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09040099 CITY OF CUPERTINO BUILDING DIVISION PERMIT "7.7 -7777777777777777777777777 �.' � * PERMIT NO. BUILDING ADDRESS: 1363 P PPY CREATIVE I PERMIT ISSUE DATE OWNER'S NAME: I !tARWA?�#.2CONTROL NO. (408) 29"-8800 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH app LICENSED CONTRACTOR'S DECLARATION Job Description m 0 I hereby affirm that I am licensed under provisions of Chapter 9(commencing U with Section 7000)of Division 3 of the Business and Professions Code.and my license is WNDW RP 1,CMNT LIKE 4 LIKE N .y in full force and effget� Lie tY v�2 License Clan [I Contractor= p Date ARCHITECCS DECLARATION # < I understand my plans shall be used as public records �aU i c y Licensed Pntfessional OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county 9 which requires a permit to construct,alter,improve,demolish.or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement ;q,Ft.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 %t--C (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $5000 y 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 APN Number not more than five hundred dollars($500). 36618023 . 00 ❑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 Required Inspections and Professions Code:The Contractor's 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 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 contractors)licensed pursuant to the Contractor's License Law. ❑1 am exempt under Sec. B&P C for this mason 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-insum for Workces Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 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 Co�fICATE mernd Policy number am: p Cartier Policy No.: PTION FROM WORKERS' ON INSURANCE (This section treed not be completed if the permit is far one hundred dollars($100) or Icss.) 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 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 Oforthwith comply with such provision or this permit shall be deemed revoked. Z ►-t CONSTRUCTION LENDING AGENCY (tet I hereby affirm that there is a convection lending agency for the performance of .7 the work for which this permit is issued(Sec.3097,Civ.C.) W QLender's Name r0 z Lender's Address [certify that I have read this application and state that the above information is cored 1 agree to comply with all city and county ordinances and state laws misting to 0 U building construction,and hereby authoria representatives of this city to enter upon the 61a ahove-mentioned property for inspection purposes. LL (We)agree to save,indemnify and keep harmless the City of Cupertino against E"t to liabilities,judgments,costs and expenses which may in any way accrue agarol said City U Z in consequence of the granting of this permit. ate -411,2,1)—o ►-� APPLICANT UND NO DW COMPLY WITH ALL NON-POINT Issued by: SOURCE REG S. 410 Q `1 Re-roofs — Signature of icandContractor am T of F:oof HAZARDOUS MATERIALS DISCLOSURE Type 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)? All roofs shall be inspected prior to any roofing material bein nsf�ll2 . ❑yesNo Will the applicant or future building occupant use equipment or devices which If a roof s installed without first obtaining an inspection,I agree to ove .mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes I have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Section 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 mquimmcn met prior to issuance of a Certificate of�c ancy Signature of Applicant Date �° `� All roof coverings to be Class'''or better Owner rho'.ed agent Date i+' CITY OF C'UPERTINO CUPEkTINO GENERAI. BUILDING PERMIT APPLICATION FORM Date: 4411 0 Building Address: kW yDwn wa Mailing Address (if different from b ding addre - tkl J v%A Owner's Name: Phone#: LSA) / J Nz. boL sok - HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Contractor: n Phone: C(�� V �` '� a�v Fax: Contractor License#: g bass-` L Cupertino Business License#: tr Contact: Phone: iLk Fax: Residential Commercial Job Description: Af A�tiJ Q�Q Q.f�C� C (L L\07,- Building \K 7,'Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B Valuation: Square Footage: Project Size: ExpressTg Standard ❑ Large ] Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicabl-., include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.buflditgreen.org Revised 02/05/09 C. CITY OF CUPERTINO CITY Of GENERAL BUILDING APPLICATION CUPEkTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 1 WINREP Replacers.ent windows/sliding glass B door (ea 3 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry (includes plan ck fee) IEPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbin€,Permit Fee P I ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1 PLMBLNCK Stand A10ne Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Zesidential B 1BSEISMICO Seismic 2ommercial B 1 TRAVDOC Travel &.Documentation B 1BUSLIC Business License B 5 of 5 Lila— /4 S �Pp (� U/o�� _ � t •vt6�o uJ Q�Q�-� C-Ly-p t T" \*e �fo�J SI-gJG {. i bJ`'��' (P IN t 4 y q S x 3 XaK QuUpion "E ae at 4011 -1 aax •�i B►1V ;•jl 3tciir LBw