02030056 (3) CITY OF CUPERTINO `
BUILDING DIVISION PERMIT CONTRACTORWORMATIOS,
BUILDING ADDRESS: PERMIT N0,
10440 DE ANZA BLVD SOUTHBAY CONSTRUCTION CC INC 02030056
OWNER'S NAME: APPLICATION SUB DATE
DR. CHIU OFFICE 511 DIVISION STREET 03/13/2002
LONE:
(408) 379-0400 SANITARY NO. CONTROL NO.
Woe m z ARCHITEC(EN'GINEER:
8 O C BLDG ELECT BUILDING INFO
PLUMBMECH
LJ L__J
LICENSED CONTRACTOR'S DECLARATION
S=C 1 batch)affirm that I am licensee under provisions of Chapter 9(commencing Job Description
„_fwilhScaion OWIofDivixion3oflheBusincssandPrafcsstoo,Code,and dr,license TEMP PERMIT. (30 DAYS ONLY, EXPIRES ON 04/1?;,
,,En is In full force and effect.
ce e< License Class Lic.e
0='kDae Can.,.
3 0 t, ARCHITECT'S DECLARATION
a O S 1 Pofesana my plans sM1all h used as public rernNs I�
u�se F
O O Licensed Professional
w e ne
o. OWNER-BUILDER DECLARATION
1 hereby affrtm that I am exempt from the Conuacror's License Law for the
?a following rt n.(Section 7031S,Business and Professions Code:Any city or county
E F e watch requires permit to construct,alter,improve,demolish,or repair any structure $56000
63C$ poor to its issuance,also requires the applicant for such permit to file a signed sa¢mem
Oat he is licensed pursuam,to the provisions of the Convenors License Law(Chapter 9 r,, pT q�ry�
(commencing with Section 7000)of Division S of the Business and Professions Code) j i.,A Valuation
o$14@J,!�C4�':
or that he is excerpt mertrom and the basis for be alleged ainmgion.Any violation '
of Section 7031.5 by any applicant for a Permit ubj«a the applicant to a civil penalty
afoot mote man five hundred collars(s300). 10q PN Nl IDAT I ON Occupancy Type
01,as oeoe,of the pmpcny,ur my employees with wages as their sole compensation. 109 _
will do the work,and the same urc is not intended or offered for It(Sec.7011,
Business and Professions Code:The Contractor's License Law docs not apply to an 103 - UFER Required Inspections "
orv�6r of property who builds or impmrts thereon,and who does such work himself
rou n his own employes.D.vrdcd mat such imptovemems art not intended or 104 - REBAR
opened 'r sale.If.however,the building or improvemear is sold within one year or - 10 5 - ANCHOR BOLTS .... .
completion,the owner-builder will nava me burden of proving that he did not build or .
improve forporpose ofaala). 106 — SEWER & WATER
(9I.a owner of be pooped,ton exclusively contracting with Teemed contractorsm 202 - UNDERFLOOR PLUMBING .. .
construct
the project(Sec.7011,Business and Professions Cade:)The Contractor's
License Law dues not apply toanowner ofproperty who buildsorimproves thereon, 203 - UNDERFLOOR MECHANICAL
Commcmrs Lneeraa Lowuch projects with a aontramorw Bat sea putseanr re me 204 - UNDERFLOOR FRAME
❑IameumptunaerSc. B&PC far bid 205 - UNDERFLOOR INSULATION
,YO PEN ON DECLARATION I I l1 °Z 301 — ROUGH PLUMBING
302 — TUB & OR SHOWER
Ie and ill ander .a Celty oficate yane
mathe
toolmwingeemorwor 303 - ROUGH MECHANICAL
I have and will maintain:cbnaraati or 37M of m seLaborre for workers 3 04 — ROUGH ELECTRICAL
Compeance. he work
provided for by Sectbn D00 I, the tenor coda. for the
' perromeance ter me wore Tor wnian mix permit is assuea. 3 05 — FRAME
0 have and will maintain workers comemaxiion mslarance,ad required by section 306 - HOLDOWNS
37W of the Labor Code,for the performance of the Work for which this permit is
iamca.My workers Compensation Insurance carrier road Policy number era: 3 07 — INSULATION
C10N'O SAnoNwsuRArvce•" ..30.8. '= SHEETROCK - '—
! CERTIFICATION OFE%EMPTIONFROM.wORRERS',i %�S �-14'-EXTERIOR' LATH '
v .. .._.. ... _ . .
am;saadohrdiednotbecomleledifthe — — — 310 INTERIOR' LATH — --
(st00)orleas.) ° pemdrsroronehundreaaou,n 311 SCRATCH COAT `
"I cenitY.thal in the"alfa'-a .'. I ... 313- ROOF NAIL
ansann the work for which this permit a issued.I
Compell nsation
Laws
Catnrmn Datin any e
scut°become subject to the Workers' 501 — FINAL ELECTRICAL' ENERGY
Compcnsation'Iaws of California.Date '
Applicator . 502 — FINAL PLUMBING ENERGY.
