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02120073Paz at U liras ~�2 Z a�a m F %0W �3LLt- F-��y.( a�p0 Xm� � - H ~za ad W 5? O �2 C W~ G UC 145 O� Ho u� U U ;e CITY OF CUPERTIINO BUILDING DIVISION ]�]�i T 07. 7�' � � t �rn .�f�7f �T �Atotal ��i[a � �� 11 itic� . BUILDING ADDRESS: PERMIT N0. 10767 N WOLFE RD OWNER'S NAME: APPLICATION SUB DATE SANDHILL PROPERTY CO. 12/17/2002 PHONE: SANITARY NO. CONTROLNO. ARCHITECT /ENGINEER: BUILDING PERMIT INFO BLDG EO PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 1 hereby 1 licensed Chapter 9 Job Description aflirrn that am under provisions of (commencing with Section 7t00)of Division 3 of the Bu 'ness and Professions Code, and my license is in full force oil r� ��S 9 - ` TI-- REMODEL EXISTING OFFICE Liven ic. p Da con cl o CONTRACTOR: CM DESIGN ARCHIECTS D ARATION 1 understand my plans shall be used as public records Licensed Professional OWNER - BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License law for the following reason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any structure prior to is issuance, also inquires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $13500 that he is exempt therefrom and the basis for the alleged exemption. Any violation of APN Number Occupancy Type P Y YP Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). 31645017.00 - ❑ 1, as owner of Lite property, or my employees with wages as their sole compensation, will do the work, and the structure is notintended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of Inspections property who builds or improves thereon, and who does such work himself or through his own employees, provided thatsuch improvements are not intended or offered for sale. If, 101 — 102 — FOUNDAriRffred PIERS however, the building or improvement is sold within one year of completion, the owner- 103 — UFER builder will have the burden of proving that he did not build or improve for purpose of sale.). 104 — REBAR ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to 10 5 — ANCHOR BOLTS construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li- cerise law does not apply to an owner of property who Guilds or improves thereon, and 106 — SEWER & WATER who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. 202 — UNDERFLOOR PLUMBING ❑ 1 am exempt under Sec. B & PC for this reason 203 — UNDERFLOOR MECHANICAL Owner Date 204 — 205 — UNDERFLOOR FRAME UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations 301 — ROUGH PLUMBING ❑ 1 have and will maintain aCertificate of Consent to self -insure for WorkersCompen. 302 TUB OR SHOWER sation. as provided for by Section 3700 of the Labor Code, for the performance of the — & work for which this permit is issued. 303 — ROUGH MECHANICAL ❑ 1 have and will maintain Workers Compensation Insurance, as required by Section 304 — ROUGH ELECTRICAL 3100 of the labor Code, for the performance of the work for hick this permit is issued. My Worker's Compensation Insurance carrier and Pol' n ner are: 305 — FRAME Pnlity .. I s �l 306 — HOLDOWNS CEIMFICAT OF PEP= FROM WORKERS' COMPENSATION INSURANCE 307 — INSULATION (This section need not be completed if the permit is for one hundred dollars (S 100) 308 — SHEETROCK or less') 309 — EXTERIOR LATH I certify that in the performance of the work for which this permit is issued, I shall not 310 — INTERIOR LATH employ any person in any manner so as to become subject to the Workers' Compensation Laws of California Date 311 — SCRATCH COAT Applicant 313 - ROOF NAIL NOTICE TO APPLICANT: If, after making this Cenificate of Exemption, you should become subject to the Worker's Compensation provisions of the labor Code, you must ' 501 — FINAL ELECTRICAL ENERGY forthwith comply with such provisions or this permit shall be deemed revoked. 502 - FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of 503 — FINAL MECHANICAL ENERGY ' the work for which this permit is issued (Sec. 3097, Civ. C.) 5 0 4 — FINAL BUILDING ENERGY Lenders Name Lenders Address 505 — FINAL ELECTRICAL i I certify that 1 have read this application and state that the above information is 506 — GAS TEST correct. 