Loading...
09050134 CITY OF CUPERTINO �t BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 10123 NORTH WOLFE RD #1 J T CONSTRUCTION OWNER'S NAME: PERMIT ISSUE DATE ALA ION : S A CONTROL NO. (408) 234-4340 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLD MECH D o p LICENSED CONTRACTOR'S DECLARATION OU4 I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description with Section 7000)of Division 3 of the Business and Professions Code,and my license is 'DH in full force and effect. UNEARTL SEWER LINE IN REST. SPACE D22— License Class Lic.N F tz Date Contractor ARCHITECTS DECLARATION ua7 U I understand my plans shall be used as public records a LO y Licensed Professional y OWNER-BUILDER DECLARATION +<2 1 hereby affirm that I am exempt from the Contractor's License Law for the L D O following reason.(Section 7031.5,Business and Professions Code:Any city or county .t which requires a permit to construct,alter,improve,demolish,or repair any structure 4;- prior to its issuance,also requires the applicant for such permit to file a signed statement F=e that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation y �- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or At .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of $20000 Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy not more than five hundred dollars(5500). 31620063 . 1095 p y Type ❑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 Conunctor's License Law does 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 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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Cont=toes Li- cense Law does not apply to an owner of property who builds or improves thereon,and, who contracts for such proje i see r(s icensed pursuant to the Contractor's License Law. Q 1 am exempt under See. B&P or thi reason n Owner Date WORKER'S COMP A N DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent to self-insure for Workces Compen- .ton,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 are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he completed if the permit is for one hundred dollars($100) or less.) e 1 certify that in the perform f o whi this permit is issued.I shall not employ any person in any c Iect to the Workers'Compensation Laws of California Dale R—PIS P4 Applicant NOTICE TO APPLICANT.If,after making this Certificate or Exemption,you should become subject to the Worker's Compensation previsions of the Labor Code,you must 0 forthwith comply with such provisions or this permit shall be deemed revoked. z "r CONSTRUCTION LENDING AGENCY (-+ I hereby affirm that there is a construction lending agency for the performance of IYi•� the work for which this permit is issued(Sec.3097,Civ.C.) WG4 0 Lender's Name z Gender's Address U C) I certify that 1 have read this application and state that the above information is Vy"" correct.1 agree to comply with all city and county ordinances and state laws relating to Obuilding construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes I a (We)agree to save,indemnify and p harmless the City of Cupertino against to liabilities,judgmcnts•costs and expenses i h may in any