Loading...
09020036uoo q, n<0. �i 3�LQ 15< X96 Lt. l " i� U [q Etx„G Y�$ i CITY OF CUPEKITNO BUILDING DIVISION ' PERMIT BUILDING ADDRESS: OWNER'S NAME: ARCHITEcTiENGINEER: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70()0) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. tY Date Contractor ARCHITECT'S DECLARATION I understand my plans shall be used as public records Licensed professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.S, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demo1Lch, or repair any structure prior to its issuance, also requires 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 (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 arty applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 1, 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 and Professions Code: The Contractors 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 sale.). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contractors 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 the Contractors License Law. ❑ 1 am exempt u der Sec. B & P C four this mason Owner Date —� ` 1 WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self -insure Cor Worker's Compen- .,ation, as 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 Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number arc: Zarrier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Phis 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, I shall not employ any person in any manner so j w bec�m subject to the Workers' Compensation Laws of Califoro*Dam. 9. Applicant NOTICE To A CAM: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permil shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is s construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) L.entices Name Lenders Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction. and hereby authorial representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATIONS. /) 1 _ Lob l Job Description ADD ONE 220 OUTLET; CHNG TO NEW DRY CLEAN MACHN (COLUMB==A MADE I PURA ) Signature of ApplicanUContractor .a.. HAZARDOUS MATERIALS DISCLOSURE 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(x)? ❑ yes brNo Will the applicant or future building occupant use equipment or devices which it hazardous air contaminants defined by the Bay Area Air Quality Management ,strict? ❑Yes Nu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant. that it is my responsibility to notify the occupant of the requirements which must b&et prior to issuance of a Certificate of Occupancy. Owner or authorized agent Datc Sq. Ft. Floor APN Number 3690600).CLNRS Required Inspections Issued b,,: Valuation Date-%—(� Re-roofsJIV Type of ]roof All roof, shall be inspected prior to any roofing material beirTg. hstalled. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signatur; of Applicant All roof coverings to be Class rr , or better Date Mt., CITY Of CUPEkT1NO CITY OF 41UPERTINO GENERAL BUILDING PERMIT APPLICATION FORM o9o�,003io APN # .3 �eQ V - 1 Date: •- yr Building Address: - Mailing Address (if different from building address): Owner's Name: 16s Phone #: HOA: (Exterior work only)_ ❑ NoO� _ ��� % 1 If es, provide letter from HOA Contractor: T�;p Phone: Fax: Contractor License #: Cupertino Business License #: Contact: Phone: Ro t1a Fax: Residential ❑ Commercial_p� Job Description: old Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: I -A, I -B ❑ II/IIIN-A II/III B, IV -HT, V -B ❑ P Valuation: qt, egoo Square Footage: Project Size: Express [`� Standard ❑ Large ❑ Major ❑ Green Building: Please c mplete relevant portion of the Green Building/LEED Checklist & attach it 7ild application or if applicable, include in plan set & the sheet index. Points Achieved:For help, contactit Green at www.builditgreen.or Revised 02/05/09 0jt1X t s , CITY Of CUPE(�TINO CITY OF C'UPERTINO GENERAL BUILD [NG APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco Arplications (up to 400 sf) additional stucco application B 1WINREP Replacem:nt windows/sliding glass door (ea 8 windows) B 1 WINMEWSTR New Window -structural shear wall/masonry (includes plan ck fee) B I ` 1 EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand -AI -one Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min when not over counter) Standard Plan Check (when no E/M/P) hourlyy=stind alone B 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICR Seismic ]tesidential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Trav:,l & Documentation B 1BUSLIC Business License B 5 of 5 c* A 44 4 IXY 0�0 oto RAR l< I V4 k"T CA "Ki -7,14 'Z* ALZ - i t4 -, Change the Fundamental Principles of Ga IPURA redefines State -of -the -Art technology in -R y6.v0 Class design. With a total liquid capacitT of less than 22 gallons, there is no need for base tanks or storage tanks. IPURA technology outpe: • 5,000 — 8,000' lbs • 95% less I • 2/3 less • 50% le • decreas • extraorc IPURA's no bath clea soil and dirt from garments process. Oily type stain cleaned away in a mos { Fiber and texture is maintz The unique filtration sysi of distillation, and ensur * Reported by IPURA owners/operators Easy to operate, a snap 1 COLL DRYCLEANII OI i OR vent Cleaning and the Difficult Gets Easy! IPURNs unique method of garment cleaning using environmentally safe Class III A Hydrocarbons, removes the need to spin the load in extraction. And without extraction, the need for drive belts, springs or bolt down have also been eliminated. simple to learn - ) install! -7qy6o0 CLASS incorporates Columbia/ILSKs patented technology of IV1K, Wet & Dry®, Quick Dri Mach 2; air power loading door to enhance the performance of cleaning in Hydrocarbon. Isoparafin's unique nature is the reason why such a process can work. With a new understanding of flexibiliiy, the development of a system to clean garments in a different way was born. A system that is not influenced by traditional cleaning funda- mentals, and therefore not bound by is complexities. IPURA is a closed loop refrigerated beat pump, non venting system controlled by touch screen IL.3 micro -processor with modem. Work Hard • Make Profit • Clean Responsibly � COLIUMBIA All information is factual at QaDRYCLEAJINO MACHINEtime of printing. Printed on recycled paper CR L o•N� 231 EDISON AVENUE, WEST BABYLON, NEW YORK, 11704 • 800-446-5634 • IN NEW YORK (631) 293-7571 • FAX (631) 293-7863 © Columbia / ILSA 6/07 � IPURA jilpir lijilpirpI 01,1111jillit -fl�6rtD C1455 NaiL ble NO Iwo footv�n�C g 0 COLUMBIA DRYCLEANING MACHINE 4 R�o•r+�c q1. 9 OWN kc4l INZY C��-A 1 W� CA QW4 Change the Fundamental Principles of Ga IPURA redefines State -of -the -Art technology in -RV6.vO Clam design. With a total liquid capacit 7 of less than 22 gallons, there is no need for base tanks or storarY-e tanks. ;%,ov 1 0 PY IR Shallow Version * Reported by IPURA owners/operators Easy to operate, a snap COLL DRYCLEANII vent Cleaning and the Difficult Gets Easy! IPURNs unique method of garment cleaning using environmentally safe Class III A Hydrocarbons, remcves the need to spin the load in extraction. And without extraction, the need for drive belts, springs or bolt down have also been eliminated. simple to learn - ) install! 1 MACHINES r N 'fi ybO CIASS incorporates Coltmbia/ILSA's patented technology of IV1K, Wet & Dry®, Quick Dri Mach 2; air power loading door to enhance the performance of cleaning in Hydrocarbon. Isoparafin's unique na.ure is the reason why such a process can work. With a new understanding of flexibih y, the development of a system to clean garments in a different way was born. A systerr that is not influenced by traditional cleaning funda- mentals, and therefore not bound by its complexities. IPURA is a closed loop refrigerated neat pump, non venting system controlled by touch screen IL.3 micro -processor with modem. Work Hard • Make Profit • Clean Responsibly CQkIUMBIA All information is factual at NINO MACHINEtime of printing. Printed on recycled paper c � 231 EDISON AVENUE, WEST BABYLON, NEW YORK, 11704 • 800-446-5634 • IN NEW YORK (631) 293-7571 • FAX (631) 293-7863 0 Columbia / ILSA 6/07 ;Illolf " r- u1in�rir. DJ N I 0-iff