1 agree to comply with all city and county ordinances and state laws relating to t building construction, and hereby authorize representatives of this city to enter upon the 5 FINAL PLUMBING above - mentioned property for inspection purposes 0 8 — FIN (We) agree to save, indemnify and keep harmless the City of Cupertino against j liabilities, judgments, costs and expenses which may in any way accrue against said City 5 ,CAL N in consequence of the��(fa[tti+tBef�Wispsxmi APPLIC NT_t)N6ERSTA%§ AND WI COMPLY WITH ALL NON- INT Issued by5 1 - G Date SO REGULATIONS. J7 �Z 12 Re -roofs Si - ture of Applicant/Co &0,r­- ate HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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 Safety Code. Section 25532(a)? C] Yes No 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 Will the applicant or forum building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑ Yes NNu I have read the hazaarrllJnut materials requirements under Chapter 6.95 of the Califor- nia Health & SaretyCodc, Sections 25505 25533 and 25534.1 understand that if the building does not cu a Iertant that it is risibility m notify the occupant of the repo' nts which must be o' cc of a Certificate of Occup cr. j Signature of Applicant Date I All roof coverings to be Class "B" or better Owner or authorized agent Date CITY OF CUPERTINO INFORMATION BUILDING DIVISION PERMIT CONTRACTOR r BUILDING ADDRESS: PERMIT NO. 10767 N WOLFE RD ER'S NAME: APPLICATION SUB DATE. SANDHILL PROPERTY CO. 12/17/2002 PHONE: SANITARY NO. CONTROL NO. ARCIIITEC (ENGINEER: BUILDING PERMIT INFO RLDG ELECT PLUMB ME hl LICENSED CONTRACTOR'S DECLARATION I Hereby aff rte Thal 1 licensed under provisions ors Chapter tt Job Description with l ] onmmense is RklO)nf Division JafN Be. ess and Professions Micheletti] my license is Mic 111 In fmn�omej�rd err .. S �+ a2'6Yks `» TI-- REMODEL EXISTING STING. OFFICE FINALM® Hal ✓ Cantct CONTRACTOR: CM DESIGN ARCIIITECTSD ARATION I understand my plans shall the used as public records FEB 1 8 2003 Licensed Professirnal OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License law far the BUILDING following mature, (Section 7031.5, Business and Professions Code: Any city or county a which requires a permit al construct, alter, improve demolish, or repair any stramum prior o its ihounce,also requires the applicant for such permit to life a signed statement sl that he is licensed pursuant the prnv ens oflhe Cumracmr's Licenu Law 9 Sq. Ft. Floor Area Valuation ar Dlvisinf 3 of the Business and vi Code) nr that exe with Section $13500 he is therefrom and aged that he is exempt tnercfsom and Nc basis for the alleged exemption. Any violation of axe on. Any APN Number Occu ane e p y Typ Section 7031.5 by any applicant for 4 rannit subjects the applicant Io a civil penalty of not more than five hundred dollars ISSUE. 31645017.00 D 1, as owner of dye property, or my employees with wages a Their sold compensation, 101 - FOUNDA =wed Inspections will d^ the work, and the structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractors License law does not apply to an owner of property who builds or improves thermal and who does such work himself orthrough his own employees, provided that such improvements are not intended or offered for sale. If, 102 - PIERS however, the building or improvement is sold within one year of completion, the owner - 10 3 - UFER builder will have the burden of proving that he did not build or improve for purpose of 104 - REBAR I, as owner of the property, am exclusively connecting with licensed contractors to 105 - ANCHOR BOLTS construct 0e project (Sec. 7044, Business and Professions Cwk:) no Contractor's Li- crew Law dos not apply toen owner of property who builds or improves theater, and , 106 - SEWER & WATER LcenseLewu(nr such Omjecu word econtracmr (s)licensed puuuam mNe COnlracmrs 202 _ UNDERFLOOR PLUMBING ❑ 1¢m exempt antic, Sec. . B A P C for thisrearn 203 - UNDERFLOOR MECHANICAL er Date 204 - UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION 205 - UNDERFLOOR INSULATION I hereby talent under penalty of perjury one of the following declarations: 301 - ROUGH PLUMBING ❑I have and wmmorby eCcn370l) oftheLaorCod ,forth for Workcracompcm sminn, as provided for by Section 3]1X1 of the labor Code, for the performance of the 302 - TUB & OR SHOWER walk foe which this permit is ismed 303 - ROUGH MECHANICAL D 1 have and will maintain Winker' Compensation Insurance, as required by Section 304 - ROUGH ELECTRICAL 370) of Ne la1WT Code. for the penfmmence of the wonkfor hichtoispermitisiaued. My Worker' s Compensation Insurance carrier and Pot' her am: 305 - FRAME camar /S 1. __o Por<y .. IGS(fnl -O 306 - HOEDOWNS CERTIFICCOMPENSATION INSURAANEORKER $' TIOWFR 307 - INSULATION (Tdawction neednn MCompleedifde permitisfornnc hundred dollars (SIM) 308 - SHEETROCK ante''`) 309 - EXTERIOR LATH I cMily that in the performance of the work for which this permit is isvued, I shall not 310 - INTERIOR LATH employ any person in any manner so as become subject to the Workers' Compensation Lows of California. Date Applicant 311 - 313 - SCRATCH COAT ROOF NAIL NOTICE TO APPLICANT: R, afar making