way accrue against said City U z in consequence f e granting of is i. APPLICA STA N W COMPLY WITH ALL ON-P INT Issued by: Date SOURCE N a Re-roofs Signature bt Apflicant/Contracror D HAZARDOUS MA ALS DISCLOSURE Type of Rc of 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)? C]Yes Q No All roofs sltall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection,I Will the applicant or future building occupant use equipment or devices which g agree to remove P hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Act? ❑Yes Q No 1 have read the hazard us materials quircmcnls under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505 533 and 25534.1 understand if the building does not cu have a ant t it responsibility to notify occupant f the requiremcn must n anceofaCertificate upancy. f Signature of Applicant Date - It'? 2,d Owner o authorized ag nt Die All roof coverings to be Class in"or better CITY OF CUPERTINO DEMO CITY Of CU INO PERMIT APPLICATION FORM APN# Date: 3 0 Building Address: Mailing Address (if different from build'vig address); 61�tz Owner's Name: Phone: � � 7 7 < -� A� Contractor: Phone : Fax: Contractor License #: Cupertino Business License #: Contact: Phone: Fax: Residential E] Sq Footage Commercial E Sq Footage Job DM ription: J 't 'p, l" k 1 4-� --�' z Valuation: Project Size: Express Standard ❑ Large ❑ Major ❑ Please complete relevant portions of the Gre m Building Checklist & attach it to the application or if applicable, include on the plan set & the sheet index. Quantity Fee ID Fee E escription Fee Group Permit Type 1DEMORES Demo-Residential B 1SFDWL-DEM IDEMOPRES Pool Demo Residential B 1SFP00L-DEM- IBCBSC Cal Bldg Standards B ALL PERMIT Commi,,sion Fee TYPES IBSEISMICRE Seismic Residential B Revised 01/07/09 :E CITY OF C-.UPERTINO ' D]KMO CUPEkTINO PERMIT APPLICATION FORM Quantity Fee ID Fee De,cription Fee Group Permit Type 1DEMOCOM Demo-Commercial B 1COMML-DEM 1DEMOPCOM Pool Deme Commercial B 1CPOOL-DEM r 1BCBSC Cal Bldg Standards B ALL PERMIT Commissi m Fee TYPES 1BSEISMICOM Seismic Commercial B 1BUSLIC Business License B Revised 01/07/09 �.5� .. .:i..".:;.•!_:'-�'r,it._: ^•,3:-�:• .t' ai•e..A t-w..::-rttTcs-; ..L.-2-...'.:,iG r:-,:'..__ -.. s-�."x.:.4c:;:91�e4.r&!lC_sh' •1Caid.!`ai-+v!'^X.s. b..�.a,'.n:G- '..'.iu..•e^_•�_-_+..z - .. __:_.. w"lC'1'C'df?SL•:>.�-.:.?•.3:::-s,..__...�:...... :.�.-e .-_'T..t-:-.. .s..:._::�"Y'::r:.' �.o...-...-e -._.. ._... ..4•...:•.:.:aL..g.6L':h_.�C'uii:. 7_ 1 _ 1� c_', ,•r _ �\t I i � r 1 , j ?r I)RAGE I ' ! WA.Ih � I. �. .__ ., 1� S �s-7 9 -1-'4•� .rT ..�. r _ �~� ,, � A� .k.. i .�.d.,. • 4 WCJIv1EPJ S LADI�ES,. oI I; OiLET ' 1� - JOFFICE ¢'1- JI _' <•r.�.cr __ '.1 '.�;j ::�. - 4' •�- J 1� oiI ._4' i ;I�.� J 'C '' —y 1 - -Y� _ •v.-' 4 �I- -.. _ U' �- T�-� 1 L I i f e � R�EC I'JING `6 - S r w , ! 1 LSGEN P'LMECHANICAL COOLER C LER UPPER OII.ING LVENOS 65i " City MECHANICALI �i mow. a AG t " _ 19 �Y -u �<.1 0.11 �. - i V - _---- ��'I .i.�._....... '_ -•--. °yt' _..-�- '�� I p 'T _�!` �is✓(f.',a • J11NI A(W21MN3 •hc L C A 5 at c -'tv, �.:-.-f; �� f a.,r✓: t I h I 'r Y yJ.o«. -'�-•o-2.- p p _.�D� � '� �. Qi _ - �41• 'r e�,n,'_.e __�! � A '� � o/ `a�' �J I � .. [--- � -_-�1�-- -- --- - f '. 