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12060135
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19625 STEVENS CREEK BLVD CONTRACTOR: ASSOCIATED SIGN CO PERMIT NO: 12060135 OWNER'S NAME: PORTAL PLAZA LP 1930 W WINTON AVE STE 13 DATE ISSUED: 06222012 OWNER'S PIIONE: 4087200500 HAYWARD, CA 94545 PHONE NO: (510) 670-1017 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL. 11 COMMERCIAL 11 License Class 0 5 Lic.-q ' EAST WEST BANK- INSTALL I WALL SIGN W/ CHANNEL �2z f Z LETTER AND INSTALLATION OF ATM SURROUND AND Conlmc r Date — CANOPY I hereby affirm that am licensed uodei the provisions of Chapter 9 SIGN (commencingwith Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and eRecL 1 hereby affirm under penalty of perjury one of the following two declarations: 1 have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. FI Floor Area: Valuation: $2100 performance of the work for whichthis permit is issued. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of die_ for which this APN Number: 31620083.19625 Occupancy Type: permit is issued APPLICANT CERTIFICATION I certify that I have read Units application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED cored. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FPOM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, \ . costs, and expenses which may accrue against said City in consequence of the j/��ljL L-2 Z� 1 Z granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations pe the Cup no Municipal Code, Section 9.18. r / RF, -ROOFS: Sign ` Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection. I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date I hereby affirm that l am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole comfensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044. Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Ilealth & Safety Code, Sections 2-5505, 25533, and 25534. twill I hereby affirm under penalty of perjury one of The following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Ilealth & Safety Cade, Section 25532(a) should I store or handle hazardous I have and will maintain a Cerlifhcate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District performance of the work for whichlhis permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Ilealth & Safer. Sa ons 25505, 25533 and 853.1, Section 3700 of the Labor Cade, for tie performance of the work for which this u permit is issued. Oh Owner or aulariz Dale I certify that in the performance of the work for which this permit is issued, I shall not employ any person inany manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. w'ork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and stale laws relating to building construction, and hereby authorize 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, ARCHITECT'S DECLARATION casts, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records, granting of this permit. Additionally, the applicant understands and will comply with all non -paint source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18, Signature Date 1 r�i�ul 111 u June 19. 2012 Mr. George Schroeder City of Cupertino 10300 Torre Avenue Cupertino, CA 95.014 Yamaoka Associates, Inc. 505 S. Pamona Ave,. Second floor Sunnyvale. CA 94086 14081770 0600 Fan (408) 737 SENT VIA U.S. MAIL AND E-NIAIL RI_': Cast West Bank— 19625 Stevens Creek Blvd. Portal Plaza Center — Master Sign Program Dcar Mr. Schroeder: RF,(-lF4,X E;D JUN 22 201Z BY: Pursuant to your rcqucvt to 'East West Bank, we would like to advise you that we acknowledge East West Bank will be submitting a "Master Sign Program" lar the Portal Plaza Center Signtech (Sign Fabricator (br East West Bank) Ibr this center. we arc also -aware than.Bast West Bank is seeking a current sign permit anti Will be unable to have their final sign inspection or final sign permit With the City of'Cupertino until the Master Sign Program has been approved by us and then filed with the City of Cupertino. If you have any questions, please contact me at 403-720-0500, ext 209 or Chris at cxt 214. Thank you. Sincerely, Portal Plaza, LP By: Yamaoka Associates, Inc.,. its property management company Andrew J. Leong Vice President, Finance cc: Miranda Chcng and Bb Kwok — East West Bank (via c -mail) Jennifer Brimm z Sign loch (via c -mail) 11;lpetl.11 16ty nr cupcninu I CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION SIGN TYPE ADDRESS: 19625 Stevens Creek Blvd DATE: 06/2212012REVIEWED BY: Sean V.•di. I'w,nrr lv.•: APN: BP#: VALUATION: 1$2,100 PERMIT TYPE: Building Permit vCl/r.rxNPi--: PRIMARYPENTAMATION USE: Sign $260 PERMITTYPE: 10EAP5 WORK Installation of 1 wall sign with channel letters East West Bank and installation of 1 ATM surround SCOPE and canopy sign. SIGN TYPE FEE ID Plow Cdr<'6 QTY V.•di. I'w,nrr lv.•: SIGN FEE IF.SICN Elec. Permit Fee: IEPERhfIT Wall Sign, Electric 1SIGNWELEC Other Elec. lnsp. 0.0 $44.00 1 Ph,mh. birp. /1•,r $260 Awning Sign, Non -Electric 1SIGNWNONE Suppl. Insp. Fee:Q Reg. Q OT 1 1 hrs $260 PME Unit Fee: $44.00 PME Permit Fee: $44.00 ( onso m ri'm 7"n A.imillwolfil' /Sa : Work Without Permit? O Yes Q No $0.00 TOTALS: $0.00 Travel Documentation Fee: /TRA VDOC $520.00 Strong Motion Fee: /BSEISM/CO NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the Drelindnary information available and are oniv an estimate. Contact die Dear for mldu 7 into. FEE ITEMS (I'ce Resolution I1-053 /itt 7/1/1 /1 FEE Plow Cdr<'6 # Branch Circuits 1 $44.00 V.•di. I'w,nrr lv.•: l'bunh. Po mil l4'er IF.SICN Elec. Permit Fee: IEPERhfIT rhh,•, ih•h. /ns/,. 011w, Phoob imp.Li I Other Elec. lnsp. 0.0 $44.00 $0.00 Ph,mh. birp. /1•,r /Slrr. bup. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the Drelindnary information available and are oniv an estimate. Contact die Dear for mldu 7 into. FEE ITEMS (I'ce Resolution I1-053 /itt 7/1/1 /1 FEE QTY/FEE MISC ITEMS Suppl. PC Fee: Q Reg. 0 OT F0,0Thrs $0.00 l Yuu l h.;',1 IrclL:'l ilcc Permit Fee: $520.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 1 hrs $0.00 PME Unit Fee: $44.00 PME Permit Fee: $44.00 ( onso m ri'm 7"n A.imillwolfil' /Sa : Work Without Permit? O Yes Q No $0.00 Sign Master Plan: Yes (F) No $0.00 Travel Documentation Fee: /TRA VDOC $44.00 Strong Motion Fee: /BSEISM/CO $0.50 Select an Administrative Item Bldg Stds Commission FCC: IBCBSC $1.00 SUBTOTALS: $653.50 $0.001TOTAL FEE: $653.50 Revised: 06/30/2012 CUPERTINO SIGN PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 V (408) 777-3228 • FAX (408) 777-3333 • buildino(a)cuoertino-oro n '� `-' PROJECT ADDRESS 19625 Stevens Creek Blvd. AIN a I Le n O C^) W� OWNER NAME rtal Pl za, LP c oq(amao�ca Associates, Inc. PuoNE 4087200500 E-MAIL STREET ADDRESS 505 S. Pastoria - 2nd FI. CITY, STATE. ZIP Sunnyvale, CA 94086 FAX 408 732 8392 CONTACT NAME Stephanie King PHONE 510 725 1598 E-MAIL sk@associa[edsigncompany. ne STREET ADDRESS 1930 West Winton #13 CITY.STATE. zn Hayward, CA 94545 FAX 510 670 1080 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT E'S CONTRACTOR 11 CONTRACTOR AGENT ❑ ARCIIITF.CT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Danny Colburn LICENSE NUMBER 625281 LICENSE TYPE C45 BUS. CR:4 COMPANYNAME Associated Sign Companyu E-MAIL dannycolburn@sbcglobal.net FAX 510 670 1080 STREET ADDRESS 1930 West Winton #13 COY, STATE. ZIP Hayward, CA 94545 PHONE 510432 7591 ARCI IITECTIENGINEER NAME. Marco Mendez LICENSE NUMBER BUS. LICs COMPANY NAME Signtech E-MAIL FAx 619 527 6111 STREETADDRESS 4444 Federal Blvd. CRY, STATE. ZIP an LAego, PHONE 619 527 6100 DESCRI/PPTIIOONNy OF WORK Install Ort[. set%otcha el letters .,�-eAge[}}}J, e/'' ((L.E.D.) J❑y USE OF SPD or Duplex ❑ Multi -Family ILLUMINATED SIGN TYPE \0 OF SIGN AREA VALUATION STRUCTURE: L?Commercial (YIN) ICODE) SIGNS (SQ. FTA (S) SIGN TYPE CODES: Y W 1 66.44 $750.00 B - BANNER SIGN M - MONUMENT(GROUND)SIGN BE, - BLADESIGN P - PROJECrINGSIGN D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER DI - DIRECTIONAL SIGN T - TEMPORARY ' E - ELECTRONIC W - WALL SIGN READI{RBOARD WE - WINDOW SIGN RECEIVED BY: '.'91V TOTALVAI_Itfp1D.00 U By my signature below, 1 certify to each of the following: I am the property owner or authorized agent to act on the pr perry owner's behalf I have read thiissl application and the information I ha a provided is correct. 1 have read th escription of Work and verily it is accuml . I agree tD mply with all applicable local IR ordinances and state Imus relaf nstruclion. 1 horiu cp sent res of Cupenino to enter the a id • tiGed IP, I''Or inspection purposes. Signature of Appficant/Age Dale', SUPPLEMENTAL INFORMATION REQUIRED OFFICE Use ONLY PLAN CHECKTYPE ROUTING SLIP Site Plan OYER -TILE -COUNTER �. BUILDING PLAN REVIEW Elevations Sign Details- including UL listing(s) applicable ❑ EXPRESS iN7 PLANNING PLAN REVIEW Structural Calculations (if applicable) ❑ STANDARD ❑ OTHER: Copy of Planning Approval Letter or Meeting with Planning prior to ❑ LARGE submittal of Building Permit application. ❑ MAJOR Sign./pp_2011.doc revised 0313111/ EAS Certificate of Compliance i n Lighting) (Page 1 ra) SLTG-1C Project Nam Dmc. Project Ad I Location of Sign ❑ Outdoor Signs ❑ Indoor Signs Phase of Sign Construction ❑ New Signs ❑ Sign Alterations Tvpc of Lighting Control O New Lighting Controls ❑ Replaced Lighting Controls J5 Not installing Lighting Controls This Certificate of Compliance includes the following components (check all that apply) ❑ Mandatory Measures (Lighting Controls) ❑ Maximum Allowed Lighting Power JM Specific Lighting Sources I. Certificate of Compliance Declaration Statement (this may be a C10, C45 mother eligible person) I certi ly under penalty of perjury, under the laws of the State of Califomia, the inl'onnatiorZ''p1i )trydcd on this form is into and correct. �"d--"•'� I am eligible under Division 3 of the California Business and Professions Code to accept responsibility I�r the lighting �esign. This Certificate OI Compliance identifies the lighting features and performance tipee'll icau(tpti required'for edin�liance wills Title 24. Parts I and 6 of the California Code of Regulations.— ,\� The design features represented on this Certificate of Compliance are consistent with the inl'ormation`pttrvidCd to document this design on the other applicable compliance forms, worksheets, calculations, plans and specif icati its sabot itied 'mthe enforcement agency fora Prov I with this building permit application. Na nor r r I�l Signature Comps . I certify that the requirements detailed on this Certificate of Compliance have been met. Ph w U3a�1�i r Address: 193o 0, Licem� a ommenx's He 41) c (:itylSa Fba.y Date 2. Installation Certificate (to be signed by responsible person alio installation) Permit number ncck d byfMw Iinf nA.m. Use Ifit c�ncmA rncv use Installation Declaration statement I certify under penalty of perjury, under the laws of the State of California, the information provided on this limn is true and , correct. 