ordinmem and sure laws muting in
OU building construction.and hereby authorise representatives of this airy to enter upon the
W andve-mcnuumml gmentaeny for inapeNdn purposes.
(We)agree do saw,indemnify and keep barmlesa Bas City of CupeNneagainst
I,IZ flabilinconseque consequence
of th,cmuand oxpaunswhim may in any way accauc against slid City
C..3 z APPLI ANT of ERSTANDS this per mit.
�-^ APPLICANT U ERSTANDS AND WILL COMPLY WITH ALL NON-POINTIssued by: Date
SOURCE RE T{0 5.
YRe-roofs
Osure of ApplicaActor Data
HAZARDOUS MATERIAL$DISCLOSURE Type of Roof
Will the applicant or future ni building occupant store or handle Health and
as tlefincd by Nc Cupertino Municipal Code,Chapter 9.13.and the Health and Safay
e.Sivaim 25532(.)? u All roofs shall be inspected prior to any roofing material being installed.
N
If a roof is installed without first obtainin an ins ection,I agree to remove
Will the applicant or sure building Occupant use equipment or devices which g P g
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Ycs L No
Ihevcreadth lbouradousma rials requirements under Chapter 6.95ofthe Califdr-
fiaHealth h Safety Code,Sections 25505,35533 and 25534.1 undcrsunaVOmtime Wilding
dom net emnemly ban xQm,lost Il Is my mapnnsNillty m mthly t pNl Or
regdiremenaxwnimmm �medpaidmi::m..of.Co;rmltdrae ey inatureofApplicant Date
16 0wnen.a uthoriJr�gcn, Data1 All roof coverings to be Class "B"or better
0
. City of Cupertino
�+ - Plan Check Transmittal
Permit# 04010022 Control# 12748
Project TENANT IMPROVEMEN Plancheck# 1
Address 10123 N WOLFE #2070 FileDate 1/8/2004
Owner CPAA ART CENTER
Description
Plan Check Status (attach comments and return to Building with pian set)
Plan
Dept check# Date Due Date Staff Comment Date Approval?
Building 1 1/12/2004 1/26/2004 BRUCE ❑ ,.
Planning 1 1/12/2004 1/26/2004 GIDDY / D .
Fire 1 1/12/2004 1/26/2004 "❑
. Assessor 1 1/12/2004 1/26/2004 ❑ ,;
Additional Plan Check Fee ❑ Hours
Planning Fees
Housing Mitigation Fee Amount
Heart of the City Specific Plan Fee Amount
WtITY OF CUPERTINO* 6 f o a Z Z
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
APN# 3 I / ?--o
d 3 ,7 Date: D � D
Building Address:
O �-3 /V', � . a
Owner's Name: 'Vv A ' Phone#: �?3
1
Contractor: License #:
Contact: Cupertino Business License#:
—5, .2_0
Building Permit Info:
Bldg Elect Plumb Mech
Job Description: �r✓�✓ - %�v��
Residential ❑ Commercial N,
Sq.Ft. Floor Area: $/Sq.Ft.:
X-.�ZT 404/
CostfProject: Occupancy oup:
T e of onstruction:
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 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
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. Housing Mit. Fee BUILDING
I of 3 �J