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07090049 CITE'OF CUPERTINO �T �TQR'IO`MA TI BUILDING bIVISION PERMIT PERMIT NO. BUILI)fr6j,��DRESS: 1U7 S DE ANZA BLVD VARDY MI{E LLC 07090049 PERMIT ISSUE DATE OWNER'S NAME: VARDY MIKE LLC 10227 S DE ANZA BLVD 09/10/2007 SANITARY NO. CONTROL NO. VE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH ad zz LICENSED CONTRACTOR'S DECLARATION Job Description w 0 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing U m with Section 7000)of Division 3 of the Business and Professions Code,and my license is T. I . C OM YI. REPLACE ROOF L I GHT I N FIXTURES =y in full force and effect. t vn z License Class Lic•# t—o Date Contractor ARCHITECTS DECLARATION i a< I understand my plans shall be used as public records iyU U. Licensed Professional a OWNER-BUILDER DECLARATION ie 1 hereby affirm that 1 am exempt from the Contractor's License Law for the .no following reason.(Section 7031.5,Business and Professions Code:Any city or county ${i which requires a permit to construct,alter,improve,demolish,or repair any structure r� prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation 5 Ft.Floor A ?a that he is licensed pursuant to Ute provisions of the Contractor's License Law(Chapter 9 q rea $4000 a FZ- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or r3 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of �N Number not more than five hundred dollars($500). 35910060 5910060 •)1 0 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 Conuactoes 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 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 sake.). 0 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 does 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 Ute ConuvWs License W 0 1 am Sec. B&2rZ/2 Owner Date WOR S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L 1 1 have and will maintain a Certificate of Consent to self-insure for worker's compen- sation,az provided for by Section 3700 of the Labor 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 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. Policy No.: 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 cenify that in the performance of the work for which this permit is issued,I shall not employ any person in any manor so as to bccor subject t Workers'Com Laws of California.Date Applicant • NOTICE TO APPLICA :If,aMr m g this Ceni tcatcvr xcmption,you ould become subject to the Worker's Com nation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. z CONSTRUCTION LENDING AGENCY (~t I hereby affirm that there is a construction lending agency for the performance of a, the work for which this permit is issued(Sec.3097,Civ.C.) W Q LendcrsName az Lender's Address U C I certify that I have read this application and state that the above information is ti+ correct.I agree to comply with all city and county ordinances and state laws relating to rJ• U building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against j.,c/) liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date l(� ►+ APPLICANT UNDE TANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE ONS. Re-roofs Signal ofApplicanV tractor Da T of Roof DOUS MATERIALS DISCLOSURE ype Will the applicant or future building occupant store or handle hazardous material az defined by the Cupertino MunicipCode.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs;;hall be inspected prior to any roofing material being installed. 0 Yes If a roof i:;installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants az ncd by the Bay Arca Air Quality Management all new materials for inspection. District? 0 Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade.Sections 25505,25533 and 25534.1 understand that if the building does not currently ha a tenant,that h IS responsibility to notify the occupant of the require ustbc etpriorto' cofaCcrtificatcofOcc�uRan Signature of Applicant Date G�� z lb b All roof coverings to be Class"B"or better Owner or authorized gent Date CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35910060. 01 DATE ISSUED. . . . . . . : 09/10/2007 RECEIPT #. . . . . . . . . : BSO )0002602 REFERENCE ID # . . . : 070)0049 SITE ADDRESS . . . . . : 10227 S DE ANZA BLVD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER VARDY MIKE LLC ADDRESS 10227 S DE ANZA BLVD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM VARDY SHTEIN CONTRACTOR LIC # *OWNER* COMPANY . . . . . . . . . . : VARDY MIKE LLC ADDRESS . . . . . . . . . . : 10227 S DE ANZA BLVD CITY/STATE/ZIP . . . : CUFERTINO, CA 95014 TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL -=-------- ---------- - BENERGY PERMIT FEE 1. 