1 mm eligible under Division 3 of the Business and Professions; r`c stF�llity((�"'or n truciioh, or an authorized representative of the person responsible for construction. )j I cenily that the installed features, materials, components, or man f tlu d v d die nn this certificate confimns to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. I certify that the requirements detailed on this Certificate of Compliance have been met. I will ensure that a completed, signed copy of this Installation Certificate shall he posted, or made available with the building pennit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to he included with the documentation the builder provides to the building owner at occupancy. Conlp 1 Resp ns r e PcNon's Name: Respmlr ible Per ni s ignature: Licens • nunahirrknay eq 's lic #) Date Signed: Positfn Aith'UOUID311 _ 2008 Nanresidenlial Compliance Forms Ocloher 10/11 C Certificate of Co liance Sin U htin ra e c DI v a x "-x., 'me: /J Da ?j 3. Ma ato Si n L htin Controls NO . Mandatory Was res (sign lighting controls) are required for compliance with the sign lighting Standards. The same e responsible person m install both the sign and the sign lighting controls, or a different responsible person may install the sign lighting controls on the responsible person installing the sign. le for installing the sign is not also responsible for the sign lighting controls, then the owner of the 2. If the person respons contract r, or architect shall be responsible to have lhesign lighting controls installed. sign, general 3. If more than one pens n has responsibility jar compliance, each person shall prepare and sign a Certificate of Compliance an Installation tifreate applicable to the portion of construction for which they are responsible: ahernanvely, the and person with chief res nsibilityjor construction shall prepare and sign the Certificate of Compliance Declaration Statement or the entire tons .-- 3a. Statements of R ponsibitity: Ceficate of Com liance Declaration Statement shall check Yes or No for all of the following statements: The erson si nin the 1 have responsibility r instilling the sign lighting controls . 1 ❑ Yes, com tete 3a and 36 of this.(orm o, com tete art 3a of this form There are no existing ign lighting controls and 1 will be installing compliant sign lighting controls 2 ❑ Yes B No ign lighting controls and someone else will be responsible to install compliant sign lighting controls There are no existing 3 ❑ No Yes There sig i lighting controls that do not comply with the applicable provision of § 119 and § 133 and I will be are existing 4 installing compliant s gn lighting controls ❑ Yes - ® No sig i lighting controls that do not comply with the applicable provision of §119 and §133 and someone else There are existing 5 will be responsible to install compliant sign lighting controls ❑ Yes M No 3b. Njandatory Sign Lighting, Controls Thep signing the C ifrwte of Compliance Declaration Statement shall answer all of the following questions if they are n liresgjEsible for com 1 inwith the si li htin control u'vtmenls. ere are construction d cuments, indicate where on the building plans the res si li tin control note block can be located: mandato measuN NA iodoo lighting is controlled with an automatic time switch control that complies with the §133(a)1. All sign ❑ ❑ 1 a licable r uireme is of 119. §133(a)l and 2. All utdoor sign lighting is controlled with an automatic time switch control plus a photo Y N NA ❑ or an outdoo astronomical time switch that comply with theapplicable requirements of 119. �.I ❑ 2 control, Exception to §733( 2. Outdoor signs in tunnels or large covered areas that require illumination during ❑ N Is da li ht hours. §133(a)3. All outd r signs are controlled with a dimmer that provides the ability to automatically reduce ❑ ❑ N si n wer b a min um of 65 percent durin ni ttime hours. 50 Y NA Exception 1 to §133 a)3. Signs illuminated for less than one hour per day during daylight hours. ❑ 3 Exception 2 to §133 a)3: Outdoor signs in tunnels or large covered areas that require illumination during Y NA da li ht hours. Exception 3 to §133 • - a)3. Only, metal halide, high pressure sodium, cold cathode, or neon lamps used for 13 Y❑ NA illuminatin si ns o §133(a)4. An Elec artsof si s. ' nic Message Center (EMC) having a new connected lighting power load greater than Y N 1p N/A 15 kW has a control nstalled capable of reducing the lighting power by a minimum of 30 percent when ❑ ❑ 61 4 receivin a demand Exception to §133( es rise signal that is sent out b the local mill )4. EMC required by a health or life safety statue, ordinance, or regulation. including Y❑ NA but not limited to t si ns and traffic signs. Field Inspector Notes: „Iv 21)10 2008 Nonresidential Compliance Forms Certific of Co ' licence Si n:Li titin (Page 3q4) 4 SLTGIC Project N r f - Da ximum Allowed Dficate Li htin Power Method of Compliance of Compli nce slid FSeid Inspection Energy Checklist Complete this pari if there are signs using the maximum allowed lighting power method of compliance. (Complete pan 5 of this Certificate f Compliance if there are si usin the S ecific li tin sources method of compliance A C D E F G H I J Allowed Watts Design Complies? $ G Watt Y/N Field. 0 o e , o Inspector u ; a c v _� �_ y vi Check that o D 0 a—' m X33 3 < "m Sign. 0 f 'E ;- N y _ Complies s eco `u x a II II "LJ o li '0 c COO�II F U Descri tion rc IY % 1 0'n ° Z Q o 1 -�' ❑ �.' .. A Symbol or eode used on I tas are end other documents. B A narrative description o the � or logon of silto on the building; and the location of siFtn on construction documents. OPTIONAL - Check this x onlyifthis sip has a permanent, pre-printed, factory -installed label, listed with Underwriters Laboratory (UL) or other testviglabo ory accredited by the National Voluntary laboratory Accreditation Program (NVI-AP) or International Standards Organisation (1 0)17025 m accordance with ISOIIEC 17011 with the products produced under an ongoing inspection program C carried out by a Type A ' - 'oa body m accordance with ISO/IEC 17020, confirming that the sign complies with the Section 148 of the California 2006 Tide 24; 6 Standards,' using the Maximum Allowed Lighting Power method of compliance. For signs with such a label, columns'Dt iroug 'I'm not required to be filled out Note: Using a label is an optional method to validate compliance. A label is not needed for com Ii - D The sign arca in squareT t E I List "I" if the sign is in illuminated. List "E". if the signis external) illuminated. F Allowed watts square not. Enter 12 if the signis listed as "I" in columm E. Enter 2.3 if signis listed as "E" in column E. G Multiply the square foo - iorolumn D times the allowed Li Power Deni LPD = watt) in column F. H Show the total installed w in the si as determined accordingto the linable visions of 130 d ore . I Enter Y if the number in lumo H is less than or m the number in column O. Otherwise, the sign does not comply. J This doubles ss s fie 'ons checklist. Field Inspector Notes: - , a 2008 Nonresidential July 2010 /I C Certificate of Co fiance Si Lighting) (Page 4 of 4 SLTG-1C Pro ect Name: Date: 5. S ific Li htin S urce Method of Compliance ficate of Compli nee and Field Inspection Energy Checklist Complete this part if ere are signs using the Specific lighting source method of compliance. (Complete part 4 of this Certificate of Com li ice if there are si s using the maximum allowed li htin ower method of compliance) A B C D E OPTIONAL Field - UL Specific light source used for Symbol or other compliance : Inspector 'Check that or Description label Shall include only lighting Si Code ;m iwim� technologies listed below Complies . below) Li apply _.. 41�p uM �, ;.o 0 El . A Svmbol or code used oz the plans when plans are required) and other documents. B A narrative description if the sim or location of sign on the building: and the location of sin on construction documents C OPTIONAL - Check th s box only if this sign has a permanent, pre -primed. factor, -installed label, listed with Underwriters Laboratory (UL) or other testing laboratory accredited by the National Voluntary Laboratory Accreditation Program (NVLAP) or International Standards Organization (ISO) 17025 in accordance with ISOAEC 17011 with the products produced under an ongoing inspection program carried out by a Type inspection body in accordance with lSO/lEC 17020, confirming that this sign complies with the Section 148 of the California 2008 Title 2j, Part 6 Standards, using the Specific Lighting Source Method of Compliance. For signs with such a label, column •D' is not required 10 bel filled ouL Note: Using a label is a t optional method to validate compliance A label is not needed for compliance Specific Lighl Source ompliance Method. The sign(s) identified above use only the following lighting technologies: List all applicable nitro mrs I throat 10 that 1 in column D above for each row. I High pressui sodium lamps 2 Pulse start or ceramic metal halide lamps served by a ballast with > 88% efficient Pulse start m cal halide lamps that are <_ 320 watts, are not 250 wan or 175 watt lamps, and are served by a ballast 3 with >80% fficiency 4 Neon or cold cathode lamps with transformer or power supply efficiency > 75% with rated output current < 50 mA 5 Neon or cold cathode lamps with transformer or power supply efficiency > 68% with rated output current > 50 mA D Fluorescent I ps with a minimum color rendering index (CRq of 80 6 Note: when sin electronic ballasts for compliance, lamps with a CRI < 80 may be used 7 Light cmittink diodes(LEDs) with power supply with> 80% efficiency Single voltag LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC 8 output, havin a nameplate output power less than or equal to 250 watts, and certified to the Energy Commission as cum I in th the applicable requirements of the Appliance Efficiency Regulations (Title 20 9 Compact flu retswitt lam s that do not contain a medium screw base sockets E24/E26 10 Electronic b2 lasts with a fundamental output frequency > 20 kHz E This page doubles w a ¢Id inspection checklist. Field Inspector Notes: 2008 Nonresidential Compliake Forms July 2010 1: increase Sim of sign 001 aM 002 to M-oso x W 0M OL -01(30112 2 change Wourt pmd loyal to ohnoual:OL-01171/12 7 added srround ATM 1.44/17/12 5revised 'v.iO02-004 and rc-anape signs arrbers.