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04050022 CITY OF CUPERTINO �a-�y� s�� ' BUILDING DIVISION PERMIT kCONT12AC1'Oit INFOW-][A.TIO1�Cc" -BUILDING ADDRESS: CUPERTINO VILLAGEASSOCIATE ;RMEN`b 4.050022 1111 OWNER'S NAME: PERMIT ISSUE DATE CUPERTINO VILLAGEA ONE: SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECTPLUMB MECH 0 M 0 ZO LICENSED CONTRACTOR'S DECLARATION Job Description 1 Mmby affirm that 1 am licensed under provisions of Chapter 9(commencing with Section 7010)of Division Sur de Business and Professions Code,and my license is 'a � in mu force andeHen. EXTENSION CORD FOR SPECIAL EVENT jn Z License Class Lk.M nF p Dam Contractor eARCHITECTS DECLARATION 1 undcmland my plans And W used u public records i'� _l G Licensed Professional ronel .<S OWNER-exempt RDECe Coninem f I hcrchy affirm that I em exempt from the Commctors License law for the following mason.(Section 7031.5,Business and Professions Code:Any city or county 9 j:00$( which requires a permit to convect.eller,Improve,demolish.or repair any struoure �'ya prior to in issuanec.alsu mquiexchu applicant forsuch permit to file ssigned stammanl that he is licensed pursuant to the previsions of the Convector's License Law(Chapter 9 Sq.Ft. Floor Area Valuation Fq 0 (commencing with Section 7")of Division 3 of the Business and Professions Code)or Nat he is exempt therefrom and tier basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjecu the applicant to a civil penalty of 3 2AMRQd7r2)cr0 0 Occupancy Type not mom Nan few hundred dollars ❑I,as owner of the property.m my employees with wages as their aale compemall". will do the work,and Neti ucude is not intended nr offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections property who builds ori unmet thereon,and whodenssuchworkhimselforthmugh his own employees,provided that such improwmenu are notintended oroRemd forWe.If. haweveq Ne building or improwment is sold within one year of mmpledon,the owner. builder will haw the burden of proving that he did not Wild or improve for purpose of - salc.). 91,a owner of Ne property,am exclusively contracting with licensed contractors to Wet the project(See.701 Business and Professions Cade:)The Centimeter's Li- cense Law dors not apply to an on,of property who Wilds ar improves daemon,add who contacrs for such pmjeeu with a con racurds)licensed pursuanuo the Convector's License Law. ❑Ism exempt and ec. ,B&PC for this me Own in 0 'S C a ION DECLA T I hcrchy a( son under penally of pe ury one of tier follewi g declamtlons: 1 haw and will maintain a Ccrtificme of Consenter self-insure for Worker'sCompen- 736'(f) on,as provided for by Section 3700 of Ne IAWT Code,for Ne peffandrec,of tW rk for which this permit is issued. 1 have and will maintain Workers Compenwlion Insurance,as required by Section of the labor Code,for Ne performance,of the work for which this permit is issued. y Workers Compensation Imumnce career and Policy number are: rtier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not W completed lithe permR ufnronc hundrcddollan($100) t or Ind.) I eenify that in Ne performance of Ne work for which this permit is issued,l shall Out employ any person in any m c norm Is at became mbject to the Workers'Compemalion Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation previsions of Ne labor Code,you must .J 0 forthwith romply with such provisions or this permit shall W m deeed resulted.r•'-r CONSTRUCTION LENDING AGENCY I hereby Or Nat there is a construction lending agency Ice Ne performance of ai> the work for which Nis permit It issued(Sec.3097.Civ.C.) QLenders Name 7,Z Lenders Address U 0 1 c,mfy that 1 haw read this applicad.n and sum that the elbow iorormmiun is lit,F coned I agree to comply with all city and county ordinances and state laws relating to -- • 0 V building convection.and hereby authorise representatives of this city in enter upon the W above-mentioned property for inspection purposes. tF^^gy (We)agree m use.indemnify and keep harmless the City of Cupertino against 416� i,i Iiabilities,judgmenta.casu andexpenses which may In any way accrue aglmtsaid City V 2 in consequence of the granting of this permit. BPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date E REI S. Re-roofs ignmurc ofApplicanplicaVConuacerr Type of Roof em HAZARDOUS ATERIAIS DISCLOSURE Will the apnt or future building occupant store or handle hazardous material - as dcfincd by Ne Cupertino Municjpal Code.Chapter 9.13,and the Health and Safety On, 0Yes 35532(a)? tr.'(N. All roofs shall be inspected prior to an roofing material being❑Yea Na P P Y g g installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove sen hazardous is contaminanu asdefincd by the Bay Arca Air Quality Management all new materials for inspection. 70cen istrict? ❑Yes Nu I have mad the hmardeus materials requimmenu underChapmr 6,95 of the Califor. a Health afclyCoM,Scenom 35505,35533 and 25534.1 undOrmnd that if Me Wilding unendy ow a tenant,than h d my mspomihility 0 nedfy me Pont of Ne gnm ea w ah asst 1 '0 ...Mace or eerllfiCamorX XV. Signature of Applicant Date Owner er atused agent Dam All roof coverings to be Class "B" or better V Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 Fax(408)777-3333 �UPEI�TINO Building De a#ment JOB ADD S:1//// Afa4Z Ra PE # y OWNER'S N �/ PHONE # L GENERAL CO OR: FAX # I am not using any subcontractors: ( 0 Sign*re Date Please check applicable subcontractors and complete the following information 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 — L Own o Signature Da e CITY OF CUPERTINO 6Cb oS�7� CUP ITY T-FNA� PERMIT APPLICATION FORM L N # Buildi g Address: j! Mailing Address (if different from building address): 0 o Owner's Name: S5� hone #: `T Contr i tor: License#: dIA- Contact: Phone: 4F-L-00 Cupertino usiness License#: I ('L Fax: 6,Y�-3 q4-0 6r Building Permit Info: Bldg I❑ Elect Plumb ❑ Mech ❑ APMOX. w f Job Description: 17 Residential ❑ Commercial Sq.Ftl Floor Area: $/Sq.Ft.: Cost of Project: N M Occupancy Group: 1'e.of Construction: N Please check this box if the project isT4second-sto addition: El ct Size: Standard ❑ Large ❑ Ma or ❑ Y 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 1 of �� CITY OF CUPERTINO Zi-ITA PERMIT APPLICATION FORM CUPEIi;TINO Quantity Fee ED Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb 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 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 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 cfrn MECHANICAL BRENL IRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMEIXT 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 BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL 2of3 CITY OF CUPERTINO CUPEI�F PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmd] 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 lnspection 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 Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Change BUILDING 3 of 3