this Cisions of of Exemption, you should hrthwi subject the Workers Compensation previsions of lhelded Coked. mud 501 - FINAL ELECTRICAL ENERGY forthwith comply with such provisions of this perrllil shall M deemed mmked. Coply 502 - FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY I hereby affirm that forte is a construction lending agency lot the penrmlence of 503 - FINAL MECHANICAL ENERGY the work for which this permit is issued (Sec. 3097, Cis. C.) Lender's Namc 504 - 505 - FINAL BUILDING ENERGY FINAL ELECTRICAL L, '.,Address I ready that 1 have mad this application and sale that the shove ialmmnirn is 506 - GAS TEST correct, l agree to comply with all city and county ordinances and state laws relating to building construction, and hereby amore, representatives of tons city to cone, upan the 5 FINAL PLUMBING .Nooc- menlioned p.,Ay far i apneti ^^purposes. O8 - FIN L Oise) agree to save, indemnify and keep harmless the City of Cupertino against liabditio, judgments, costs and d sperms which may in any way adcrue against said City 5 N In consequence rf dM�fjnm ®�If liMa P' APPLIC NT- UNDERSTANDS AND WI COMPLY WITIi ALL NO/N/-�P� TNT Issued by51 - G Date SO : REGULATIONS. 1! Z 12 (N� Re -roofs Type Of Roof Si "j um Applicud/C^ nn . ^' m HAZARDOUS MATERIALS DISCLOSURE Will Nc applicam or future building occupant store or handle haaNaus material defined by the Cupertino Municipal Close , Chapter 9.12, and the Great and Safety m, Seefian 25532ba)1 Dyes KN. 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 Will the applicant or future building occupant tau equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Month? ❑Yes No have mad NC hater nos muerialsrcyuircmcnu under Chapnrfi 95 n(NC Califnr ram l lanlhNr Safely Code, Section. 5505 25533 and 25534.1 undenaml deal 11 the building dtC rnl cr • a Mnanl. Blal it is nsonIdy to nadfy the rkcupaut of the rest; ruwmenmratic cenra Certificate, orGaap cy. ! Signature of Applicant Date t 2 All roof coverin s to be Class "B" or better g owner Is, r auNOrired agent me CITY OF CUPER NO I "I I.�II I •�I "I "I I( •� IN (ul I (I)1':� D Z/2- o,) 7 ,3. AP #,,X ✓,. 4, ,, Date: Building AddKe,W.. 10 74 7 Owner's Name:.-'-- Phone #: �-� 3 _ '® Contractor: License M Gm 71St Contact: Phone #: -ve' Applicant/Contractor: Fax M Ind/Off/Comm/Quasi ®6 ermit Info: Elect Plumb Mech go2 ption: Residential: Commercial: Sq.Ft. Floor Area: $ /Sq.Ft.: Architect/Engineer: Valuation P ° q// �✓f Type of Construction: Occupancy Quantity ]Fee ID Fee Description Yee Groan BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH I 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 B EN ERGY Energy BUR LMNG BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi - Family Res MECHANICAL BNEWMULTI New Multi-family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 1 of 3 ,p 1 CITY OF CUPEkT1NO 0 0 CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BNUMULTI New Multi-family Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING - BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE BPGAS Pb1g Fixture - Gas Piping System Fee PLUMBING PLUMBING PINTERCEP Ind Waste Interce for PLUMBING PLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Re eat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sawa a Di osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK BPSTORM Lawn S rinklerBackflo StomVRain Water PLUMBING PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT BPWATER Alt of Drain & Vent Install/Alter Water Pie PLUMBING PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Buswa s ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL ",00,;2 BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace > 1 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 ti, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL, 2 of 3 o CITY OF PE 1R\ MHT A ?PLH l ATH(BN 1C ®RM CUPS TNO Quantity Fee RD ]Fee IDescri Lion Fee Group BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSVS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSIEIShUCOM Msmk C®unmeirciall BUILDING BSIEISMICRIE Seismic Fee Res BUILDING BSF&2FAM Sin le & 2 Family BUILDING BSFNA Single Family New Add BUILDING BSPECIAL Special Ins ection 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 IERMITIF7ElE IEllec Permit Issuance ELECTRICAL MPERMFEE Mechanical s . foot MECHANICAL RY P ERMITFIEIE Mech Permit Issuance MECHANICAL ]IDP ER MITFIEIE Plumbkg Peirmh Issue PLUMBffN G PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Change BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100IC to 500K Btu MECHANICAL BBOMER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75 M Btu MECHANICAL 3 of 3