-0L-0Si(B/12 EASTWESTBANK PRICE COPY R1ECFj1V1E1:) JUN 2 2 2012 3Y: CUPERTINO Building Department JUN 2 2 2012 REVIEWED FOR CODE COMPLIANCE Reviewed By: ,t 11 j� l i / l l PLOT PLANS CHEC rkD BY az 1 zP'-,V r DATE 4pp1 "wl S L'a 'I ING DEPT. Svbn.i- ch 1 DATE 9 �U m.vc: DIElr15P„� � I a__Prdr free Ln” Q i G III _ Id vdl l.i �n Z u � IY v a Dr ®� -forest &P - Amherst 3 -e o < Vauco Pk„• Vadcp PtwY / 2 t5 Wheaton. or ,I I Blvd �StevenrCreekBlvd r - ,L—�— Ste�ens.Geek6lvd ' c b'bl q, 2° \ 01 o` Plice ave a: Ave '^ S r �' Way I Hall CI `w4Mon pad _ u G M1fuidL La roar Dr tot i Dr - = t W r'rar DrCalle de Barcelona r"" u Signtech- 4444 Federal Blvd. San Diego CA 92102 Phone: (619) 527-61001 Fa:: (619) 527.6111 www.signtechUSA.com J Qts, Wroanoui s. � East West Bank 19625 Stevens Creek Blvd Cupertino, CA. 95014 Date: 01/25/12 Salesperson: Art Navarro Coordinator: Marco Mendez Designer Oscar Lemus Scale: As Noted IA, F CUSTOMER APPROVAL Customer Signature Dale COPY, COLORS & SIZES Signtech does NOT provide primary electrical to sign location - RESPONSIBILITY OF OTHERS/ Customer Sigrinlu a Date This design is the encfuslve property of Slgntect and cannol be reproduce in whole or In part, without their prior written approval. Drawing Number: 14_00097 Work Order Number: 54815 Sheet: 1 of: 11 RE I Increase sit( al signs 001 am D02 to 36- OM 30 ora. -Ti 2. change bridal Oand layout to bihrgual OL -01131,12 S added mummd ARA. -046111]112 1 changed ATht surround 10 blue. 040120'12 5 revised sign, 001 to be 36- o a h .deiced signs 002-004 and isarrage signs nwrders -0L-0 OW 2 EvNu:on �:.6m la ion S:wo FA N0 FOAF A: umn YI .Irnmri C+nrne R :-rnl big M a I c;Dra[r Ou 54v.nM Gra. ell 0 Zann Sewing & Accr;nmm II PRO DENTAI. I :. I F't., -- Stevens Creek Blvd Stevens Creek Blvd 1 I Creek Blvd -- Steve Blvd Stevens Creek Blvd Stevens Creek Blvd Surmml e^M nj 6!clMm PI CcINm k 6 6 & Evrwynw 5 Crnrol fi,nh B n:IN O SITE PLAN N.T.S. CUPERTINO Building Department U JUN 2 2 2012 REVIEWED FOR CODE COMPLIANCE Reviewed By: 4'� f -j t5hrtechn- 4444 Federal Blvd. San Diego CA 92102 Phone: (619) 527-61001 Fax: (619) 521.6111 Jwww jwII .signtechUSA.com F— K 95/6► iprrar no.a Si bm.ra East West Bank 19625 Stevens.Creek Blvd Cupertino, CA. 95014 Date: 01/25/12 Salesperson: Art Navarro Coordinator: Marco Mendez Designer: Oscar Lernus Scale: As Noted 0 A CUSTOMER APPROVAL Customer Signature Dale COPY, COLORS a SIZES Signtech does NOT provide primary electrical to sign location - RESPONSIBILITY OF OTHERS! Customer Signature Dale This design is the exclusive ormi of Some Drawing Number: 12_00097 Work Order Number: 54815 Sheet: 2 Of 11 RE I: increase Use of sips 001 ark 002lo 36-oan a 3p oN -0L-01MI2 2. Mange lenmpmd layout to OlinguaL-Ow1131112 3 aWW vxrpnd ATM-0l--W7j12 4'. changed ATI,f sunound to Muo.-0L-012112 5: revised sips 00110 be 36'0 ah, ddel:d signs 002-004 and to arr2W dgns numbers: OL -W06112 EXISTING CONDITIONS Building Department 101 JUN 222012 J ( . I Signtechn- 4444 Federal Blvd. San Diego CA 92102 Phone: (619) 527-61001 Fax: (619) 527.6111 www.signtechUSA.coin LIS., DESA �Ixroeamweiw Appsppy{ . East. West Bank 19625 Stevens Creek Blvd Cupertino, CA. 95014 Date: 01/25/12 Salesperson: Art Navarro Coordinator: Marco Mendez Designer: Oscar Lemus Scale: As Noted CUSTOMER APPROVAL Customer Signature Dale COPY, COLORS & SIZES Sigmech does NOT provide primary electrical to sign location - RESPONSIBILITY OF OTHERSI Customer Signature Dale This dosign is the excluslve piropell of Sigmecl and cannot be reproduced In whole or In pan, withoul their prior wntten approval. Drawing Number: 12-00097 Work Order Number: 54815 ISheet: 3 of: 11 RE Revisions 4. . ji I Id 36• a-. chagcd Ano Suno" b bIM-OLa420?12 5 rxmdsixebe l totx3fi' a a h.Wl,kdSoM002-0 a1d 5 7/8" 25 5/16" L� — y��p 3' 25 5/16" 1' I DAY NIGHT FACELIT LETTERS, REG. LOGO WITH CHARACTERS ON WIRE WAY 250 3/4" TWEST 472 1/4" 4 7/8" 91, 91, 91' I 35 1/4" 1 I 35 7/8" 1 1 40 7/8" 1 1 36 1/4" M LOGO: TO BE 3" DEEP OF ALL ALUMINUM CONSTRUCTION FACE: TO BEA77"THICK #7328 WHITE FLEX WITH #3630-33 RED VINYL OVERLAY FOR GRAPHIC. t TRIMCAP: TO BE 3/4" RED TRIMCAP RETURNS: .040" X 3" PRE -FINISHED BRUSHED ALUMINUM. ILLUMINATION: NICHIA CHIP WHITE 7500 KELVIN WHITE LEDS "EAST WEST BANK": TO BE 3" DEEP OF ALL ALUMINUM CONSTRUCTION. FACE: TO BEA 77" THICK CLEAR PLEX WITH FIRST SURFACE OPAQUE PERFORATED VINYL TO MATCH PMS #282 SECOND SURFACE 3M #3635-30 WHITE DIFFUSER VINYL. TRIMCAP: TO BE 3/4" BRUSHED ALUMINUM ' RETURNS: .040" X 3" PRE -FINISHED BRUSHED ALUMINUM. ILLUMINATION: NICHIA CHIP WHITE 7500 KELVIN WHITE LEDS CHARACTERS: TO BE 3" DEEP OF ALL ALUMINUM CONSTRUCTION. FACE: TO BEA 77" THICK #7328 WHITE FLEX WITH FIRST SURFACE 3M #7725-197 LT. NAVY BLUE VINYL (ONLY WHITE TO ILLUMINATE) TRIMCAP: TO BE 3/4" BRUSHED ALUMINUM RETURNS: .040" X 3" PRE -FINISHED BRUSHED ALUMINUM. ILLUMINATION: NICHIA CHIP WHITE 7500 KELVIN WHITE LEDS ATTACH LOGO, LETTERS, & CHARACTERS FLUSH TO WALL CUPERTINO Building DsPertlin"gnt JUN 2 2 2012 OE OMFLIANCE ' REVIEWED FOR{ ROV10wod, ®Y; .040" ALUMINUM RETURN LETTER-LOK FASTENING NICHIA CHIP WHITE 7500 KELVIN WHITE LEOS SPLICE CONNECTOR 177" PLEX FACE .050" PRE -PAINT WHITE ALUMINUM BACK #6 SHT METAL SCREW 1/4"0 WEEP HOLES REQUIRED WITH LIGHT BAFFLE SCALE: 3/8"= 1'-Ou SQ. FT: 118.15 3" Y. #10 SCREWS INTO BLUEANCHORS (MIN 4 PER LETTER) REMOTE POWER SUPPLY TOGGLE DISCONNECT SWITCH (TYP.) �U:C.APPROVEO LED CHANNEL LETTER WITH REMOTE POWER SUPPLY SCALE: 1 1/2" = V-0" Ngntech 4444 Federal Blvd. San Diego CA 92102 Phone: (619)527.61001Fax: (619)527-6111 YY�p www.signtechUSA.com _=A K � /®► Easf;West Bank 19625 Stevens.Creek Blvd Cupertino, CA. 95014 Date: 01/25/12 Salesperson: Art Navarro Coordinator: Marco Mendez Designer Oscar LemuS Scale: As Noted ID 0 CUSTOMER APPROVAL Customer Signature Dale COPY, COLORS & SIZES Signtech does NOT provide primary electrical to sign location RESPONSIBILITY OF OTNERSI Customer Signature Dale This deslon Is the exclusive orocerfy of Sterne Drawing Number: 12-00097 Work Order Number: 54815 Sheet: 6 ot: 11 RE T'. iwease sireV signs 001 anNO2 to 36.00 t'30' 2. chortle tenant panel IayM to aingual -0L-01/31112 3. added surround ATM.OL-04117112 4 charged ATM sunoum to due: OL -042(1112 5. revised sips 001 to da 36- o ah., dclead signs 002 L W W N [FACING I INSIDE < M rn O Cuslomer Signature Date COPY, COLORS & SIZES m U U CV 16° CO cV m ~ 1 CV II F F _ NEW FACE: TO BE 1 Tr CLEAIvrLEX, - BACKGROUND TO BE SECOND SURFACE OPAQUE 3M #7725-197 LT. NAVY WITH 'ALL, COPY (PLUS KEY LINES, WEEDED OUT)D B 'ANACKED UP,ENTIRELY WITH 3M,#3635=70 WHITE'DIFFUSER FILM. LOGO. FIRST SURFACE DECORATE WITH" 39 #3632-' 0TWHITE VINYL OVERLAY WITH 3M #3630 33 RED VINYL LEAVE KEYLINE TO SHOW THRU WHITE DIFFUSER -VINYL SECOND SURFACE. "EAST WEST BANK": TO BE #3632-20 WHITE APPLIED FIRST SURFACE, LEAVE KEY LINE TO;SHOW' THRU WHITE DIFFUSER VINYL SECOND SURFACE. NOTE: VERIFY IF SIGN IS CURRENTLY WORKING ELECTRICALLY AND IF IT SHOULD BE REPAIRED. KEYLINE FORMULA: 10 INCH "E" GETS A 3/32" OUTSIDE KEYLINE THE KEYLINE MOVES PROPORTIONATELY UP AND DOWN WITH SIZE AFTER THAT R-0" CABINET TBD CUT SIZE 8'-8" V.O. , _ 871/4^ LOVE EXISTING EXTERIOR -SIGN FACE I ' I C ERTIR10 i/ Building a De rtrnent FRONT VIEW SCALE: 3/4"=1'-0 AMTCAM111 I V:11111 1111MMATFin Mf1MIIMFMT CIGM., - PROPOSED CONDITIONS JUN 2 2 2012 8 5/16" REVIEWED FOR C,IDQE COMPLIANCE - Reviewed By: 6 5/8" 1 LJ' PAINTEDTO MATCHATCH 3M #7725 197 OPAQUE LT .� NAVY BLUE ORPMS'#282 BLUE -WHITE KEYLINE ► FOR RED LOGO .FACING OUTSIDE 3M #3630-33 RED TRANSLUCENT VINYL OVERLAY 3M #3632-20 WHITE TRANSLUCENT VINYL OVERLAY WHITE KEYLINE FOR RED LOGO CLEAR FLEX 3M#3635-70 DIFFUSER FILM, WHITE. 70%, LIGHT TRANSMISSION PAINTED TO MATCH 3M #7725-197 OPAQUE LT. NAVY BLUE OR PMS #282 BLUE WHITE KEYLINE FOR "EAST WEST BANK" COPY 3M #3632-20 WHITE TRANSLUCENT VINYL OVERLAY WHITE KEYLINE FOR "EAST WEST BANK" COPY CLEAR FLEX < Signtechr- 4444 Federal Blvd. San Diego CA 92102 Phone:(619)527-61001 Fax: (619) 527-6111 www.signtechUSA:corg W CEPA. . IYIGIWIOINL aWl A69WM1T11. East WesYBank ��. 19625 StevensCreek Blvd Cupertino,- CA. 95014', 'FACING � - Date: 01/25/12 Salesperson: Art Navarro Coordinator: Marco Mendez Designer: Oscar Lemus scale: As Noted FAI [FACING I INSIDE < CUSTOMER APPROVAL - Cuslomer Signature Date COPY, COLORS & SIZES —, FACING OUTSIDE [a ,. – Signtech does NOT provide primary electrical to sign localion - RESPONSIBILITY OF OTHERSI Customer Signature Dale This designcannot isbe the e>tcluslreproduceve property and Inwhole ool5r iinpgneteclrt, without their prior written approval. Drawing Number: 12-00097 —i Work order Number: 54815 Sheet: Of : 11 RE l; unease sire of sign 001 ana 002 to 36• oan F 30'oN.-OL-01130/12 2. Marge tenant pang layout to lingual. -0L-01131112 3 addN Surround ATM.-0L-ON17112 4. Manion! AVA swuu d Is, Nue: OL -0@0'12 5 revised sign 001 to 0e 36' o ah., ddecd signs 002-004 and,cauage signs nufters:OL05.W12 PROPOSED NORTH ELEVATION' .. . A PROPOSED NORTH ELEVATION' .. . CUPERTINO Building Department til JUN 2 2 2012 REVIEWED FOR CODCOMPLUANCE Reviewed By: ,ili 6 Slgntech- 4444 Federal Blvd. San Diego CA.92102 Phone: (619)527.61001 Fa:: (619)'527.6111 www:signtechUSA.com East West. Bank 19625,Stevens Creek Blvd Cupertino„ CA.• 95014 Date: 01/25/12 Salesperson: Art Navarro Coordinator: Marco Mendez Designer Oscar Lemus Scale: As Noted CUSTOMER APPROVAL :Tomer Signature Dale COPY, COLORS & SIZES Signiech does NOT provide primary electrical to sign location RESPONSIBILrrY OF OTHERSI Customer Signature Dale Thls deslqn Is the exclusive prooerN of Slantei Drawing Number: 12.00097 Work Order Number: 54815 Sheet: 8 Of: 11 R: VOPY CUPERTINO Building Department til JUN 2 2 2012 REVIEWED FOR CODCOMPLUANCE Reviewed By: ,ili 6 Slgntech- 4444 Federal Blvd. San Diego CA.92102 Phone: (619)527.61001 Fa:: (619)'527.6111 www:signtechUSA.com East West. Bank 19625,Stevens Creek Blvd Cupertino„ CA.• 95014 Date: 01/25/12 Salesperson: Art Navarro Coordinator: Marco Mendez Designer Oscar Lemus Scale: As Noted CUSTOMER APPROVAL :Tomer Signature Dale COPY, COLORS & SIZES Signiech does NOT provide primary electrical to sign location RESPONSIBILrrY OF OTHERSI Customer Signature Dale Thls deslqn Is the exclusive prooerN of Slantei Drawing Number: 12.00097 Work Order Number: 54815 Sheet: 8 Of: 11 R: 1'. i meax sift of Lg%001 aM 0021036' Oah R 30 -ON -0L-01(30/12 2. charge ieoaol pale 1ay00t to bifnguai, 0L-01131112 3 aee-•__ .. ..... .. ....... a ma 5 ,eh 9n^ FRONT ELEVATION SCALE: 3/4"=1'-0" II MANUFACTURE AND INSTALL ONE (1) ATM SURROUND AND CANOPY FOR EXISTING ATM MACHINE SCALE: 3/4"=1'-0" � L�htgd �8 .;�nu'e/e !;� Nqntech- 4444 Federal Blvd. San Diego CA 92102 J Phone: (619) 527-61001 Fax: (619) 527.6111 HOLE FOR ATM AND DEPOSIT BOX TO BE CUT INFIELD FOR BEST FIT AND ANY ADJUSTMENTS THAT MAY NEED BE MADE Top Canopy : 1 '/2" X 1/8" Alum Angle Frame With .125" Rolled Skin On Front And Sides. Paint To Match PMS #282 Dark Blue, semi -gloss finish, Lens : Underside To Have .177" White Lexan Lense For Casting Illumination Illumination : Use 800ma Day Light Fluorescent Lamp And Ballast Finish : Paint To Match PMS #282 Dark Blue, semi -gloss finish, Attachment:: Attachment To Wall.With Nuts'And Washers. New Alm Surround Panel Scale 3/4" = V-0" Manufacture And Install (1) New Alm Surround Surround :.125" Aluminum w/ Routed Face and interior illuminated ID panel and down light. Paint To Match PMS #282 Dark Blue, semi -gloss finish, Stripes painted PMS #485 red, semi -gloss finish. ID panel to be clear Lexan w/ second surface vinyl graphics. East West & Logo: .177" Clear Lexan with Second Surface Vinyl Graphics. Background : 3M # 7725-197 Lt. Navy Blue Weeded to show East West Bank. Logo: 3M # 3630-33 Red Overlay all with 3M # 3650-20 White vinyl Illumination: 800 Li ht fluorescent lamp and ballast system CUPERTINO 5: Building Department JUN 2 2 2012 REVIEWED FOR CESA- East West Bank - 19625 Stevens Creek Blvd Cupertino, CA: 95014 Date: 01/25/12 Salesperson: Art Navarro Coordinator: Marco Mendez Designer Oscar Lemus scale: As Noted F CUSTOMER APPROVAL Customer Signalure Dale COPY, COLORS 8 SIZES Signtech does NOT provide primary electrical to sign location - RESPONSIBILITY OF OTHERSI Customer Signature Dale This deslon Is the exclusive property of Slgnle IDrawing Number: 12-00097 Work Order Number: 54815 Sheet: 9 of: 11 Rr" to MW o ah.. ddckd sign 002-M and rc-amps gws mmbas.