05090041 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �aCONTRACT�OR�INFORMATION`
BUILDING ADDRESS: MARK THOMAS & CO. INC. PERMRN0.05090041
20833 STEVEN
OW NER'S NAME: PEIEMIT ISSUE DATE
MARK THOMAS & CO. INC. 2005
E:
SAN RARY NO. CONTROL NO.
ARCHITECT'ENGINEER: BUILDING PERMRINFO
BLDG ELECT PLUMB MECH
0 0 0 0
moo LICENSED CONTRACTOR'S DECLARATION
1 Z C w 1 hereby affirm that 1 am lumneed under provisimu M Chapter 9(wmrromang Job Description
<b iN Sectsort Mri)of Division Jaf the Businev Profc s Code,and my license is �"[t
^�N mmummronearea. 1 S'73 8' TI-REMOVE 2 WALLS TO #104/MINOR.
Z License Class Lie.x
=rEDw Dam Conmcm e.+a-r-' ELECT. & MECH. 5 56 1AL
FF ARCHITECT'S DECLA ATIOIT N
C I undersand my plans shall M used as public r.ords r q
I. ` 2006
s G t; Liumsed Professional
3 OWNER-BUILDER DECLARATION p
1 hereby.7irm that I am exempt from the Contractor's License Law for the 1 e .. 'I �y�,
20 following reason.(Section 71D 1.5,Business and Profemions Code:Any city or county Ia,~U r''I' _- SY l�l�j 'r_35
which requires a Permit to commuter,eller,improve,demnlLxh,Or repair any srr.tue �f_.I� Aj `1 ,i\/•
Prior m its issuance.also requires thc applicant for such Permit to rile a signed eatom.t -- — -
ss<
that hcislicensed purment10 mProvisions Ofthe Contractor's UcensLaw Sq. FL Floor Area Valu 46504
X (commencing with Section 7")of Division]of she Business and Proressions Codc)or
that M is exempt therefrom and the bases for the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjecu the applicant to a civil penalty of Occupancy enc
not mese than Tac hundred doll.(ML 3263205APN Number p y T ype
❑I.as owner ofthe property.a my employees with wages ax their solo compensation,
will do the wurk,end testmcthre is mutimendednrnffered mralc(Sec.7014.Business Required Inspections
and Professions Cock:The Contractor's Licence Law doer roe nst apply to an owner of q p
Property who builds orimpowns thereon,and who doessuch work himself or through his
own employees,provided Nat such improvements are nothdrem ed or offered for ak.IL
however,the building or improvement is sold within one year of completion,the owner.
builder will have the border of proving that M did not Mild or improve for purpose of
ale.).
❑1.as ow.r of the property,am exclusively contracting with licensed contractors to
construct tM project(See.7044.Business and Professions Code:)The Contractor's U.
come law does not apply to an owner of property who builds or improves Nee e.and
who contracts for such projects with a eamractor(s)licensed pursuant o the Contractor's
License raw.
❑I am exempt under Sec. ,B l P C for this msson
Owner Data
pIWORKER'S COMPENSATION DECLARATION
1 Mmby air=under penalty of perjury ore of the following dalaauons:
he
and will maintain a Cenifcate of Consent to self-insum for Worker's Compen-
sation,as provided for by section 37M of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 haat and will maintain Workers Compensation Insurance,as required by Section
37M of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's C�om,mi auoa Inwnace carrier and Policy number are:
carrier: � se/U2 wa' AEL iMPyiryNo.: I� 277
CERTIFlCATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This seem.need tot Mcomplcted if dre permit or for.hundred deBars(SIM)
or Iess.)
I certify that in am performance of the work for which this Permit a issued,I shall not
employ any person in any manneren as w become subject o the Wdrkem'Compcosation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to the W.keri Compensation mvisions of the Labor Caere.you most
.JO forthwith comply wit such provisions or this Permit shall W deemed mvokcd.
z CONSTRUCTION LENDING AGENCY
(-+ I Mmby affirm dun Nero is a coomucuon lending agency for the performance of
W'
the work for which this permit h im.d(Sec.3097,Civ.C.)
aQ Lender's Name,
Q z Lender's Addma
U Q 1 sonify that 1 have read We application and sum that the above information re
Fcormet.I agree to comply with all city and county ordinances and state laws elating to
0 building construction,and hereby authorize mpreemmatives ofthis city to cnpr upon the
r cA above-menudSm Property(a i expcn=purposes.