00 34 .86 0. 00 34 .86 0. 00 BREMFIXT NO. FIXTURES 9 . 00 10.80 0. 00 10.80 0. 00 BSEISMICOM VALUATION 4, 000. 00 0 .84 0. 00 0 .84 0. 00 EPERMITFEE FLAT RATE 1. 00 40.79 0. 00 40.79 ----- -0. 00 -- ------ ---------- ---------- - TOTAL PERMIT 87 .29 0. 00 87 .29 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ----------- CREDIT CARD 87 .29 MC --------------- TOTAL RECEIPT 87 .29 0709 00Lf CITY OF C UPERTINO CUPf TINO PERMIT APPLI=CATION FORM R� CPN# JP- Date: Building Address: Mailing Address (if different from building address): (c> 2.2_ S d k' 4--1 4,9- 73 V6 Owner's Name: Phone #: Contractor: (0, 9 9 License#: Contact: Phone: r((6yk_>1P Cupertino Business License#: i�I� �/ Fax .op 1 ly y�_3 Building Permit Info: -7,,:,c CC-7, ,I. rv,40,1 1:5�), Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential ❑ Commercial)t Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: _ Please check this box if the project is a second-story addition: El Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 Bo:.ler<= 100,000 Btu MECHANICAL BBOILER2 Boile-> 100K to 500K Btu MECHANICAL BBOILER3 Boil,-r> 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 Co a. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Co:istax-Resi/Mobile BUILDING BELEC 1000 El-,c 600V <= l OOOA ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING I of 3 ON CITY OF CUPERTINO aClWF PERMIT APPLICATION FORM CUPfR,TINO Quanti Fee ID lee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comn. Housing Mit. Fee BUILDING BNUCOMME Nc.w Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP N-,w Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atraospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE B Idg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plal Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Rei i e Of Fixtures PLUMBING BPSEWAGE �.lewa a Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING BPS-T-ORM Storm/Rain Water - PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT AA of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER W ater Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cf n MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> I OK btu MECHANICAL BREMHEAT I[eater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rent 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 'Ropair/Alter Heating MECHANICAL BREMRESAPP Rerzodel Res Appliance ELECTRICAL 2 of 3 aTwyFCITY OF CUPERTINO PERMIT APPLICATION FORM CUPEkwO Quanti Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Ven t Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Sei imic Commercial BUILDING BSEISMICRE "I-leismic Fee Res BUILDING BSPECIAL S:)ecial Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC 11'lectrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING — -PPL-BG- -- - Ph.mbing-Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING 3 of 3 COMM RC] AVINDUSTRIAL INTERIOR CITY OF IMPRO`EMENT.S COVER SHEET CUPERTINO - Assessors Parcel Number: :S:� ��" d d Name of business. V rd ( K-f'- Project address. 1�'�Z7 s �� i'i2i� a L 440 Contact person. V z 5k f ill✓ —Phone. D �(�6 -Z 4 C) Fax. Current use of space. / ` -J1 .y orrnr�non�r �{TH (NF rirY Lt l.L� I rr rrvvvr CUPERTINO CODES ANO O,p{NAMCES Proposed use. �— Building construction type. SIGNED ---'- This set , be kept cI Occupancy Group(s) lawful to r;- or fl!lei in same „ Occupancy Load. 111,3 h"' The �HAII. NUT be he t p�,mit or W Square footage of remodeled area. 10proval ot thea.gunOf ally 000=t Is the building equipped with: Fire sprinkles? Y pir6 alarm system? Y Number of floors in the building? _ 0 a what floor(s) is work being done? Brief description of work. �'�� r le--/(:ZU 1 u �- 6-A171 Code editions:2001 CBC -N)2001 CFC 2001 CMC (Y-N) 2001 CPC (Y -N)2001 NEC N) Effective 11/1/02 Are there any chemicals/hazardous materials to be stored at site? Y - If above answer is yes,provide a list of materials and quantities. If job is involves food service,provide 3 extra T Ian sets for Health Department review. OFFICE C Commercial Plan Review CST evised 4/28/04 :! ff7 I K f It LL < t co aCiOrJ. ! ! G-uZ�N y n I f! 1 I V. I � t 1 �LL v5c/) � Qo G r 1 1 � r Lu ! f 1 S 1 .firi f I , 1