-0L-05Aerl2 3 3/4" R3" TYPICAL - 5•-.1 U'• , 5'=2 1/211 - y 51 -51-1011- 5-2 5'-10"- 5-2 1 /2" TOP VIEW 5QALL 1: 16 3 3/4" —rt 6" c� 1 1/2" x 1 1/2" x 3/16" ALUM. ANGLE FRAME 1/8" ALUM. ACCESS DOORS FASTENED A—TO ANGLE FRAME W/COUNTERSUNK SCREWS AS REQ'D 2'-4 3/4" 2'-4 3/4" 6„ ACCESS DOOR 1/2" ACCESS DOOR 1/8"ALUM:-ROLLED ti SECTION C -C ALUM. CLADDIN — SCALE1 12- FRONT VIEW 5UALE 1:16 -ANGLE TO '-' CLADDING', ' 1/87 TYPICAL'- 45/8 1/8" -ALUM. 1/2" AVON ITE COUNTERTOP BACK PANEL #C1-1700'ADOBE'BROWN' ALUMINUM SECTION D -D 1/8" ALUMINUM URN PANEL SCALE 1 :12 RETURN PANEL 1/8" ALUMINUM ROLLED CLADDING 1/8" ALUMINUM ACCESS DOORS FASTENED TO ANGLE FRAME W/ COUNTERSUNK SCREWS AS RE( 6„ 2'-4 3/4" _ ACCESS DOOR 1 1/2" x 1 1/2" x 3/16" ALUM. ANGLE FRAME _ 2'-4 3/4" 1/2" ACCESS D00 SECTION E -E SCALE 1 : 12 t5igntech- 4444 Federal Blvd. San Dlego CA 92102 Phone: (619)527.61001 Fax: (619) 527-6111 wwwsigntechUSA:com s� -East WestBaink 19625 Stevens Cree& Blvd 45 !8" Cupertino, CA. 95014 . Date: 01/25/12 Salesperson: Art Navarro Coordinator: Marco Mendez Designer Oscar Lemus Scale: As Noted 6" CUSTOMER APPROVAL CuslomerOPO, C Dale COPY, COLORS 8 SIZES Signtech does NOT provide primary electrical to sign location - CUPERTI RESPONSIBILITY OF OTHERS[ Building Departnt _ Customer signature Dale JUN 2 2 2012 TRASH BIN ANGLE FA§VEWED FOR 041%DEA�( TO 1/8" CLADDING Reviewed By: �Puj or Drawing Number: 12-00097 Work Order Number: 54815 Sheet: 11 of: 11 R` T 5•-.1 U'• , 5'=2 1/211 - 51 1==- - ---- -------- -C I I I I ------------------ D cc I Lr. n cr. I 3/4" X 7" TRASH SLOT I Ecc I I o: ---- --- ------ —�E r I I ice— 1 i -7u FRONT VIEW 5UALE 1:16 -ANGLE TO '-' CLADDING', ' 1/87 TYPICAL'- 45/8 1/8" -ALUM. 1/2" AVON ITE COUNTERTOP BACK PANEL #C1-1700'ADOBE'BROWN' ALUMINUM SECTION D -D 1/8" ALUMINUM URN PANEL SCALE 1 :12 RETURN PANEL 1/8" ALUMINUM ROLLED CLADDING 1/8" ALUMINUM ACCESS DOORS FASTENED TO ANGLE FRAME W/ COUNTERSUNK SCREWS AS RE( 6„ 2'-4 3/4" _ ACCESS DOOR 1 1/2" x 1 1/2" x 3/16" ALUM. ANGLE FRAME _ 2'-4 3/4" 1/2" ACCESS D00 SECTION E -E SCALE 1 : 12 t5igntech- 4444 Federal Blvd. San Dlego CA 92102 Phone: (619)527.61001 Fax: (619) 527-6111 wwwsigntechUSA:com s� -East WestBaink 19625 Stevens Cree& Blvd 45 !8" Cupertino, CA. 95014 . Date: 01/25/12 Salesperson: Art Navarro Coordinator: Marco Mendez Designer Oscar Lemus Scale: As Noted 6" CUSTOMER APPROVAL CuslomerOPO, C Dale COPY, COLORS 8 SIZES Signtech does NOT provide primary electrical to sign location - CUPERTI RESPONSIBILITY OF OTHERS[ Building Departnt _ Customer signature Dale JUN 2 2 2012 TRASH BIN ANGLE FA§VEWED FOR 041%DEA�( TO 1/8" CLADDING Reviewed By: �Puj or Drawing Number: 12-00097 Work Order Number: 54815 Sheet: 11 of: 11 R` T I 1, inc ease size of sign 001 aM 002 io 36• azh a 3"NALMi3Q112 2 charge anent panel layout 1" Nhgual.-OL-01(,1112 3 added srrauld ATM -0L -W 17112 1/8" ALUM. ACCESS DOORS a manniATM sMo.wuaae.-oL-wrza12 FASTENED W6# 10 COUNTERSUNK SCREWS 5. renised signs 001 lo the 36•a ah -deckled signs 002-004 and re-amge signs mimes- L-05, &12 AS REO'D 1/8 ROUTED 3/16" WHITE LEXAN LIGHT PANEL - 1 " x ANEL 1"x 1" x 3/16" ALUMINUM ANGLEFRAME PIANO HINGE 11/2" x 11/2" x 3/16" ALUM.ANGLE ' 3/8" HARDWARE TO — >x%x •FASTEN:SURROUND - TOGETHER (6 PLACES)• B— PAINTINTERIOR AREA OFSURROUND-AROUND LIGHTING _; _IWITH SPRAYBRITE_ /DETAILB SCAL- E 1 : -2: . 3/16" CLEAR LEXAN ID PANEL W/ SECOND SURFACE VINYL GRAPHIC BACKGROUND IS 3M#7725-197 LT. BLUE WEEDED TO SHOW EAST WEST BANK 1/8" ALUMINUM RETURN PANEL 1" ALUM. SQUARE TUBING WELDED TO 1/8" GRAPHIC HINGED PANEL USE COUNTERSUNK SCREWS TO SECURE HINGED PANEL 1/8" ALUM. HINGED TO SURROUND THRU SQUARE TUBING GRAPHIC PANEL AS REQ'D 1/8" ALU RETURN ROUTED OUT TRASH SLOT SEE 'SURROUND TOP' FOR DETAILS . 1/8" ALUMINUM RETURN'PANEL: • Y `-1/8" ALUM. TRASH BIN 1 112" x 1 1/2" x 3/16" ALUM. ANGLE BASE FRAME SECTION A -A SCALE 1 : 12 —1/8'."ALUM. CLADDING W/ #4 STAINLESS STEEL LAMINATE 'ALUMINUM BACK PANEL #4 STAINLESS STEEL LAMINATE 1/2" THICK AVONITE #C1-1700 'ADOBE BROWN' COUNTER TOP 1/8" ALUM. CLADDING W/ #4 STAINLESS STEEL LAMINATE SEE'SURROUND BASE' FOR DETAILS CUPERTINO 91Building Department JUN 2 2 2012 REVIEWED FORfQW Reviewed By; (-;, 4"MPLIANCE Signtech- 4444 Federal Blvd. San Diego CA 92102 Phone: (619) 527-61001 Fax: (619) 527.6111 015S44 d,onmom: ero" a napex. ,. East West.Bank 19625 Stevens Creek Blvd Cupertino,'CA. 95014 Date: 01/25/12 Salesperson: Art Navarro Coordinator: Marco Mendez Designer Oscar Lenlus Scale: As Noted A A CUSTOMER APPROVAL Customer Sigrwlure Date COPY, COLORS 8 SIZES Signtech does NOT provide primary electrical to sign location - RESPONSIBILf Y OF OTHERSI Customer Signature Date This desfon I5 the exclusive property of Slgmei Drawing Number: 12-00097 Work Order Number: 54815 Sheet: 12 Or: 11 RE CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19625 STEVENS CREEK BLVD CONTRACTOR: TftD i9$E PERMIT NO: 12060135 OWNER'S NAME: PORTAL PLAZA LP I :5A An ^ h I DATE ISSUED: 06/22/2012 I OWNER'S PHONE: 4087200500 I , V ( PHONE NO: I ❑ LIaCENSED CONTRACTOO�Re'-Se7DECLARATION License Class G /SSG Lic. # Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION 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 authorize 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 accrue against said City in consequence of the granting of this permit: Additionally, the applicant understands and will comply with all non -point rce regulations per the Cup ino Municipal Code, Section 9.18. Signature Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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 & Professions Code) I, as owner of the property,.am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor'Code, for the performance of the work for which this permit is issued. 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 Worker's Compensation laws of California. If, after -making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 authorize 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 accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date JOB DESCRIPTION: RESIDENTIAL EAST WEST BANK- INSTALL 1 WALL SIGN W/ CHANNEL LETTER AND INSTALLATION OF ATM SURROUND AND CANOPY SIGN Sq. Ft Floor Area: I Valuation: $2100 APN Number: 31620083.19625 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WIT 80 DAYS OF PERMIT ISSUANCE OR 180 DA F OM LAST CALLED IN SP CTION. Issued by: Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &Safety Code, Sect' 505, 25533, and 34. Owner or authorized age Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITE' OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: OWNER'S NAME: ARCHITEC IENGINEER: p p LICENSED CONTRACTOR'S DECLARATION'. m C 1 hereby affirm that I am licensed under provisions of. Chapter 9 (commencing Z m with Section 7000) of Division 3 of the Business and Profession; Code, and my license is '=4 H in full force and effect License Class Lic. N I m Date Contractor „t ARCHITECTS DECLARATION 1 e 1 understand my pians shall be used as public records :yU ' u. y Licensed Professional t y 3 OWNER -BUILDER DECLARATION i'> I hereby affirm that I am exempt from the Contractors License Law for the p O following reason. (Section 7031.5, Business and Professions Code: Any city or county : m which requires a permit to construct, alter, improve, demolish, or repair any structure Z y prior to its issuance, also requires the applicant for such permit to file a signed statement ? S 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 Profcasions Code) or .. that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 70313 by any applicant for a permit subjects the applicant to a Civil penalty of not more than five hundred dollars (55001 ❑ L as owner of the property. or my employees with wages as their sole compensation. win do the work and the structure is not intended or offered forsale (Sr -7044. Business 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 himselforthrough his own employees, provided that such improvements m not intended or offered for sale. if, however, the building or improvement is sold within one year of completion. the Owner- 5 wner- builder have the burden of proving that he did not build or improve for propose of sale.). as owner of the property, am exclusively contracting with licensed cantractos to construct the project (Sec. 7044, Business and Professions Code:)The Corhactors Li- cense Law does not apply to an owner of property who.b ilda or improves thereon, and who contracts for such projects with a contractor(s) Hennaed pursuant to the contractor's License Law. 131 am /e�m/p�tunderSee. B&PCf this n Owner >f r l 1 2 /�� *-Date WORKER'S COM SATION DECLARATION I hereby affirm under penalty of perjury one of diefullowing declarations: ❑ l have and will maintain a Ceriflcate of Consentto self insure for Workers 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 Stiction 3700 of the Labor Code, for the perfmrmance of the work fawhich this permit is issued My Workers Compensation Insurance varier and Policy number ate:. Cartier. Policy No.: CERT111CATE OF 15FEMPi'ION FROM WORKERS COMPENSATION INSURANCE (This section need not be completed if the permit is forone hundred dollars ($100) or less.) I certify that in the performance of thew rk for 'ch this ermit Is issued, i sball not employ any person in any manner sggtjm ,A - employ oIt' fie Workers' Compensation Laws of California. Date Applicant ✓L/i� NOTICE TO APPLICANT: If after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of due Labor Code, you mast Oforthwith comply with such provisions or this permitshalt bedecmed revoked. Z 0-4 CONSTRUCTION LENDING AGENCY '.~.e CA -+ I hereby affirm that there is a construction lending agency for the performance of x > the work for which this permit is issued (Sec. 3097. Civ. C.) 7a Q Lenders Name Lenders Address J C) I certify that I have read this application and state that the above information is 1, correct. 