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CITY OF CUPERTINO
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BUILDING DIVISION PERT
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BUIIDN A DRESS:
PERMITNO.
��1c23 N WOLFE RD #2021
TBD —t TO BE DETERMINED
08050114
ER'S NAME:
FERNUT ISSUE DATE
JIMMY CHEN
05/13/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECTIENG1NEER:
BUILDING PERMIT INFO
BLDG EIRCE PLUMB MECH
E 0
LICENSED CONTRACTORS DECLARATION
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Job Description
1 Wmby stfirm won I am Ikea d under pmvi (mmmeming
with Scotion]gkn of Divison 3ofdc BusmssaM Pm(culom Code.am mylkense is
COMMmL TI -CUP SQUARE CINNABON, INTERIOR ONLY
in full forte and rated.
bream Class Lk.11
TEMP PERMIT GOOD THRU 6/13/08
Dam Conmacmf
ARCH5IECIS DECLARATION .
'
1 understand my pines shall be used u public meoma
Licensed Peofesut ..I
OWNER-BUILDER DECLARATION
rcby aM. that I a raccepa from the Conbactoes Liccnse Law for die
1 W m
,
following mason. (Smiion 71131.5. Busims and Predilections Code: Any ily or co unty
which remiR3 a Permit in coM1WICt alter, improve, comolum. or Rpur my surnames
poor m its i smance, also fequirm the applicant reattach permit m rile a signed mmmml
dw he as licensed pussumt to One PMA40M of tic ConOansnh Unsnso Law (Chaplm9
Sq. Ft. Floor Area
Valuation
(commencing with Section ]OTD)of Division 3 of the Business and Professions Code) or
-
,$100000 ,
mat W is evropt therefrom and the bnu for the slkgeL eaempeim My Holuim of
section 7031.5 by airy applicant for a Permit subjects the applicant m a civil penalty of
Ay umber
Occupancy Type
and mmmao five hundred denars
31620096
❑I. as ewrcrofthe Property. or myemployees with wages as their sobu comes aadon,
with dorbewmis, andd: The Comunots Lacer oroRemes net apply an USircss
W Professions The ConoanbYS Liens Law deer net apply ir an owner
Required Inspections
ldscr is
property wW buildsaimprovp Ihimt andwhosectimchworkhimselfmtiumgh his
awn provided mbar such improwmmts tae net intended eroRered fmsa
builder. transit,
er. theuil on i the dose
Wildingruimpeovemmnucold within one Sear of mmove
ill of
builder will have the burden or proving that W did net build or Improve far purpose of
for
'
nk.) /-
Q /. u owner of the pmpcny, am eschodwiy..muting with licensed contrarian to
cmmuvct the Project (Sec. 701,1, Business and Professions Cade:) The Commacti Li
.
cerise Law does not apply to in owner or property who Wilds or improves th r an, and.
who comae s fine surd prajew with a convacm(s) licensed personnel to the Convener,
'
Llcena Law.
❑ l con eaernpt rndm see Ba PC for this roman
Dam NAY r�
C/
.p
M DECLARATION
I here alit uMCr pmalty of perjury of the following dccunumms
❑ Thaw aM munuinaCenifinm of GanXnl le self -iwmrt fa WOrteYS Campen-
udm. as provided for by Seed. 3700 of the labor Cade, for the perform. of tic
were for which out permit is Leaned.
❑ 1 have and will maintain Wartmer Compensation Iomranm, as myvired by Section
3RD m use Labor Code for the pcif.. of the waft for which this permit 6 armed,
'
My W.rt a Compemuion Iruunn¢ carrier and Policy number tae:
Cu1kr. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rrnu mlannmd notbocmnpkmtlif mho pefmitufwam htandretl donut (3100)
titles)
I wtify that in tic perforecucc or We work for whkh thl Ivmh' m, I small rim
creployney'nasomanym nr tat ecc can 'ec she '6 Compesuadan
77
Iaw,of Califores.Dam 1
A,ficsm
NOTICE TO APPLICANT: If, after making mm}} mum of emptlon, you ,hmW
xcome.0jett m the WartC, Campenumio(m pry sides of the tabor Code. you most
foMwirh comply with ouch Povisimu m thifysnmil abbot W dmmed sewkcd.