r1 (We)agree to ase,indemnify and kap harmless the City of Cupertino agsoom
Uzed incoides.quene or ts,the ramming of this Permit. may inany way eccmc againstmid City
in consequence of the gaming of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO Poll
PJOINT Issued by: Date
spun � ods-�^ aN rep 4 MTC.9//S/OS Re-roofs
Sig name of App MCovert
ao/
US RI
MATEALS DISCLOSURE DA
Type of Roof
Will the applicant or future ni building occupant nom or handle Health
sd Safety u re.Seg io the Cupertino Municipal Cdgc,Chapter 9.11,and the Health and Safcry
cele,Section 25532(a)?❑Yrs ON.- All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment Of devices which If a roof is installed without first obtaining an inspection,I agree to remove
r i humorous air contaminants as defined by tM Bay Area Air Quality Management all new materials for inspection.
❑Yea .gNo
I have mad the by iiusmamrialssequimmena under CNpmr6.95 ofthe Califor- -
nuT 16&Safety COM,Sx-e=MM5,25533v 2553d.lundersunditif Ne,Wilding
does rpt cu ase o wnanl Nat it u my mapomibility w notify the occupmt of the
m n ubeme,poor toiaua.cnr,Cermfcateoroccuponcy. SignatureofApplicant Date
a2d 70 V Ate �° r'T All roof coverings to be Class"B"or better
Owner or au 'red a en oto
CITE'OF CUPERTINO �y T�T *q
BUILDING DIVISION �E�Vj�y �t) i1� � tYi1. O �
BUILDING ADDRESS: MARK THOMAS & CO. INC. PERMIT NO.0 5 090041
20833 STEVENS CREEK BLVD
OWNER'S NAME: PERMIT ISSUE DATE
MARK THOMAS & CO. INC. _ 09/15/2005
r HONE: SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ARCHITECTIENGINEER:
BLDG ELECT PLUMB MECH
L� 0
Q 0 p LICENSED CONTRACTOR'S DECLARATION Job Description
inC I hereby affirm that I am licensed under provisions of Chapter 9(commencing
m with Section 7000)of Division 3 of the Business anQ Profressions Code,and my license is
� y in full force andcffect TI-REMOVE 2 WALLS TO #104/MINOR
Eig K License Class Lic.#
;:w Date Contractor` s� ELECT. & MECH.
a ARCHITECTS DECLA ATION
aI understand my plans shall be used as public records
�yU
U.in Licensed Professional
n y OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
pO following reason.(Section 7031.5,Business and Professions Code:Any city or county
ff which requires a permit to construct,alter,improve,demolish,or repair any structure
Z
In prior to its issuance,also requires the applicant for such permit to file a signed statement � lU il�>S 5 0 4
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area
F$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
a. 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 APN Number Occupancy Type
not more than five hundred dollars($500). 32632053 . 00
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of q p
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.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.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law docs not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec. B&P C for this reason
OwnerDale
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
Q I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier: TYU�1 P11l
CAr&eicy No.: /�
LL /% T 2–7~
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify 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,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J 0 forthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued(Sec.3097,Civ.C.)
Wfs.Q Lender's Name
a z Lender's Address
U O 1 certify that I have read this application and state that the above information is
lL►'' correct.I agree to comply with all city and county ordinances and state laws relating to
0 V building construction.and hereby authorize representatives of this city to enter upon the
W ahove-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
1_4 co) liabilities,judgments,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 Issued by: Date
SOURcE ATION�S.
.�"` DION 720 6,RM-211 / OS" Re-roofs
Signawrc of App anI/Contracto Da Type of Roof
HA AR OUS MATERIALS DISCLOSURE yp
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)7 All roo�'s shall be inspected prior to any roofing material being installed.
❑Ycs E}No
Will the applicant or future building occupant use equipment or devices which
If a Too;is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
[]Yes -e-No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&SafetyCode,Sections 25505,25533 and 25534.1 understand that if the building
does not curt ave a tenant,that it is my responsibility to notify the occupant of the
rey menLs- st be met prior to issuance of a Certificate of Occupancy. Slgnatu Ce Of Applicant Date
IV c �171D �s All roof coverings to be Class"B"or better
Owner or aurh izcd a ent bate
CITY OF CUPERTINO
__ gym 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng: Sub: Blk : Lot:
APN . . . . . . . . : 32632053 . 00
DATE ISSUED. . . . . . . : 09/15/2005
RECEIPT # . . . . . . . . . . 31215
REFERENCE ID # . . . : 05C90041
SITE ADDRESS . . . . . : 20833 STEVENS CREEK BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUFERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MARK THOMAS & CO. INC.