1 agree to comply with all city and county onfinances and state laws relating to = E" building construction, and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertinoagainst rrA liabilities judgmcros, costs and expenses which may in any way accrue against said City J 2 in consequence of the granting of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ANO -POINT SO REGU ONS. 56 Signature of Applicant/Contractor -I Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building oceupantstore or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9. It and the Health and Safety Codc, Section 25532(a)? . -J ❑Yes Wxso Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management District? []Yrs t+ 1 have mad the hazardous materials requirements untdcrChapter6.95 of Oa Califor- nia Health & SafctyCode, Sections 25505, 25533 and 25534.1 understand datif rho building docs not currently have a Ienant, that it is my responsibility to notify the occupant of the requirements which mutt be met.2 to�iss\ua11�m� ora Colinc oe of (Occupupann/ct. 6 Owner or 2 orized agent Date Job Description INSTALL WASHER/DRYER UNITS IN APTS—INCLUDES E/M/P'S—SEE PERMIT #09030198 FOR PLAN CK COMMENTS. 32609041.223 Issued by: Re -roofs Type of Roof Occupancy Required Inspections Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date . All roof coverings to be Class ';q" or better throats nu. PERMIT ISSUE DATE S R CONTROL NO, BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 Job Description INSTALL WASHER/DRYER UNITS IN APTS—INCLUDES E/M/P'S—SEE PERMIT #09030198 FOR PLAN CK COMMENTS. 32609041.223 Issued by: Re -roofs Type of Roof Occupancy Required Inspections Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date . All roof coverings to be Class ';q" or better CITY OF CUPERTINO CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM �7 APN # 3z6 -0q— O Ljas Date: Me/./C-L20 2O0 Building Address: 20 Z -7S V-2 Mailing Address (if differe t from building addr ss): Q �,. f -- Owner's Name: I-,,— / L,e+ Phone #: (Exterior work only) Yes LJ No [ . q8,HOA: (5- 2� _ 2—c�d If yes, provide letter from HOA Contractor: / Phone: Fax: Contractor License #: Te 1 Cupertino Business License #: Contact: Phone: Y o �� ��, _ 7 6q 3 Fax: 107S Residential Commercial Job Description: Building Permit Info: ,_ Bldg Elect �d Plumb &r Mech Type of Construction (Usage Class): Occupancy Type: 4-2— 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B /4-2— Valuation: `06 Square Footage: Valuation: Project Size: Express ❑ Standard 0/ 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.buildit�� Revised 02/05/09 CITY OF CUPEI�TINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) additional stucco application B 1 WINREP Replacement windows/sliding glass door (ea 8 windows) B 1 WINMEWSTR New Window -structural shear wall/masonry (includes plan ck fee) B IEPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min when not over counter) Standard Plan Check (when no E/M/P) hourly -stand alone B 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B n ` 1TRAVDOC Travel & Documentation B 1BUSLIC Business License B 5 of 5 City of Cupertino Building Department CITY OF (� 10300 Torre Avenue C, I p E k T I N J Phone: (408) 777-3228 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner -builder you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally performing their .own work. If your work is being performed by someone other than yourself, you may protect vourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to :perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner -builder building permit, erroneously implying that the property owner is providing his or her own labor and -material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino Printed on Recycled Paper OWNER -BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform A. _ All the work authorized by this permit B.portion of the work C None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. /-All of the work B. _V A portion of the work (complete section below) Contractor Address/City. Phone # State License # Type of work to Ov✓ ws 6 p CG �alC� 3. Z will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be ormed I declare under penalty of perjury, that the above is true and correct. I have read and understand the Owner -Builder Information (reverse side). Property Owner's Signature: mow- Date: G I210 Job Address: 0} V o f� 2 2 3 ?.� fh pp, eA Permit # D g n 3 010 Any changes to the. information provided on this form shall be submitted to the Cite of Cupertino Build Department. CITY OF CUPERTINO xa R�iA r h BUILDING DIVISION PER UT •.:.. ice,# )k'l' < BUILDING ADDRESS: - PERMIT NO. 20975 VALLEY GREEN DR #236 OWNER'S NAME: � � � � / PERMIT ISSUE DATE PHONE: S A 2 9 G 9 CONTROL NO. ARCHrrECr/ENGINEEL ^^ BUILDING PERMIT INFO 10 zo LICENSED CONTRACTOR'S DECLARATION HthatI hereby affirm I am licensed under provisions of Chaptca9 (commencing with Section 7000) of Division 3 of the Business and Profesdiom Cade, and my license is !;4 H in full form and effect. j 2 z License Class Lic. S t DateContractor . ARCHrMCTS DECLARATION ee U 1 understand my plans shall be used as public records 7y e w y Licensed Professional 5 G OWNER -BUILDER DECLARATION,- �2 fl5 1 hereby affirm that 1 am exempt from etre Contracto'r's License Law for the p o following mason. (Section 7031.5, Business and Ptofessiam.Codti Any city or county u^ � which requires a permit to construct, alter, improve demolish. or repair any structure z y prior to its issuance. also requires the applicant far such permit to fife a signed su entent that he is licensed pursuant to the previsions of do Contractor's License taw (Chapter 9 (commencing with Section 7000) of Division 3 of theBusiness and Professions Code) or i 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'penaity of not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employers with wages as their sole compensation, will do the work, and the structure is not intended or oBe ed for sale (Sec.7044,Business and Professions Cade: The Contractors License Uw A oes sot.apply to an owner of property who builds or improves thereon, and who does such work himselfor through his own employees, provided that such improvements are r otintended or offered for sale. If. however, the building or improvement is sold within.ona:yearof completion. the owner - builder will have the burden of proving that he did not bailt or improve for purpose of tV Ks. owner of the property, am exclusively contracting with gmnsed cwttracters a construct the project (Sec. 7044. Business and Profession$ Code:) The Contractor's Li- ccnse Law does not apply to an owner of property who builda;er improves do Man and , who contracts for such projects with a mntractor(s) licensed prsu uant to theContr;c es License Law. ❑ I am exempt under Sec 3 t B & P C forthis r1awo Owner""Date WORKER'S COMPENSATION sDECLARATION I hereby strum under penalty of perjury ane of the -following declarations: ❑ 1 have and will maintain a Certificate of Consent to self-4asum forWorker's Compen- sation, as provided for by Section 3700 of the tabor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Workers Compensation Insrranee, as required by Section 3700 of the Labor Code, for the performance of thework for which this permit is issued. My Warker's Compensation Insurance carrier and k*,number are: Carrier. Policy No.; CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is farone hu ulmd dollars($100) or less) I certify that in the performance of the rk for hick this permit is issued. I scall net employ any person in any manners o er�ma tu6�rt4 tha Workers' Compensation Laws of California. Dt (� V ` Applicant NOTICE TO APPLICANT: If, after making this certificate of Exemption: yob shouu income subject to the Worker's Compensation ptovisioni of the labor Code: you must 0 forthwith comply with such provisions or this permit shalt be deemed mrolmd Z " CONSTRUCTION LENDING AGENCY [� I hereby affirm that there is a construction landing agency for the performance of the work for which Itis permit is issued (Sec, 3097, Civ. C) W Q Lender's Namt z Lender's Address U O 1 certify that I have read this application and state that the above information is LL H correct I agree to comply with all city and county, ordinances and state laws relating to O U building construction, and hereby authorize representatives of this chyto enter upon the W above-mentioned property for inspection purposes. On (We) agree to save, indemnify and keep harmleis do City of Cupertino against to liabilities, judgments, costs and expenses which mayhrany way accrue against said City: IL) Z in consequence of the granting of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH A NON -POINT SO REGULA ONS. ` Signature of Applicant/Contractor r—t Dad HAZARDOUS MATERIALS DISCLOSURE - Will the applicant or future building occupantatme or kaadle hamtdoas mamtial as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, section 25532(x)?All roofs shall be inspected prior to any roofing material being installed. ❑ Yes M4O If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Job Description INSTALL WASHER/DRYER UNITS IN APTS—INCLUDES E/M/P'S—SEE PERMIT #09030198 FOR PLAN CK COMMENTS. Sq 32609041.236 Issued by: Re -roofs Type of Roof Area 1 Required Inspections Valuation Date 5, (p , O Will the applicant or future building occupant use equipmentordevices which emit hazardous air contaminants as defined by the Bay�Ama'Air Quality Management District? L ❑Yes b�tvo I have read the hazardous materials requirements under Chapter6.95 of the Caii[or- nia Health & SafctyCode, Sections25505, 25533 and25534. I undmuW tharifthe buitdtng does not currently haw a tenant. that it is my respoosibility:tonodfy"the occupant of the romiraments whichmust be met odor to issoance of a Catilicato of Occupam*. / Owner or authorized Signature of Applicant Date All roof coverings to be Class 'A" or better r CITY OF CUPERTINO CITY OF CUPERTINO .GENERAL BUILDING PERMIT APPLICATION FORM Q9636103 APN # /G'J Building Address: 20 qts µl�� Mailing Address (if diff ere t from building addr ss): TQ W.e- Owner's Name: p Phone #: HOA: (Exterior work only) Yes Lj No rX 0 0 2-00 If yes, provide letter from HOA Contractor: / Phone: Fax: Contractor License #: Te to Cupertino Business License #: Contact: Phone: L4 o 5-2- - 76 q 3 Fax: Llog- - o2S Residential Commercial El Job Description: Building Permit Info: Bldg Elect ,_ Plumb Ltd' Mech Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B Valuation: 106 Square Footage: Project Size: Express ❑ Standard 0/ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the applicatibn or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreegM Revised 02/05/09 CITY Of CUPERTINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) additional stucco application B 1 WINREP Replacement windows/sliding glass door (ea 8 windows) B 1 WINMEWSTR New Window -structural shear wall/masonry (includes plan ck fee) B �j J� 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min when not over counter) Standard Plan Check (when no E/M/P) hourly -stand alone B 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES /X 1`\ 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1TRAVDOC Travel & Documentation B 1 BUSLIC Business License B 5 of 5 3 City of Cupertino Building Department CITY OF f'� 10300 Torre Avenue C I P S kT I N J Phone: (408) 777-3228 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner -builder you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their .own work If your work is being performed by someone other than yourself, you may protect vourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner -builder building permit, erroneously implying that the property owner is providing his or her own labor and, material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino Printed on Recycled Paper OWNER -BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: A _ AD the work authorized by this permit B.portion of the work C. None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A _ ,AIl of the work B. V A portion of the work (complete section below) Contractor Address/City. Phone # State License # Type of work to L_.. -...moi..