08110096CITY OF CUPERTINO
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CONTRAC'T'0' '10
•BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PE1m, r NO.
N
R'SftliCH AVE
PERMIT ISSUE DATE
A CONTROL NO.
ARCH ITECTIENGINEER:
BUILDING PERMIT INFO
BO MECH
LICENSED CONTRACTOR'S DECLARATION
Job D0sCilpUOn
1 bucby aRrm that 1 am immsed under provisions of Chapter 9 (commencing
with Section 70(18) ofDiviaon 3 ofde Business and Prabsdans Code. red my licene u
lo full I. echo urecL
TEMP POWER (GENERATOR). FOR XMAS TREE LOT
Rune Clan LicJ
Dee Cotrumr
ARCHn Ecrs DECLARATION
1 ..dust" my plans shall be used u public naords
Licened Professional
OW NER- BUILDER DECLARATION
I hereby ff,. that 1 em cumpt from Ibe Cantreclars lice.¢ Law for do
following mein. (Section 7031.3. Business and Profeuiom Code: Any city or county
which mquim. permit m e^nawcl, ales. tmpmve, dcmolud. m emo err ammum
prior m its issuance. a1W Imports the appllcNl for such permit to rile a signed susement
Contractors LJcc. U. 9
Sq. Ft. Floor Area
Valuation
Nu he is Banned puoantlo the provieions of the (Chapter
(commencing with Svcuon 700M of Division 3 of NC Business and Prafcuiom Code) or
Nat he u cumpt d uefrom and the basis for the alleged eaempolon. Any violation of
APN Number
Occupancy Type -
Section 7031.3 by any applicant for a permit roblects the applicant e • civil penalty Of
not mom dun five hundred dollars (SSOO).
31620019. XMAS
❑I,uowor of the prvpeny. amywployca with ngesu Ne'v role campntsaton,
Required Inspections
will doW worst. and theaWclure it Out trended MOECad fmsdo(Sec. 7DM. BuLMIe
and Profeasians Code: The Conmcmr's License Law does rot apply a an Owmr Of
q p
property who builds u improves thence., and who dos Duch work himself or mrough his
Own employees. provided that such ierprovemcous Mom imended oro0ered for vale. It.
however, the building or improvemest is sold within one Ku of completion, the owner -
builder will have de burden of proving that he did Out build or Improve for purpose of
sky
Jgn)e owner of the propcny, +m ucra t c^^uauing with licemed mnuanan to
and lam Code:) Tie Li-
mnswa the probe. (Sec. IOW, Business and
es thutars nd
of proper( wee builds Or improves Neman. rod,
are Law dons not apply je an property who
-
wM canuacu for such projects with a anRacwrtO Reentrant pursuant m the COntnumrs
with
sw.
trtmn undo See , B & N%is r�eu�an
�P,C�/fo
1. Dais L1`-1
ON
i
I hereby aRhhu under penally of perjury We Of the following decleadOw
ve and will mainWn a Certifiae of Consent lo self -loom fur WmkclsCaoprn-
as provided fee by Section 3700 a the labour Cade. for the p uform+^0: of the
work for which Ws permit is Wood.
0 I have ad will mains. Workers Camperand. Insurance, u lequimd by Scotian
37W of the Labor Code, for tc perfmmuce a(the woh for which This percent is issued.
_
My Workers Compensatio huiwmce ar ins and Policy ^umber ate:
Carrier. Policy NO.:
CERTIFICATE OF EXEMMON FROM WORKERS
COMPENSATION INSURANCE
(This evict mad rot becompiced tide permit U forme hmbuddollm (SI W)
or Ina)
1 wtify then, in the polmore tee of the work for which this permit is issued. ) "I net
employ any person in maacr laumlemmc subjectblhe WOrtus ` Compr4tsauon
-
-
Laws ofCalifomis, a�
NOTICnt
E TO APPLICANT. 1 . afar making pr Ccm ram o you Yeuld
NOTICE
the Isles Code YOU muss
n the LAW d
becomesubjecty the Wodvls Campeorthis provisions
Is
forthwith comply with such provisions a this penrmit shall he damN rovoked.
)
'
CONSTRUCTION LENDING AGENCY
I hereby affirm that them is a construction lending agency for Nc perfurou r es of
' the work for which this permit U issued (Sec, 3097, Civ. C.)
'
Lenders Name
,
Lender's Addmu
1 cesnify that 1 have mad this ."Ih ation and sets, Net the above informed.. is
' cores. l ogee to comply with all city and county omina,ces and sou Ian elau,g w
building construction. and hereby Marie epmemauveS Of Nis city a cns,r upon the
shove- menuomd propcny for inspection purposes.
