Loading...
06100102 CITY OF CUPERTINO BUILDING DIVISION PERMIT +C� I' RtC? 2 I� } MTIfJN� BUILDING ADDRESS: PERMIT NO. 06100102 6100102 OWNER'S NAME: PERMIT ISSUE DATE TARGET STORE SNE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH i o p LICENSED CONTRACTOR'S DECLARATION v I hereby affirm that[am li �grovisions of Chapter 9(commencing Job Description Z to with Section 7000)of Division 3 e Business and Professions Code,and my license is t<a in full force and effect. Q ; ? License Class Lic.B_J C— ¢ C?A L L REPLACE 3 A/C UNITS. : o Date ARCH ContractorZ2�ra� REPLACE LIKE FOR LIKE (EMERGENCY REPLACEMENT) r U I understand my plans shall be us as public records C ja. G In Licensed Professional r >! OWNER-BUILDER DECLARATION Z 1 hereby affirm that 1 am exempt from the Contractor's License Law for the .CO following reason.(Section 7031.5,Business and Professions Code:Any city Of county rL which requires a permit to construct,alter,improve,demolish,or repair any structure -Z r prior to its issuance,also requires the applicant for such permit to file a signed statement I F that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuagn6 5 0 0 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 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 not more than five hundred dollars(5500). Occupancy Type ❑1,as owner of the property,or my employees with wages as their sole compensation, 32632055 . 00 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 docs not apply to an owner of Required Inspections 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 We.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 Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: J 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. ❑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 am: yam, Carrier. STA-e� Goµe policy No.: C/ ( 7?03 CERTIFICATE OF EXEMPTION FROM WORKERS' Q COMPENSATION INSURANCE Zp4&'70(17O `j (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,youshould become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked Z 2 CONSTRUCTION LENDING AGENCY E-+ -- I hereby affirm that there is a construction lending agency for the performance of (y.� the work for which this permit is issued(See.3097,Civ.C.) �W Q Lender's Name Z Lender's Address U Q 1 certify that 1 have read this application and state that the above information is (y correct.I agree to comply with all city and county ordinances and state laws relating to U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned properly for inspection purposes. H nWi (We)agree to save,indemnify and keep harmless the City of Cupertino against CA liabilities,judgments,costs and expenses which may in any way accrue against said City J Z in consequence of the granting of this permit. t" APPLICANT UNDERSTANDS AND WILL COMPLY WIT7,,A NON-POINT Issued by: Date SOURCE REGULATI NS. / ��Ti l3/ Re-roofs Signature of Apphc l5Cf. factor Date 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)? ❑Yes EINO— All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove .:zit hazardous air contaminants as defined by the Bay Arca Air Quality Management District? all new materials for inspection. ,.., E]Yes �o— 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health a Safety Code,Sections 25505,25533 and 25534.I understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be met prior to u c a Ccnificae of (�c! Signature of Applicant Date Owncr or auft ent Da All roof coverings to be Class "B"or better CITY OF CUPERTINO �m 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw COPY # 3 Sec : Twp: Rng: Sub: Blk: Lot : APN 32632055 . 00 DATE ISSUED. . . . . . . : 10/13/2006 RECEIPT # . . . . . . . . . : 36430 REFERENCE ID # . . . : 06100102 SITE ADDRESS . . . . . 20745 STEVENS CREEK BLVD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER TARGET STORE ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : MINNEAPOLIS MN, CA 55402 RECEIVED FROM . . . . : MICHAEL MARTIN CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---- - ---- - -- ---- ---- -- ---------- ------- --- ---------- - --------- BREMAIRHAN NO.UNITS 3 . 00 30 . 78 0 . 00 30 . 78 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BSEISMICRE VALUATION 16, 500 . 00 1 . 70 0 . 00 1 . 70 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 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 182 . 45 0 . 00 182 . 45 ' 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - - - - ---- - ---- - --- ---- ------- - ------------------ OTHER 182 . 45 VISA TOTAL RECEIPT 182 . 45 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL 10/13/2006 08:22 FAX 408 777 3333 CITY CUPERTINO [a002/002 Community Development 10300 Torre Avenue 1 Cupernino CA 95014 Telephone(408)777-3228 -� Fax(408)777-3333 CUPEkTINO St,--v B1j1*1di�_, a axt 'U pEItMI'�`# EGENEiRAL D7RESS: 'S NAME= C��- 01.rc-t:� PHONE # �CJC> - FAX ,* "ISZ. _ CONT- ACTOR: p.�uE,n /z. I am not using any subcontractors: _ Date Si€,_1 lature Please check applicable subcontractors and com ,l'+te the followin h-Lformation: SUBCONTRACTOR BUSII�_:-SS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing - Electrical Excavation �Fencing _ Flooring: Carpeting Linoleum/ Wood Glass / Glazing _ ✓ Heating �- imulatioyn Landscaping Lathing _. Masonry _. Ornamental Sheet Metal Painting / Wallpaper . Paving Plastering Plumbing . . Roofing _. Septic Tank _. Sheet Metal Sheet Rock Tile v�3 Date Owner/Contractor Sigmatuxe 10/13/2006 08:21 FAX 408 777 3333 CITY CUPERTINO 1a001/002 CITY OF C:UPERTINO FiJR]o1A.CEIAC" CU �NO PERMIT APPLICATION FORM PEkMI , - Date: Building Address: S � Phone#: Owner's Name: ©q S— NN`— License#: - Phone: Contractor: tc� - 3S 1 S1 $ -� Cupertino Business License® Contact' Phone �O NA rB11d ng Permit Info: Elect Q E'lumb p Mech El - ��� u Wob Description: c= v -05 � v1�� rs•a X16 Residential ❑ Commercials — cz S a�'�� For Pesideutial InAlUations: Attica 1�`floor ❑ 2"d floor❑ Adhere to min set back requirement❑ For Commercial Installations: ("t st.•uctural talcs) Replacement same weight ' Additional weigh Structural Calculations required for new installation New installation Planning ADDToval Re aired ❑ Oce anc gt�P. Cost of Project: Type of Constmi:tion: p S Q) <S �� � 1bSc�o � . Strapped LJ On Plat Bonded C', Sq.Ft. Floor Area: ? QReplacement New Location R lacement _ Qty. if Fee Descrition Fee Grow A livable p ee ID _ BY 1ILDING BENERGY aez MECHANICAL �',unace BREMFURN - MECHANICAL BREMACOVER � /C Unit> 10,000 cfm MEC�iANICAL BREMAIRHAN �'JC Units = 10, 000 cfm ELECTRICAL BREMRECEPT F.ec tl, Switch&Outlets BUILDING BSEISMICRE `eismic Fee Ices BUILIDNG BSEISMICOM ` eismic Commercial ELECTRICAL EPERMITFEE 1 lec Permit Issuance MECHANICAL MPERMITFEE P tech permit Issuance PLUMBING PPERNIITFF-E I:lumbi Ig Permit issue BUILDING BPERMFEE I.ld Permit Fees BUILDING BPLANCHK T lan Check Fee PBG BPGAS 1;Jas Pi in System Fee BUILDING BUSLIC :Business License-.