08010114CITY OF CUPERTINO
BUILDING DIVISION PERMIT
a C01�iTR:e.CTORIN'EURMATI N aY_
BUILDING ADDRESS:
PERMIT NO.
20128 STEVENS CREEK BLVD #102
TBD — TO BE DETERMINED
08010114
NEWS NAME:
PERM] T ISSUE DATE
JACK BITHER
-
01/17/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
INSTALLATION OF NEW
a o PLO MEOCH
O
LICENSED CONTRACTOR'S DECLARATION
lb Description
o
1 hereby alTrm am Nan I licensed under provisions of Chapter 9 (commencing
— ^^^^^
with Section 7000) of Division 3 of BU Business and .1casions Code, and my license is
in fun torte and tjr4 3
Licence CWa Lk.
Date_ Contractor
ARCHITECTS DECLARATION
I under amid my plans shall be and as public meoNs
-
Licensed Professional
OW NER-BUILDER DECLARATION
1 hereby alTnrm that I am tempt from the Contractor's License law far the
d Pox as Code: Any city Or many
fallowing mason. (Section 7031.5, Business anesuse man
which rewres ia permit re camtm0. son. Improv, demaikh, fir mpdr any summers
hit any
Prior m its Woman. Asa requires the applicant forsuch permit to rile Wtemeal
that he is licensed punuantm the pmriaimu.t the Conneur's Uccnse Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Olvki.n 3 of the Business and Pmpurd... Code) ser
,hat he I, exempt therefrom and Ne buts for the alleged taemptioo. Any violation of
APN Number
OCCU anC e
P Y EYP
Section 7031.5 by any appllcem far a permit mbjecu Ne applicant in a civil penalty of
nm mom than R. hundred dollars ISM
❑ 1, a.wm of Ilia pmputy, m my wploycu with urges u Neo ale compemdon,
Required Inspections
will do the workmd Ncswcum is mtinunded of offered for We(Sec. 7014, Busi•...
and Pmftad.ns Code The Conuacloh License Law dean ore apply e an owner of
ns
q p
property who buildsorimpmsea Ihvamn, and who doessuch work Macau er Waugh his
Own employees, pmvided that such improwmrnts art not Intended oroaar d forsale. R.
however. tie building car improsemmt is sold within one year atcmopkti.n. the aw cr-
Wilder will haw Um hadan of purring that he did m build Or important for purpose of
ask..
❑ I. u atom of the Property w eaduaiwly canaaning with licensed comaerOMs in
-
muum the PmPMt (Sec. 709/, Bawai u and Professlou Coda:) The Committees Li-
cense law data not apply in an mane r or property who bundn or impmwa thereon, and
who dnaams for such projects with a comaermis) licensed pursuant to the Contncar's
License Law.
❑ I am exempt under Sea .B&P C for WS Mason
ncr
.f' W 'S COM SATION OECLA N
y arnan under Pe Perjury ate of the following deelaradou:
❑ I haw and will in of Conserv sure for Workeh Ca
337M of Ma
Section 3]00.1' the labor Code. for W peAormaree of de
sedan, pimided for SedanCode,
for b
mi
woh 1'w which this permit is iasued
r
1 bate and will maintain Worker's Compensation Insurance, as required by Scotian
3700.1'W labor Code. far the peRamunmafthe work far which this permit is issued.
'
My Worker's Cempeesatim Insurance artier and Policy number am:
Cartier. 12&L AV Policy No.: 7o&9
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This aecim and nolhecomples d if de permB Is forme heanNed dallm ($I00)
or less.)
I certify that In the performance of the work for which this Permit k issued I shat not
employ any permn In any manamm as in become subject to ine Warlb rs Compensation
Laws of Calfomla. Data
Applicant
NOTICE TO APPLICANT: IL aner making this Certificate of Exemption, you should
Isadore subject an the Worker's Compensation provisions at rite labor Code, yon must
forthwith comply with such previsions or this permit.hal be dttmd remained.
CONSTRUCTION LENDING AGENCY
I hereby affirm Nss them is a distraction landing agency for Ne performance of
Me, work for which thus permit Is issued (Sec. 3097. Cir. C.)
Lender's Name
,
Landels Address
1 amity that 1 hoe read this application erW suss Nu the show Information k
cortecc I agme m comply with al city and county aNinancat and aura laws relating in
building cmmuction, and hereby authdre rtpmxnutives of Nie city in enter upon the
ahWtrmentioned property for Inspection purp6w:i
(We) agree to an, indemnify and keep harmless the City of Cupertino against
11a1tRiden judgmenu,costs and expenses which may in any toy scene against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Type of Roof
Signaurc of AppliesntlC.macter Data
HAZARDOUS MATERIALS DISCLOSURE
Will the appiicnnl or future building one pant A.re or handle ha'vNon materia
u dcRmd by rix Caperton Municipal Code, Chapter 9, IT* and the Nautili,and Safety
seeder 25533(.)T Em
❑Ye
All roofs shall be inspected prior to any roofing material being installed.
'Win
If a roof is installed without first obtaining an inspection, I agree to remove
the applicant ar future :filing mutant sex equipment andevices which
COOK havardeta air mnuminanu fined by the Bay Area Air Quality Management
Oimicr7
- all new materials for inspection.