(We) egme to save, indemnify and keep humkss the City of Cupertino against
7 Inabihdes, jYQments, cots and N. which may In any way accee 49.1 said City
: i. consequence of NC gmvmung of Nis mail
v APpy. UNDERSfAN 1 CORM WITH ALL NON -POINT
swlA
Issued by: Date
SOURCE Rj ATIO
Re -roofs
�S d
Signuure ^lAppliun n ter Dae
H MATERIALS DISCLOSURE
Type Of ROOF
utum m handle haeamou m.erial
Will de applicant o (Muni building
e. Chapter
deRod by de Cupenio Municipal Code. Chapter 9.11. and the HcdN and Safety
. Sato,15531ta)7
All roofs shall be inspected prior to any roofing material being installed.
QYns NO
devices; which
If a roof is installed without first btaining an inspection, I agree to remove
Will thc+pplinnt or future building aecuP + ^t oc cyuipmeot m
I huameu air Lmllamins.ts u dcrined by the gay Arta Air Quality Management
alt-n materials for ins eCtlon.
cR
❑ Yes N
I have mad the hvaNaumueriaLSe mrnc uundcrCNper6.95 ofthe Califon-
%�
ms Ha1N &SafnyCOdc -Smiau strut 25534. It NuifNC hosomeg
r
dam nay, have. mwe It u my stability WufY NC .CCYPanerrde
mgmromemr het amar9Yvpaq.•= 6
ignatureofAp licant Date
l (
All roof coverings to be Class'W' or better
Owrenm Nadudagcm
DGaa1
EEECl OF
IJUPEkTINO
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777 -3228
Fax (408) 777 -3333
Building De artment
JOB ADDRESS: iN etl �yUFit£S eIZ�T
#
OWNER'S NAME: i jQ7Z4
PHONE # C-Sa
BUSINESS NAME
GENERAL CONTRACTOR:
F ,#
I am not using any subcontractors: I 'q- '2 S— — `t�
Signature Date
Please check applicable subcontractors and complete the following information
•
Owner/ Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
•
Owner/ Contractor Signature
Date
0 4 ITEMS OF 4
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31620019.XMAS
DATE ISSUED.......: 11/25/2008
RECEIPT #.........: BS000006693
REFERENCE ID # ...: 08110096
OPERATOR: patg
COPY # : 1
SITE ADDRESS .....: N W CORNER STEVENS CREEK BLVD
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: SAND HILL PROPERTY CO LLC
ADDRESS ..........: 2464 EL CAMINO REAL
CITY /STATE /ZIP ...: SANTA CLARA, CA 95051
RECEIVED FROM ....: DAVID E DUTRA
CONTRACTOR .......: LIC # *OWNER*
COMPANY ..........: SAND HILL PROPERTY CO LLC
ADDRESS ..........: 2464 EL CAMINO REAL
CITY /STATE /ZIP ...: SANTA CLARA, CA 95051
TELEPHONE ........:
• FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
1BREMMISC FLAT RATE
1.00
122.38
0.00
122.38
0.00
1BSEISMICO VALUATION
499.00
0.63
0.00
0.63
0.00
1EPERMITFE FLAT RATE
1.00
40.79
0.00
40.79
0.00
1TRAVDOC FLAT RATE
1.00
40.79
0.00
40.79
0.00
TOTAL PERMIT
204.59
- - - - - -- ---
0.00
- - - - --
204.59
--
0.00
METHOD OF PAYMENT
AMOUNT
REFERENCE
NUMBER
----------- - - - - -- ---------
CREDIT CARD
- - - - --
204.59
---------------
AMEX
- - - --
---------------
TOTAL RECEIPT
204.59
J
r
0
O
•
CITY OF
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
AF1 1 o 0i(
APN #
Date:
Building Address:
Mailing Address (if different from building address):
Owner's Name:
Pho e #:
Contractor:
Phone:
Fax:
Contractor License #:
Cupertino Business License #:
Contact:/
2)
� �
Phone }
03
Fax:
Residential Commercial
Job Description: / p
KIM AS
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1 -A, 1 -B ❑ II/IIl/V -A ❑ II/III B, IV -HT, V -B ❑L ,-"
15
Valuation: X Yg9 Square Footage:
Project Size: Express Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditgreen.org
Revised 10/20/08
i ZIV
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf
Fee ID
Fee Description
Fee
Permit Type
Group
1GENRES or
1GENCOM.
1 BBOILERI
For the installation or relocation of ea
M
boiler /compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw
1 BBOILER2
Installation /relocation of ea
M
boiler /compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1 BBOILER3
Installation/relocation of ea
M
boiler /compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1 BBOILER4
Installation/relocation of ea
M
boiler /compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILER5
Installation/relocation of ea boiler or
M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
I BAPPLOTH
For ea appliance or piece of equip
M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
1 ELECINSP
Other Electrical Inspections (per hour)
E
1MECHINSP
Other Mechanical Inspections (per
M
hour)
1PLMBINSP
Other Plumbing & Gas Inspections
P
(per hour)
1MEETINGIHR
Application Meeting
B
V;
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u
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