ADDRESS . . . . . . . . .
CITY/STATE/ZIP . . . : CUFERTINO CA, 95014
RECEIVED FROM . . . . : MARK THOMSA & CO.
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : MARK THOMAS & CO. INC.
ADDRESS . . . . . . . . .
CITY/STATE/ZIP . . . : CUFERTINO CA, 95014
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPER.MFEE VALUATION 46, 000 . 00 505 .44 0 . 00 505 . 44 0 . 00
BPLANCHK PERMIT FEE 505 .44 674 . 51 0 . 00 674 . 51 0 . 00
BENERGY PERMIT FEE 505 .44 242 . 61 0 . 00 242 . 61 0 . 00
BSEISMICOM VALUATION 46, 000 . 00 9 . 66 0 . 00 9 . 66 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
ELECTRIC SQUARE FEET 480 . 00 38 . 40 0 . 00 38 . 40 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 1585 . 73 0 . 00 1585 . 73 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 1585 . 73 58732
TOTAL RECEIPT 1585 . 73
CITY OF CUPERTINC
CIT'OF PERMIT APPLICATION FORM c' 0 �
CUPEkT1NO
Date:
Building Address: Mailin Address (if different from building address):
2-08. 3 Sli–=Uo l 4_�— ptvp. 7t- v
Owneer�''ss Name:
/J,� I //�}� D�` A f Phone �j /JQ10/ 1 /`fes 7 / lji, S "'"` M STN �A)Ct4c
2-SJ- 1.s63Contractor: License
Tucif&-)e aAJSr2P&7-t P U
ContPhone:SGA-2S3-"7843 Cupertino Business License#:
f)t:oAJ TbY Fax:W$-293-.5173
Building Permit Info:
T—r c v>li m C'w-Lwr-1 R6r v aw 2 jF4(- w4u-f To ewC-f-e616 S vl TE loo
Bldg 0 Elect R Plumb ❑ Mech ®
Job Description:
�a
Residential ❑ Commercial ❑
Sq.Ft. Floor Area: jrm lbq.Ft.: 4o C->Q,_
Cost of Project: * Zo, Occupancy Group:
o00 .ao
Type of Construction: Please check this box if the project is a
TM second-story addition: ❑
project Size: Standard Large ❑ M�jor ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Bailer<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> l OOK to 500K Btu MECHANICAL
BBOILER3 Boi_er> 500K to 1M Btu MECHANICAL
BBOILER4 Boilor> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX In d/Off/Comm/Quasi BUILDING
BCONSTAXBQ Cc n. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax-Resi/Mobile BUILDING
BELEC 1000 El ec 600V <= I OOOA ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD 17 nergy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of 3
s.- s� 73
w CITY OF CUPERTINC
T
CUPEf�TINO PERMIT APPIACATION FORM
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCON4MM Now Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTEVM Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum . PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS G is Piping System Fee PLUMBING
BPINTERCEP bid Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Pian Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Dis osal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT )alt of Drain &Vent PLUMBING
BPWATER Insi:aWAlter Water Pie PLUMBING
BPWHEATER Nater Heater/Vent PLUMBING
BPWSVCS main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C'Units<= 10,000 cfrn MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY :Zemodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BRENVURN Rolocation of Furnace MECHANICAL
BRENULRNOV Re:o Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BRENIINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rer.i 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 R.. air/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2 of 3
r; 'ITY OF ("'UPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkT[NO
Quantity Fee ID Fee Description Fee Grou
BREMSIGNAD Rn-dl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS 'Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
(` BSEISNUCOM S:ismic Commercial BUILDING
BSEISNIICRE Seismic Fee Res BUILDING
BSPECIAL -Special Ins ection BUILDING
BSW1M Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Tempora Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
C EPERNIITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanical sq. foot MECHANICAL
MPERMITFEE M ech Permit Issuance MECHANICAL
PPERMITFEE Pi imbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Plannirg LR Comme/Multi-Fam PLANNING
PLLONGRNGR Plannir.g Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
3 of 3