-�...7 e✓�. �( cam. s sc �'�t �� /U b Josc c� t- Alfall-0 UJ 6 S� 2 SbO C9 -1 Gc 3`( 3. V I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Persor/Tirm Address/City Phone Number Type of work to be Qerf rmed ns e • o G ( 20C,- 7o C( �w I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner -Builder Information (reverse side). Property Owner's Signature: Date: job Address: d Uq � L&A `v10, C' Permit # b90 301 0 3 Anv chanzes to the. information provided on this form shall be submitted to the City of Cupertino Build Department. BUILDING DIVISION PERMIT OWNER'S NAME. ARCHITECT/ENGINEER: 0 p LICENSED CONTRACTOR'S DECLARATION v 1 hereby affirm that I am licensed under proviskms AfChapter 9 (commencing M with Section 70(X)) of Division 3 of the Business and;Profeasions Codo.and'my license is U in full fora and effect v� Z License Class Lic. M _ t in Date Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records �96U 4 O y Licensed Professional n y OWNER -BUILDER DECLARATION `2 1 hereby affirm That 1 am exempt from theContiactoes License Law for the i in o following mason. (Section 7031.5. Business and Professions.Code: Any city or county a m Pi which requires a permit to construct, alter, improve, demoltsh, or repair any structure Z yy 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 Comiaet6ea License Law (Chapter 9 2 92 (commencing with Section 7000) of Division 3 of The Business and Professions Cade) or y .. that he is exempt therefrom and The basis for The alleged;e tamption. Any -violation of Section 7031.5 by any applicant for a permit subjects the.411cantto aeivil penalty of not more than five hundred dollars ($500). ❑ L as owner of the property, or my employees w(ih wages as their sole compensation; will do the work, and die structure is not intended or oireja forsale(Sec. 7044. Business and Professions Code: The Contractor's License Law dues not apply to an owner of property who builds or improves dtemon, and who don imehwork himself Or thmugb his own employees, provided that such improvemems aye not intended orofeted'for=I-- if. however, the building or improvement is sold within orae yesrof, comphs)on, to owner builder will have the burden of proving that he did not build or improve for purpose of seeZees owner of the property. am exclusively contrasting with licensed comraemrs to construct the project (Sec. 7044. Business and Profevsions.Ccdtc) TheCoohaetoes Li- cenae Law does not apply to an owner of pmperty who builds or improves drereon, and . who contracts for such projects with a contractor(s) licensed pursuant to ft Contcactot s License Law. " ❑ I am exempt under Sec. e� ; B & P C f this n OwnerDue WORKERS COMPENSA77ON:DECLARATION I hereby alllrm under penalty of perjury One the;folhrwing declarations: ❑ 1 have and will maintain a Certificate of Consenrto self-inaum fa Workers Compen- sation, as provided for by Section 3700 of the Latior Code. for the perfoonance of The work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as ttxtrdred by Section 3700 of the Labor Code, for the performance of rhe.woiktforwhichthis permit is issued. My Workers Compensation Insurance carrier and'P611; number are Cartier. Policy No : CERTIFICATE OF EXEMP 7ON FROM WORKERS COMPENSATION INSURANCE (This section creed not be completed if the p rmitis 1'arone husdrod dollars ($100) or less.) I certify that in the performance of the work for which this -permit is issued,:l shall not employ any person in any manner so as to beccIne6subj&t tBdt�Workere Compensation Laws of California. Date 55 1 Applicant - NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provrsiens of the Labor Code; you must ,J ,z forthwith amply with such provisions or this peanivshalt be deemed revoked Z O CONSTRUCTION LENDING AGENCY [" er m�.m I hemby affirm that then: is a construction lending agency for the performance of pG ✓ the work for which this permit is issued (Sec. 3097, Ctv. C�) a Q Lender's Name L.emiers Address U 0 1 certify that I have read this application and state that the above information is L>~ HcormcL I agree to comply with all city and county,nrdi'"o amlatate laws relating to U building construction, and hereby authorize repres6i a lies of tins city toenter upon the W above-mentioned property for inspection purposes' C4 (We) agree to save, indemnify and kap harmless the City of Cupertino against mF.r rA Iiabii(des, judgments, costs and expenses which may inany way aecme agdait said City r,) Z in consequence of the granting of this permiL .-r APPLICANT UNDERSTANDS AND WILL COMPLY WITH >N N -POINT SOURCERE TONS. -�i�� 5 1 b _ u� Signature of Applicam/Contracmr Dato HAZARDOUS MATERIALS. DISCLOSURE Will the applicant or future building occupant stoic bell,ndle hazardous tnattnial as defined by the Cupertino Municipal Code. Chapior %M and;tkoHealt"and Safety' Code, Section 25532(a)? ❑ Yes (�No Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arms Aii (jWltyManagement District?' ❑Yev Uro Ihavereadthe hazardous materials requbcnacmaunder Chaprer' 95ofciteCalifor- nia Hcalth& SafctyCodc, Savers 25505.25533 am1755M.I undo vmw tiro l'Wn building does not currently have a tenant. that it is my responsibility to notify tlw^.gccup'aht of the reauirements which must be mitt ,,,,oc a=e•uana ora Certificate of (1ccupa4i. Job Description INSTALL WASHER/DRYER UNITS IN APTS-INCLUDES E/M/P'S-SEE PERMIT #09030198 FOR PLAN CK COMMENTS. Sq. 32609053.692 Issued by: Re -roofs Type of Roof. Area Required Inspections Occupancy Date 5 - U .0 All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date . All roof coverings to be Class'n" or better PERMIT NO. D nqnini r.2 PERMIT ISSUE DATE S CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB 0 � 0 Job Description INSTALL WASHER/DRYER UNITS IN APTS-INCLUDES E/M/P'S-SEE PERMIT #09030198 FOR PLAN CK COMMENTS. Sq. 32609053.692 Issued by: Re -roofs Type of Roof. Area Required Inspections Occupancy Date 5 - U .0 All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date . All roof coverings to be Class'n" or better ONO CITY OF CITY OF CUPERTINO CUPERTINO GENERAL: BUILDING PERMIT APPLICATION FORM APN # Date: 32-6 _ Building Address: ' zo qo f/u Mailing Address (if different from building addr ss): Owner's N e: HOA: (Exterior work only) Yes ❑ No If yes, provide letter from HOA Contractor: Contractor License #: Cupertino Business License #: Contact: Residential. -2G, Phone #: 14 o zS-3 -o zoo Phone: Fax: Phone: Lf 08�_ 2,c2- 3 Fax: 90�- q73 -10z -S' Job Description: W & 5 CLQ-- 4 �S Building Permit Info: Bldg Elect 1� Plumb Mech Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IUIIIB, IV -HT, V -B p /4 -2 - Valuation: Square Footage: Size: Express ❑+ Standard Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the applicatiodor if applicable, include in plan set & the sheet index. Points Achieved: . For help, contact Build it Green at www.huilditcrree„ nro- Revised 02/05/09 CITY of CUPEkTINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) additional stucco application B 1 WINREP Replacement windows/sliding glass door (ea 8 windows) B 1 WINMEWSTR New Window -structural shear wall/masonry (includes plan ck fee) B 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE 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 Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min when not over counter) Standard Plan Check (when no E/M/P) hourly -stand alone B 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES n( 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1TRAVDOC Travel & Documentation B 1BUSLIC Business License B 5 of 5 Jaded pSjOAoaa uo paIuud our padnJ ;o X;D 'IuauxgedaQ Sm plmg 'smoi( Xln4 LMA paum}ai st uopaar;uan acp jqun pansst aq ;ou � 4nuiad 2urprmq aqy •sra�u asaq};o a�n1� axe nod }eg; ULTgUoo ueo anti;eila. os uuo; uot}eot} MA zaplmq-zaunao pasoPua aq� um}aa pue a4alduioo asuajd TISS6 enuo}tleJ'OTuauzuzoeS'4aax1S N OZOL 4e zo jS}ttmunaoo mo�S to pzeog amaorl a4e4S ,szopTa4uo:) aq; 2u.roe4uoo Xq paurggo aq Xum szope4uoo pammor{ }nogg uot}u=opzl •djleuoszad �jzom unto nagj .2uitazo;rad axe dagq ssalun szaumo f}xadozd Xq pau2rs aq o4 parmbaz 4ou axe gpmad Outplmg •hjluuoszad leuajetII pue zogel umo mil.10 srq ,9uiptnozd si zau,Ao Xzadozd atp 4mp j9u?Xjduuq Xlsnoauoua'IyLuzad 2utplmq zapU q-zaunlo ue azruas o4 st szo-pa4uoa aq of 2urssa;ozd suoszad pasaaorlun;o ao szd �uanbaz; •suor�rpuoo palturq zapun Xluo 'zo�oez uoogns zo zo�ouz�uoo pasuaotl e 4notpyA- ,saa�Soldura unao xrag� g2noxg4 zo Xnuuoszad xzonl nam uuo;rad 04 panaoUe axe szope:quoo pasuaotl }ou axe ognl szauMo i4mdozd'ales zo; papualul st azrq.onz}s atp 3I •sIuapp:)v rer4snpuI;o uoisrrsiQ aq} pue sjuaurlSed Ipuaq jo TmuxlxedaQ ag4:oe}uoo'na� alr4s spun suogL . qo moi jnoge uogeuuo3 ' �t}nads azotu zo3 •(uor;ei�sL =pv ssautsng um=s •S•fl aq4'ggfm nox -T, Tue) aotnxas anuanall FMa}ul aq4 pe4.uoo'naul lezapa; zapun suogatlgo .moX 4noge uot}u=o;ttt Quads azoui zo3 •aouemsui uopesuadtuoo s1wixom of padsax gauti snozzas J(jlepadsa axe s)lsu asagj pue 'suo7ga-qqo asatp ono L= 4ou op noiS;t noX zo; sxsrz pn ueug aq Xmn azatlL suot}ngl4uoo uogesmduzoo luau udolduraun pue 's4soo aouemsut tltgesTp'aouemsuc uot}esuadtIIoo. ,siaxzom'saxe} 24z as Imos lezapa;'2urplogq�tna xe� a►uooui lezapa; pue ams Stgpupui suope.2tlgo lezanas o} Pa. axe no�S pue zaXoldura ue se 4uatatuaao,9 lezapa; pue a4e4s atp q}tM zajsdaz 4snm noX'zaXoldma ue axe noX }I nSolclma ue aq Xzm noX uag4 sxope:quOJgns zo s3oPv-4uoJ se pasuao. 