NOTICE TOctto be Worlee.after Compensation
that Cmifaa of Lend,code.year should 503 - FINAL MECHANICAL ENERGY
becomesubjectto the such Pr Compensation permitoha°fee Iab°r re,okyou must
z Q forthwith comply with such provisions or this partner hall h deemed revoked.
z . 504. FINAL. BUILDING ENERGY, . .
> " ' CONSTRUCTION LENDING AGECY t
r
thereby writer that mereis'a'comuuNon lendingv.Cr) for be perfomunce 505 — FINAL ELECTRICAL
of workthe mrwtdmbid pcmdtisissued(sea.3B97.e..c_) 506 _ - GAS TEST
a-ZLender.Apares.._'..... .. .
t<peararvame��-• 507 FINAL PLUMBING
v'O reify ear I nave recta rms.ppbaaaon a e oma mat above mrort anon as
508 — FINAL MECHANICAL
kT+ F eoieect.l agree m comply pithall city and county ordinances and state laws relating5 0 9 — FINAL GRADE
�J to buileing mnswnion,and hereby eueorix rcprtsenutives of this city to enter upon
be above-mcationed v,.,cry for inspection purposes. 510 — FINAL PLANNING
E.t
P. (We) Fee to save,indemnify and keep kinnleai the City of Cbpcnino-gaiter
U N' liabilities,itnones consequence
cons and aapcnahi which may in any way accrue against said 514 - F INA PU I C WORKS
V i Cary in consequence of the gnd ex,er this phich m - l/
AP LICAN r Ur ERSfANDS AND WILL COMPLY WITH ALL NON P INT
S URCE REG RNs: •• ,L Issued by: Date
ignam'mo pbcaaccontn :.:'��•_. Re-roofs /
HAZAR US MATERIALS DISCLOSURE'
Will the applicam or None building occupant store or handle tivafdoua material Type of Roof _
ai EUned by tet=Cupertino Municipal Cade,Chapter 9.12,and the Health and Safety
Cada Section 255]21a1T .. . .. - r
All roofs shall beinspected prior to any roof ng material.being installed.
Will the appl cant f hurt holding m pant um egri p r device:wham If a roof Is installed without first obtaining an inspection,I agree to remove
t nnard sus air contaminants as defined by be Bay Area A 0 al ty Management
'°"" ° all new materials for inspection. Applicant understands and will comply with
I have all non-point source regulations.
1 have tcadee has dous materials requirements under Chapter 6.95 of the
Cabfomu Health&Safety Cod>Sections 25505,25533 and 25534.1 underhand that
if Jte building does not currently have a tenant,that it is my responsibility to notify the
acuWm of the rtyuihich mesa be met prior to issuance of ro C<nificete of
caacy ' `r
Signature of Applicant
g PP ._ Date
Owner or Obixed agent D rc All roof coverings to be Class "B" or better
OFFICE-
._ -.._ .. . . . . . _ ..._
CITY OF cuPEN' CONTRACTOR INFORMATIO"
uuu,DlNC DIVISION' gDFRMRT
BU3LDING ADDRESS: PERMIT NO.
10440 DE ANZA BLVD SOUTHBAY CONSTRUCTION CoINCO2030056
OR;NER'5 NAME: APPLICATION SUB DATE
;#
DR. CHIU OFFICE 511 DIVISION STREET 03 13 2002
' LONE: SANITARYNO CONTROL NO.
1•
4082554100 CAMPBELL CA 95008
ARCHITECTMNIGINEER: PHONE# BUILDING PF,RMIT INFO
BLDG ELECT PLUMB ?I CH
TEMP PERMIT. (30 DAYS ON Y_ -] EXPIRES ION 04' .1-3
w o INSPECTIONS DATE INSPEC TO ARRANGE INSPECTION ,LOB DESCRIP PION
<u G : CALL 777-3228 MONDAY-FRIDAY.4 HOURS RESIDENTIAL,
BEFORE REQUIRED INSPECTION.JOB ADDRESS 0 SFDWL 0 KITCHEN REMODEL
s,sVz
FOUNDATION/PIERS/H.D.S. AND PERMIT N ARE NEEDED WHEN PHONING.
UFER GROUND ❑ ADDITION 0 PLUMBING RE PIPE
0 MULTI-UNIT 11 STRUCTURAL,
�cca PAD/SETBACK-CERT
-RESIDENTIAL—COMMERCIAL OTHER_ MODIFICATION
p c u GARAGE SLABS/PREGUNITF, 0 INTERIOR ❑CHIMNEY REPAIR
3 3 LL G HAZARDOUS FIRE AREA
POUR NOCONCRETE UNTILABOVE HAS BEEN SIGNED IMPROVEMENT ❑ SWIMMING POOLS
f r 0 BATH REMODEVREPAIR 0 DEMOLITION
:Eop UNDERGROUND/SLAB OYES It yes 1 undemanJ that a CIa,sA rwf a,amhly is reyuimd ❑ OTHER
uy PLUMBING_...!_`,t__.._.._..._............ . ... .__,....,-...... .- .- .. .... . .... _. .... _...