11 '{{` �- ,;�:_ ri} - -t i , ° !' ;� ��•`c� ,cam c - ... 4, n _ Y ,-,_Aa- - ,7 Y 1 A` •Ft1�. RN?:rrgl a, �..E Yn,Y'f+.'_ ',� ctiT;E.aT.+�c ' 7 � .1'. i ��\ S::/h x' 1^'V.ro'S A.�� ING LINEFir� ` �t N. I '�F� ::•�E.- �� � Sr:° � Ci � I � ry�!� �7 ,S 'T.�; ` a, '.�` ;�,..,,..�r�y�_� S1 LK DINING �II ti-_�v.q svu..,oc �iDINIG v.-'='' • _ z' 11.J�: rfi��&_ ., ' '� Elg_ 1.. � � _,- �..._•. ',. p.r�."'l i V „ -'. _ {:: Iii� j IOTrir I,I.�SJ•: I W : _�_2•Lti _ a_moi. Alz \\t'IY \� DtSNWA,SHING � IWAITE . PIC} UP C HIEAS A �xysTgNo f ,���p((��A�6�,p�{��� J(`iJ` �(Q ,� F c�i- `1 ""� `C+% Itr .J�rt e{.I I� =•f��_`"� 5 , �+i° BAR LEVEL .�� u.o +x "r"•ry rt='..1 �i ! 't A,1 s' tl �4 °T PNJEvr f, s __tr_.m ec LIJU STORAG CO2 STORAGEII� + •7 -w -=y= I"_ "w_ .r•�� -_ _ ♦ �•��� l��y i '+_�- _.. L.`.?WER DINING •,;tia,�,. I � A) © -T,/1� � l I LJ 3 MID - n ___ z'_ L•_. -- _ :J. ...mac-- -'k - t- -k- - .. -- ., ._ ,; . _x- _ � w. �,� � �Az� f 6T.0 w• 7 § 1 4 �� tr 1\ l X O n7 o _ - -�-1- --•mom --���r-- -� y I � 1+ ) _ AIS I COOLER 12- L C, � -- __ '� 'I i ��- -k i -I i•�C'jAfw _-- - Al2 l_- - ��1 -__- � II°' I I I I -I_ VESTI jS8}AERRUICzE.yiI1- 3_U - :_ �# . DMPArEA2 fit i 3 'A j vr. .�..,. ✓, r, 1 ra SIDE'�1.iX. _ - I - �: 1 I I ul I IJSJ�g, L k ._ Ali DiNI_NG ( r � COVERED WALKWAY � ��s�+_-ate I `� ! ac.j -�I I i "4.�'l!•., __. _ k - -- _ - is--_ _ _ —_�. I U =� 1 > SC JA i $1 r I (D7I 0OR PLAN i � 4 ---- / I I �/j_1 I pj/Ve YOFTH-.. 7C, �� l I 1 r `' �1 /' V� / I A � � G t I � YUL6 P' \\\ ✓✓✓ l IN STFIUCTURAi ENG'•INEERS. ME.GI EL='C.ENla•-'INEE}�j' q.^iGHITE� : ¢ �� I� ASSOCIATE ARCHITECT: PgOJE-CT: _� '>�_IITJ�TRj��r.O,L�: AAh'OLO&P.UFICM,INC. 2._TlCVA LT 6 V1NTriER,INC N.F_1VIN R. rP:N - JAMLS MCI�NT A .A. 'T,Gj.Fc:x- �Y v ��� ��-.�A!�r y_�-` - '.S M OAK CLIFF BANK MERCANTILE CONC TWE_WTAL gp(• 7616 ..BJ FR.NY. S'V ITE CO--'. '� A_ ___- --- LWLIA^y,iFXAS �G8 OALLs ,TEXAS /S-J'i LJ t.:..-A5 TEY,A: 7_ St SANTA MONIt;A��.A SQIIG•1 T.[i,1.FRir•4Y5 P. fiLJPTE 3C3 _ ��� .^,-i[_4VE. �19rt8-3lt�i 1 Crtl7!`!E: (T.KI'Ja'1•�:"i � P4D1:E: C:_t4) \'a8.'FTxi.:',�2T+K+. n'7N. +- _...LKSLiC'"3:R@@�3'�IK^:^_ ;77Ci��.2!RL'-1;e-.'^ 'i!bECliUi'�t?22'lnbSk.2�. _.. � �W:=. � .Q',y;,�L..^.SY:11FhY.Rrypl• S'S L-9�. ']FAt1AR, r. ._.�TiCX.G .s � '. �_ _— ..— 4.^. '�8'+e9F Lr. .h.,�.t. �.v>L 7n •,2'=S•SaiiY!_@Lr�R�f:� I .:.::-'1"-E'•'Q.;c"'7irt"3"`?s"'--"'s+ -...?•!.�a��.;.. .... .. _,..,. .....<. -.-. �,. ,_s..,, �r-wr. -�`i'C.aw:aRf'3'�+�..'.'<c•.•'�M-�a�'"f-�T4+i' ���.+� ,•�..-..+181a• _..#R"'!ft^:�."'.'i:.Y�fS3,=3N..au�'_..'.'4ES�_...Y.c.,..Y, S -�*:. •ft�"'�iY C� yFY4'FSX S�-.a� - r _._._:_-......,,>.,.:_..,. _... .a_.. >_ ....... ':�=5::^... ....b:�.^ss�r.• a�zL�• T>r - `3it.,r�s+:.t�T.^s{€=st;se,:..�r. .a.�•�- �- Pfte7�:•. .. !'35��A3ffiX Community Development ;A 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkTINO Building Department JOB ADDRESS: ,& PERMIT # OWNER'S NAME: c ` L < << _e C G C' PHONE # — U GENERAL CONTRACTOR: T/ --FAX # I am not using any subcontractors: Si;nature Date Please check applicable subcontractors and complete the following information: 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 _ ko Owner/Contractor Signature ate