4ou axe suosxad gons pue 'pa[ozd ax4 a ag+ zo; azotu zo OOZ$ st (s;soo zaq o pue gmua4euz 2utpnlauc) xxom atp pue 'Xlu=j a}utpauxtnt zaoX uu�. xagjo suoszad Sue a2u2ua asrnnzaq4o zo Xoldura noX jj uot}oaloxd pue 1. auaq mod xoj uogv=opn.2uWjjo; aq; jo azenae aq pjnogs noX'pez;uoogns o4 ueld noxi jrq4 sape4 sno=jo uot}daoxa age tptna'3[ At utvi n Sop o� uqd no 3I •dldde i(alp gonjm zo; s;tuzrad Ne uo xagi=u asuaotl xpip;nd o; Haul Sq pazmbax osle axe fagL •.S unoa lo,,4p atp moi; asuaotl ssautsnq L, aneq of pue rpmoy.leD jo a;i4S aq; Xq papuoq pue pasua:)q aq of Alin Sq pazmbaz axe szo}o'az4uOD •auieu rag zo snl tit �tuzzad xadozd atj� zo; satldde uoszad �eLl� }tt[Lgeil algtssod uio r; }Taszno�S �oa�ozd near noX '}jasxnotS ueg4 sai.Ro auoatuos Sq pauuo;rad 2uraq sc xzoris moA jj -4zona unao zrag} 2upuzo;rad XlIeuosrad axe Xaqj ssalun szautAo X4zadozd Xq paints aq o4 pannbaz }ou axe s-4pzmd 2u7pjmg •4tuuad a gans uo pzooax;o Ljxed alglsuodsaz atp axe no,S zappmq zamwo se Imp axenae aq pinogs noX uopoajozd mo i zo3 •par,;nads s4uauranoxdun Xjxadozd aqp ;o xaplmq atj� se }Iasmod �ugstj aumu mo. i to pa:qu uaaq sett �tuuad �i�tpjmq e zo; uot}eotldde uv :zau mo X:zadox�j xeaQ SME -LLL 80; :auoga V 1 l i d I d I I anuaev azzoy 00£OL AO A.1.1J luau4zEdaQ 2urping ougmdnJ;o IWD OWNER -BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: A. — All the work authorized by this permit B.portion of the work C None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. --,,All of the work B. V A portion of the work (complete section below) Contractor Address/City. Phone # State License # Type of work to e (Liod 2'--( 6 p �j� c � 6— S-7Ojt( J � 3. V I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. PersorVFirm Address/City Phone Number Type of work to be erformed AA 40 IN �G p �j� c � 6— S-7Ojt( J � I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner -Builder Information (reverse side). Property Owner's Signature: C Date: G[2-1 a Job Address: 0 y dr b 9 Z, . ttil�c��, �'/�" Permit # q 0;;C), 6 2_ Anv changes to the. information provided on this form shall be submitted to the Citv of Cupertino Build Department. IN CITx OF CUPERT O BUILDING DIVISIONPERMIT ..k:%iii:: ..,, vv BUILDING ADDRESS: PERMIT NO. 20800 VALLEY OWNER'S NAME: ,6 PERMIT ISSUE DATE 2 8 8 9 PIONPS Skf4ftft CONTROL NO. ARCHTIBCTIENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH o a o 0 LICENSED CONTRACTOR'S DECLARATION 9 ,lob Description 1 hereby affirm that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Coda. and my Ircensc is in full form and effect INSTALL WASHER/DRYER UNITS IN APTS—INCLUDES License Class Lic. N Date Contractor E/M/P' S—SEE PERMIT #09030198 FOR PLAN CK ARCHITECT'S DECLARATION' 1 understand my plans shall be used as public records COMMENTS . ( DOUBLE FEES) Licensed Professional OWNER -BUILDER DECLARATION.. I hereby afThrn that I am exempt from the Contractor's License Law for the following reason. (Section 70315, Business and Professions Cada: Any city or county 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 sighted statemant Law'(Chapte 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Contractoes License (commencing with Section 7000) of Division 3 of th° Business and Professions Code) or 1 0 that he is exempt therefrom and the basis for the alleged exemption. Any violation o[ APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mom than five hundred dollars (5500) 32609040.506 ❑ L as owner of the property. or my employees with wages as their sale compensation, Re uired Ins ections 9 P will do the work.and the structure is not intended or offered forsale (Sec. 7044. Business 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 workbimaelf or tlmngh his own employees, provided tre that such improvements anot intended oroffered far sale. If, however, the building or improvement is sold within one year of comPletim.-the owner - builder will have the burden of proving that he did not build or improve far purpose o[ �sa as owner of the property. am exclusively contracting wilh.fiamad.conuactors to O construct the project (Sec. 7044. Business and Professions Cmdn) The Caotraeto's Ir - 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 Comraetoes License Law. C3Olam exempt under See , B tit P C for maven Owner O1MM— Date WORKER'S C MPENSAMON'MECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure far WorkeesCompen- sation, as provided for by Section 3700 of the Labor Cote, for the performance of the work for which this permit is issued ❑ I have and will maintain Worker's Compensation Inauratee: as required by Section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number arm Cartier. Policy No.: CERTIFICATE OF EMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit Is foram hundred dollars ($100) or Icsa) 1 certify that in the performance of the won c for ich this permit is issued I shall not c o bjrFt!r Workers' Compensation employ any person in any manner so asla m � Laws of California Aa e 7 U - Applicant ^+"'�'-��� NOTICE TO APPLICANT: If, after making this Cettificam of Etiampdm you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this pcsT. shall be deemed revoked. ' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agony for the performance of the work for which this permit is issued (Sec. 3097, Civ. C) Lender's Name Landee Address 1 certify that I have read this application and state that the above information is correct. l agree to comply with all city and county mdinancrs and state lays relating to building construction, and hereby authodre representatives of this city to enter upon the for inspection ? above-mentioned property purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against j 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 Issued by: Date SOURCE REGULATIONS. 3 I <Vy_ ^l ✓�„� - to bQ Re -roofs of Roof Signet m of ApplicanUContrador 1134 1 HAZARDOUS MATERIALS DISCLOSURE IType Will the applicant or future building occupant store or handle huardous material as defined by the Cupertino Mum -pal Code, Chapter 9.12• and the Health. and Safety Code. Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes No If a roof 1S installed without first obtaining an inspection, I agree t0 remove Will the applicant or f°turc building Occupant use equipment or devices which emit haardous air contaminants as defined by the. Bay Area Air Quality Management all new materials for inspection. District? [I Yes U^° 1 have mad the harsrdous materials requirememts under Chapter 6.95 of rice Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 undersand that if the building docs not currently have a tenant, that it is my responsibility tonotify the t of the mq°xj�� wm� be"'atp rtoyanc� rN�^ ax°°r Signature of Applicant Date Uta g 6 0 �r All roof coverings to be Class'n" or better Owner or authorized agent 1521c /..a, CITY OF CUPERTINO CITY OF CUPERTINO GENERAL. BUILDING PERMIT APPLICATION FORM APN# v` Date: Building Address: / �0 V6, g� 1 e Mailing Address (if different fr an building address): Owner's Name: U � � Phone #: HOA: (Exterior work only) Yes U No % If yes, provide letter from HOA Contractor: T 9 Phone: Fax:. Contractor License #: Cupertino Business License #: Contact: ,A� Phone: Ltd!�, Fax: '173 - 102,5 - Residential Commercial ❑ Job Description: O wt CA -L eV -C-( ! a./�(,�tevt`� 13✓ 11c) i �`rS `s Building Permit Info: Bldg Elect Plumb Mech L� Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B z- A— 2 - Valuation: /00, Square Footage: Project Size: Express ❑ Standard u Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the applicatiolh or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.org Revised 02/05/09 CITY Of CUPEkTINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) additional stucco application B 1 WINREP Replacement windows/sliding glass door (ea 8 windows) B 1 WINMEWSTR New Window -structural shear wall/masonry.(includes plan ck fee) B �j j� 1EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE 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 1 PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min when not over counter) Standard Plan Check (when no E/M/P) hourly -stand alone B 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES /X 1`\ 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel & Documentation B 1BUSLIC Business License B 5 of 5 City of Cupertino Building Department I pCITY OF (� 10300 Torre Avenue C U r E k I IjO Phone: (408) 777-3228 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner -builder you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally performing their .own work If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner -builder building permit, erroneously implying that the property owner is providing his or her own labor and -material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or. at 1020 N Street, Sacramento, California 95814. , Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino Printed on Recycled Paper OWNER -BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: A. _ All the work authorized by this permit B. _ A portion of the work C None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A.of the work _B. A portion of the work (complete section below) Contractor Address/City. Phone # State License # Type of work to 2 3. ZI will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be rmed P •e c, S -S3 eZ5Z5 U �G C G (- Zo6 70q I declare -under penalty of perjury that the above is true and correct. I have read and understand the Owner -Builder Information (reverse side). Property Owner's Signature: Date: 612,401 Job Address: Q09 00, V'oa:i!:tt qM-¢-L,�'�!.�`J�� "AO� Permit # 09 d W 136 Any changes to the. inf ormation provided on this form shall be submitted to the City of Cupertino Build Department. CITY OF CUPEK-EINO :, m BUILDING DIVISIONPERMIT BUILDING ADDRESS: 20975 VALLEY GREEN DR #254 — OWNER'S NAME: NORFT FC1T=ATTnN PHONE: ARCHITECT/ENGINEl7t: O c LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Ctiapter 9 (commencing fl with Section 7000) of Division 3 of the Business and Profeasiom Code, and my ficemc is !' y in full force and effect. t v� Z License Class Lic. ti t O DateContractor ' ARCHITECTS DECLARATION i to I understand my plans shall be used as public records >96 r a h Licensed Professional e y OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from elm Contractor's Liccaae Law for the .in o following mason. (Section 70313. Business and Professions Code: Any city m county e which requires a permit to construct, alter, improve, demolish, or tephir any st"m a Z y prior to its issuance, also requires the applicant for auclirpgrmitto file a signedstalemcm o that he is licensed pursuant to the provisions of the Coo)racioei Lkense Law (Chapter 9 e t- (commencing with Section 700M of Division 3 of time iiia ss and Profusions Code) or that he is exempt therefrom and the basis for tbe:a5leged eta option</lxty violadon of Section 7031.5 by any applicant for a permit subjects the ippIlMl. to a civil penalty of not more than five hundred dollars (5500). ❑ I uowner of the property. or my employees vrages`aa their sok eomperaadon will do the work, and the structure is notimended oroNered forsale (Sec 70K Business and Professions Code: The Contractees License Laav,does not apply to of property who builds or improves thereon, and who does suchmar thueselforthmugli his own employees, provided that such improvements are not )tiknded oroffared forsale.. If; m . however, the building or improvement is sold withinro oyear o(imapletit ,the owner. builder will have the burden of proving that he did "ret h idil'orhnprow for ptirpme of saki I. as owner of the property, am exclusively eordmC ttgawith 11cenxA connetors to construct the project (Sec. 7044. Business and Prot evsians,code:).Tba coetracroes