M=a D NO Initial LC.B.O.N
ELECTRICAL. - •-
u 3 DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED EXISTING ROOF COVERING COMMERCIAL,
PLUMBING 0 NEW BLDG/ADDITION 0 DE\101.1'TION
Numberof e,i3Ong covering, O.TENANT 0 FOODSERVICE
MECHANICAL -. 'IMPROVEMENT ._
'ELECTRICAL. To be renxrved Th be retained 0 OTHER '
FRAMING VENTS
: INSULATION
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEENSIGNFD T'VI'1;OF ROOF COVER INC
ROOF SHFAIHIDIAPHRAM EXISTING: PROPOSED: — -
PLUMBING D Bulh-Up Roof D Btalit-Up Roof
TUBS R SHOWER PAN D Asphalt Shingle, 0 Asphalt Shingles
- MECHANICAL0 Woad Sh'J" ts` t O Wood Shales
FLECTRICAVPOOL BOND O Wood S" iM'g ei_F 'v' D Ward.Shingle,
FRAMING/STAIRS/E.EGRESS D Othe, (Speeify) �..�. C Oak,(Specify)
NSULATION/VENTIIAI';ON Provide LCB.O.Repos No.
=
OVER NO N'ORK UNTILABOVE HAS BEEN SIGNED Provide Mfg,In,tallation Specs.
'EXTERIAL SHEAR/1101-1)DOWN -
INTERIOR SHEAR/HOLD DOWN
SHEETROCK/SHEETROCK SHEAR INSPEC'T'ION SPECIAL INSPECTION REQUIRED ❑ DATE INSP
EXTERTOIl LATHM'-SCREED.
SHOWER LATH ��� V""/ •"I -� ''V U
. NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED
SCRATCH COAT
_SEWERM'ATER, -
TEMPORARY APPROVALS
OCCUPANCY."
..FINALS.
z -
PLANNING 777-3309 - -
Z Q GAS TEST _
GRADE(P.W.777-3354)
C FIRE
= z _,HANDICAP.
U 0 -ELECTRICAL.:.
wC F PLUMBING -
W MECHANICAL-
9L
ECHANICAL-h ENERGY -
U VISUAL.FINAL ONLY
BUILDING
'OCCUPANCY OF'BUfLU1NG'IS NCIT PERMIT-1
UNTIL BUILDING FINAL IS SIGNED BY BUILUNG
- - .INSPECTOR. . CERTIFICATE OF OCCUPANCY❑
PRELINSPECTION: - PLYWOOD: IN-PROGRESS 1
p..
'INSP.' ` DATE INSP. DATE INSP. DATE
TEAR OFF INSPECTION: BATTENS: FINAL: .
' 'I,NSP. DATE INSR DATE INSP. DATE . .
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION :
4_ ' - APPLICANTS POSTING COPY
CITY OF CUPERTINO
I* 1 of 2 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng : Sub : Blk: Lot :
APN . . . . . . . . : 36940015 . 00
DATE ISSUED. . . . . . . : 03/13/2002
RECEIPT # . . . . . . . . . : 17624
REFERENCE ID # . . . : 02030056
SITE ADDRESS . . . . . : 10440 DE ANZA BLVD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : DR. CHIU OFFICE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : CTC FUNDING, LLC
CONTRACTOR . . . . . . . : RUSSELL, DAVID J LIC # 5655
COMPANY . . . . . . . . . . : SOUTHBAY CONSTRUCTION CO INC
ADDRESS . . . . . . . . . . : 511 DIVISION STREET
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 379-0400
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- - - ------ -- - - - - - - - - --- - -- -- - - --
BTEMPPERM FLAT RATE 1 . 00 200 . 00 0 . 00 200 . 00 0 . 00
------ - - - - ------ ----- - - - - - --------
TOTAL PERMIT 200 . 00 0 . 00 200 . 00 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
101 FOUNDATION 102 PIERS
103 UFER 104 REBAR
105 ANCHOR BOLTS 106 SEWER & WATER
202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL
204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION
301 ROUGH PLUMBING 302 TUB & OR SHOWER
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
305 FRAME 306 HOLDOWNS
307 INSULATION 308 SHEETROCK
309 EXTERIOR LATH 310 INTERIOR LATH
311 SCRATCH COAT 313 ROOF NAIL
501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY
503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY
505 FINAL ELECTRICAL 506 GAS TEST
507 FINAL PLUMBING 508 FINAL MECHANICAL
509 FINAL GRADE 510 FINAL PLANNING
514 FINAL PUBLIC WORKS
•
CITY OF CUPERTIN i 636�51�
CGo D
CUPEI0 PERMIT APPLICATION FORM
APN # 13 —C)?—
Building
vZBuilding Address:
Owner's Name: Phone#:
ZS - �y(oo
Contractor: License#:
Sn t� �-o�S-I. .
Contact: Phone#:
Z4+)-I U-33 X Z2
Applicant/Contractor: Fax#:
wand
d
Builing Permit Info: / /'
ldg Elect (IPll b (Mech
escription:
Residential: Commercial: Ti
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
Type of Construction: r Occupancy Grou
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
JE" BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
1 of