❑Yes Na
I WthehvaNausma
ldi.-
M5.25quirements adMS3.1.n&pterd. ifftWiofthe
k cly Calc. SmtionsiatitI3mymmo23334.1 building
data in
Jm c rely haw a tens t It b my rtapansihllity w notify die rccupann of the
scamp
re whichmuatm t .cow. andancemneaearpmd
Signature of Applicant Date
D
All roof coverings to be Class "B" or better
owner ser.amnrirnd agent Dasa
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CY OF CUPERTINO
BUILDING DIVISION PERMIT
EVENS CREEK BLVD #102
OWNER'S NAME:
JACK BITHER
ARCHITECT/ENGINEER:
Cd
o LICENSED CONTRACTOR'S DECLARATION
m I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Y with Section 7000) of Division 3 of the Business and rofessions Code, and my license is
a a in full force and of L 3/ d
License Class Lic. p
F o Date Contractor�iE�ALrd�/b�tl�/N�
,� ARCHrrECI-S DECLARATION
a 1 understand my plans shall be used as public records
�yU
H Licensed Professional
rn
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contracices License Law for the
00 following reason. (Section 7031.5, Business and Professions Code: Any city or county
< m Pi which requires a permit to construct. alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant forsuch permit to file a signed statement
C 2 G that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
at— $ (commencing 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
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than rive hundred dollars (5500).
0 I, as owner of the property, or my employees with wages as thew sole compensation,
will do the work and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does 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 are not intended oroffered for side. 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.).
0 1, as owner of the property, am exclusively eonuacting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a conuactor(s) licensed pursuant to the Contractor's
License Law.
0 I am exempt under Sec B & P C for this reason
Owner �e
re-rey affirm under peri 4.0perjury one of the following declarations:
0 1 have and will maintain a Certificate of Consent to self-insum for Worker's Compen-
sation, as provided for by Section 3700 of the tabor Code, for the performance of the
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the tabor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier. S%tide %UNa Policy No.: /5 9Q�
ERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(17tis section need not be completed if the permit is for one hundred dollars ($100)
or less.)
I cenifv that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
.J Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
[-r I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued (Sec. 3097, Cir. C.)
Q Lender's Name
r7 z Lender's Address
U Q 1 certify that I 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
Ubuilding construction. and hereby authorize representatives of this city to enter upon the
>4 U above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
uF.0 f/1 liabilhies,judgmems, costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS.
Signature of Applieam/Contraetor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safely
Code, Section 25532(a)?
0 Yrs No
Will the applicant or f�Nol
riding occupant use equipment or devices which
emit hazardous air contaminafined by the Bay Area Air Quality Management
District?
O Yes
I ad ill It ardortsmaterialsrequiremcnt.sundo Chapter6.95ofthcCalifor-
nia1o�. lyCodc, 06u.`us:9505,]5533and25534.IundcrsurudThatifthebuilding
does tit qp,/mntly have a lenaq['igat it is my responsibility to notify the occupant of the
moum.FfrTenis which must be nicL atior to issuance ora Certificate of Occupancy.
Owner or authorized agent / / Date
TBD — TO BE DETERMINED
INSTALLATION OF NEW
PERMIT NO.
08010114
PERMIT ISSUE DATE
01/17/2008
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Sq, Ft. Floor Area Valuation
APN Number Occupancy Type
Issued by:
Re -roofs
Type of Roof
Required Inspections
Date
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
'� ll
Signature of Applicant Date
. All roof coverings to be Class "B" or better
st,
CITY OF
CUPFI�TINO
CITY OF CUPERTINO
SIGN
PERMIT APPLICATION FORM
/IAS /4///
APN #
Date:
LP 9 03 061 do
/1q/07
Building Address:
�-o Q-16 '54cveAJ rre.
Mailing Address (if different from building address):
Owner's Name:
Phone #:
cr ����^��
�Io� 761 l3�%
Contractor:
Phone #:
Fax #:
Contractor License #:
Cupertino Business License #:
Contact:
Phone #-, %—O f
C�,��� `I�SZ��✓
Fax#:
Building Permit Info:
Bldg ❑ Elect ❑ Monument ❑
Mounted on Building
Residential ❑ Commercial
Job Description:
f?i
Valuation (cost of project):
CITY OF CUPERTINO
ziSIGN
CITYOF •
CUPEVIINO FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee _
Group
Permit Type
1 SIGNDIRECT
Directional
B
1SIGN/RF
Ground/Roof/Projecting Signs
B
1 SIGNMASCK
Master Plan Sign Check
B
1 SIGNREWRKG
Rework of any existing Ground
Sign
B
1 SIGNOTHER
Other Sign
B
1 SIGNREINSP
Re -inspection Fee
B
1SIGNWNONEL
Wall/Awning Sign, Non-
Electric
B
/
1 SIGNWELEC
Wall, Electric
E
IESIGN
Sign, Outline Lighting System
or Marquee supplied from one
branch
E
10EAP5
IESIGNADD
Additional Branch Circuit on
Same Sign, Outline System or
Marquee
E
10EAP6
IELCPLNCK
Plan Check Fee
E
EPERMITFEE
Electric Permit Fee
E
/
BSEISMICOM
Seismic Commercial
B
BSEISMICRE
Seismic Residential
B
TRAVDOC
Travel & Documentation
B
BUSLIC
Business License
B