CON=UCnON LENDING AGENCY
I bereby air= dom them U a construction bustle, agent' ref the pMamanm of
the work for which this permit is issued (son. 309), Cn.. C.)
Lender's Name
Lances Address
1 mthly, that I have mad this appiicatim and sum this the above iafomtaum is
mneeL 1 a,me to comply with all Cry and county amientrues and a= laws relating m
Wilding eonstrunion, and hamby indicates representatives of this city in come upon the
.hove- no.domed property for inspection purposes
(we) agme rd save. indemnify W bump humhss the City Of Cupertino a net
Ii Wilities,JW,mcnta, costa eM expenses which yinanyway.ccrueaipshal.mid0ty,
in covequence of she granting thu pemmi
APPLICANT UNDERSEA AND OMPLY WITH ALL NON -POINT
Issued b :��
Y Date
SOURCE REGULATION
_
/t to w
Re -roofs
Sig or Appli o Dam
DOUS MATERIALS DISCLOSURE
Type of Roof
Will die pl Iorfuuue Wilding davpant atone m handle hvameus mucrul
u denned by nino Municipal de. Chapter 9.13, and the Hcalth .rid Safety
. Section zss3z(a>]
❑Yu
All roofs shall be inspected prior to any roofing material being installed.
Will the applkant or forum Wildint Pant taw cyuipmem w dcvim, which
If a roof is installed without first obtaining n inspection, I agree to remove
g P
moil haoundou, tar comaminanu u ticfi by the Bay Ara Air Quality Managcmcnt
all new materials for inspection.
❑ Yn
I have read die hara dousmamri ds requirements underchapmr 6.95ofOcblifep
nu HealthaSair YCade 25M 25533.ntl 530.1 undcsuaM timific Wiidmt
does not currtndy haw a L thm h u 'hility m mtiry me maupnel of um
royal m Prd acemdncamorampamy.
A Ice
Signature of Applicant Date
All roof coverings to be Class'W' or better
Owned boat, , _ Dp
- /
CITY OF
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
oe?05 of l td
APN # � n �
Date:
MAI
4� v .
0
13 2&
Building Address: �.ltP�72nlO SQwA4E
10123 WOLPL- 90Ai> e-rz40
c-A E1256 C-:rANf4&�ni
Mailing Address (if different from building a dress):
U87'7 MgLka &AD. 5 A,-J &A 5
3
Owner's Name:
Phone #:
Contractor:
Phone:
E3, V.
Fax:
Contractor License #:
Cupertino Business License #:
Contact:.
Phone:
Fax:
Residential ❑ Commercial
Job Description:
Gy�N14s�
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Is the project in the Wildland- Urban Interface Fire Area? Yes
❑ No
Building Permit Info:
Bldg E!I-'. Elect Cam-- Plumb Mech 0--
Type of Construction (Usage Class):
Occupancy Type:
1 -A, 11 -B ❑ 11, 111,V -A [11, 111, 1V V -B ❑
Valuation:
Square Footage:
Project Size: Standard Q," Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green
Building/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditgreen.org
• i.
CITY OF
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity /Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
1WINREP
Replacement windows /sliding glass
door (ea 8 windows)
B
1 WINMEWSTR
New Window - structural shear
wall /masonry (includes plan ck fee)
B
1 EPERMITFEE
Electrical Permit Fee
E
1MPERMITFEE
Mechanical Permit Fee
M
1 PPERMITFEE
Plumbing Permit Fee
P
1 ELCPLNCK
Stand Alone Electric Pln Ck (hourly)
E
1 MECPLNCK
Stand Alone Mechanical Pln Ck (hrly)
M
1PLMPLNCK
Stand Alone Plumbing Pln Ck (hrly)
P
1 STPLNCK -(3 Hr Min
when not over counter)
Standard Plan Check (when no E/M/P)
hourl -stand alone
B
1BSEISMICR
Seismic Residential
B
1BSEISMICO
Seismic Commercial
B
1TRAVDOC
Travel & Documentation
B
1BUSLIC
Business License
B
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