Li - erose Law does not apply to an owner of property'who builds or 6proms thelegn. and • who contracts for such projects with a conuactor(a)I rtsEd pursuant to theContrkwes License Law. ❑ I am exempt under See. - o q , B dx P C for Oil sawn Owner51 li WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following di!dsryiont ❑ I have and will maintain a Certificate of Conwntle self,-ituure tarwadwes Compen- sation, as provided for by Section 3700 of the Labor. Code for the'porfa mance'of time work for which this permit is issued ❑ I have and will maintain Worker's Compentudon'Iawrxiere, as nq med by Section 3700 of the tabor Code. for the performance of the worifor which this permit turbaned. My Worker's Compensation insurance carrier and 'Policy number am: Carrier.PolieyiNo: CERTIFICATE OF EXEMPTION FROM WOR_ KERS' COMPENSATION INSURANCE' (This section need not be completed if the permit is fdrow huodmildayars ($10W) or less.) I certify that in the performance of thq work for which this permit 191 ssued.shall not employ any person in any manner k ec m jb "the Iht Workers"Cahpentatiat Laws of Catifomia. D ^ Applicant _r NOTICE TO APPLICANT: If, after mating this Cero cath &I kkcmpdon,, yeu Should become subject m the Worker's Compensation ptovtsion of the Labor Code. -you main ,J Zforthwith comply with such provisions or this peered shall boaleemed tevoiod: O Z ►r CONSTRUCnON LENDING AGENCY (~—t rA I hereby affirm thin there is a constructionknidng agency for the performance of ai > the work for which this permit is issued (Sec. 3097, Cv. C.). W Q Lender's Name Z Lenders Address U O 1 certify that I have read this application and'state thatthe;above information is LLEconect. I agree to comply with all city and county oididinces and stale laws relating to U building construction. and hereby authorize mpresx:otaiives of this city to cntor upowthe U above-mentioned property for inspection purposes (We) agree to save. indemnify and keep harmless'the City of Cupertino against HrA liabilities, judgments, costs and expenses which may in any izsy Aceme against said City U `Z in consequence of the granting of this permit - �-i APPLICANT UNDERSTANDS AND WILL COMP6Y WITH ALL NON -POINT SOURCE REGU TIONS. n,,,, 4n__ _1 n I n f h6 PERMIT NO. nqn-ini 2o PERMIT ISSUE DATE el SA R CONTROL BURRING PERMIT INFO BLDG ELECT PLUMB Job Description INSTALL WASHER/DRYER UNITS IN APTS-INCLUDES E/M/P'S—SEE PERMIT #09030198 FOR PLAN CK COMMENTS. Floor Area 32609041.254 Issued by: Re -roofs HAZARDOUS MATERIALS DISCLOSURE. ' Type of Roof Will the applicant or future building occupant stow, or fisndle harardons material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Hcalthand Safety Code, Seven 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yu ❑No Witt the applicant or forum building occupant use aquipmcot m devices which If a roof is installed without first obtaining an inspection, I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes ONO - I have mad the hazardous materials mquitctnents pnderCbapter&95 of the Califor- nia Health & SafctyCodc. Sections 25505.25533 am425534. i understand then(tltn tiuildng does not currently have a tenant that it is my rupcnsihililptonotify die oxopent'of the 'W,='whia ••�' era cen4hate efoc .Signature of Applicant Date ) '�'''"� 151 1 � � All roof coverings to be Class'n" or better rt 100 Date 5, V. r ai;of CUPERTINO CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM 6 D301a6 APN # 2 Z6 _ � — � � r Date: Building Address: D q7 S V, G �� V� �� �• 2 Mailing Address (if differe t from building addr ss): cr L -S. P Owner's Name: p / LI-e-4- Phone #: HOA:(Exterior work only) Yes U No ( 0 0 2-00 If yes, provide letter from HOA Contractor: / Phone: Fax: Contractor License #:� Cupertino Business License #: Contact: Phone: t_( o g�_ 25 -'76 q3 - Fax: Llog- % oZS- Residential Commercial Job Description: s(cpe- Ap, (A TS Building Permit Info: Bldg [� Elect Plumb Mech Lf Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B Valuation: 106 Square Footage: Project Size: Express ❑ Standard V 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 02/05/09 CITY OF CUPEkTINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) additional stucco application B 1 WINREP Replacement windows/sliding glass door (ea 8 windows) B 1 WINMEWSTR New Window -structural shear wall/masonry (includes plan ck fee) B 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 Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min when not over counter) Standard Plan Check (when no E/M/P) hourly -stand alone B 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1TRAVDOC Travel & Documentation B 1BUSLIC Business License B �(z atLn (?,Cce- P (�* 1P iN7 5 of 5 City of Cupertino Building Department CITY OF 10300 Torre Avenue C U P E R T I NO Phone: (408) 777-3228 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner -builder you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect vourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other cosh) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations iruluding state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner -builder building permit, erroneously implying that the property owner is providing his or her own labor and -material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or. at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino Printed on Recycled Paper OWNER -BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: A. _ All the work authorized by this permit B. portion of the work C. one of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. _ �A portion of the work (complete section below) Contractor Address/City. Phone # State License # Type of work to Ue O✓✓p c✓ WeZw b G ✓ vot (✓ e 9- -CRIAZ 916 3. V I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be ormed �-3 l - S"3 f - EzS J �c I declare -ander penalty of perjury that the above is true and correct. I have read and understand the Owner -Builder Information (reverse side). Property Owner's Signature: C `� Date: 6 �� Job Address: 0 s 'V dr 1254 �t�,'no�Gq- Permit# 0 1030t2y Any chan-ges to the. information provided on this form shall be submitted to the Citv of Cupertino Build Department. �r CITY OF CUPERTINO { ;< BUILDING DIVISION PERIVIIT- BUILDING ADDRESS: PERMIT NO. 20975 VALLEY GREEN'`DR #278 ED 1 3 2 OWNER'S NAME: � ( PERMIT ISSUE DATE PHONE: S CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 a 0 i p g LICENSED CONTRACT'OR'S' -DECLARATION v 1 hereby affirm that I am licensed under provuiaos'or Chtpter 9 (commencing ? q� with Section 7000) or Division 3 of the Business and Professions Code, and my license is y in full fora and effect. License Class. Lic. 8 ;;:,m DateContractor C ARCHITECT'S DECLARATION eexP� I understand my plans shall be used as public mc&ds: e a y Licensed Professional � y 3 OWNER -BUILDER DECLARATION` T hereby affirm that 1 am exempt from rho Contractors License Law for the in ofollowing reason. (Section 70315, Business and Professional Code: Any city or colony e o e which requires a permit to construct. alter, improve, demolish, or repair any stntctum o Z } prior to its issuance, also requires the applicant for such permit to file a signed statement = G that he is licensed pursuant to the previsionsof the Contractor's Liccnx;Law (Chapter 9, g [- (commencing with Section 7000) of Division 3 of the Business and Profetiaions Code) or e; g that he is exempt therefrom and the basis for the allegedgumption• Any violation of Section 70315 by any applicant for a permit subjeeta Uig applicant to acivil penalty of not more than five hundred dollars (SM ❑ I, as owner of the property. or my empioyces with stages as -heir sole compensadon, will do the work, and the structure is not intended or offered tarsale (Sec. 7044: Business and Professions Code: The Contractor's License Lawodoesnot:apply to.sit-owner of property who builds or improves thereon, and who daeastiehvvor'lihimael[arthihugh his . own employers, provided that such improvementsare not intended oiolfemd fors ik. If. however, the building or improvement is sold within one year:ofcompW914 die owner - builder will have the burden of proving that he did not build or improve for purpose ;of ser y L as owner of the properly, sic exclusively eoouacting with licensed contractors W convect the project (Sec. 7044, Business and Piefessiont Cade:) lira Coodactm'sLl- cense taw does not apply to an owner of property who builds'or improves theteon, and who contracts for such projects with a cenaactoKs)'Ikensed pursuant to the contractors License Law. . ❑ I amt under Sec. B & P fm town Owner exem Data WORKER'S COMPENSAMON DECLARATION I It I hereby affirm under penalty of perjury one of:the- following declarations: ❑ 1 have and will maintain aCerLificateofcomnt6,riclf-iisum forworimescompen- 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 Compensaliop Inmwmeas icgrdmd>byStxtion 3700 of rite Labor Code, for the performance of "46rk for which'this permit is issued My Worker's Compensation Insurance carrier acrd Poliey'nmobcvam: Carrier.Policy No.. CERTIFICATE OP EXEMPPIO14.0ROM•WORKERS COMPENSATION INSUAANq (This section need not be completed if the peiath is ro_rone hundrbd dollars (5100) or Ices) I cenify that in the performance of 14c we ror.wluclt this permit Ts issued. I shall not employ any person in anymannc e b o jgc} is Ince Workers' Compensation Laws of Cali ra i . Date Applicant NOTICE TO APIROCKNM If, after making this certificate of Exemption, you should become subject to the Worker's Compensation pmvisions`.of the Labor Cade you must O forthwith comply with such previsions or this permit shall be deemed invoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of ptS the work for which this permit is issued (Sec. 3097 Civ. C-) W A Lender's Name — z Lender's Address U O 1 certify that I have read this application andA to that the above information is LL ►-h comcL I agree to comply with all city and cormty ordinances a d state laws relating to Vbuilding convection, and hereby authorise represemadvgs of Ytis cilym enter upon the W above-mentioned property for inspection purposes (We) agree to save, indemnify and keep hamrltss the City of -Cupertino against y liabilites, judgments, costs and expenses which may in ihry'way.accrue agairW said City U z in consequence of the granting of this permit. 0'+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH NON -POINT S R GU ONS. Si of App licant/Conuacmr HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant stare err handle havatdous material as defined by the Cupertino Municipal Code, Chapter 9:12. grid M Heahb and Safety Code, Section 25532(a)? _ ❑ Yes INN. Will the applicant or future building occupant fisc oquipmgntor devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑Yes �o 1 have read the hazardous materials requirements under Chapkr6.95 of the Califor nia Health & safety Code, Sections 75505, 25533 and 25534.I:tinderstand thatirthe,building does not currently have a tenant. that it is my respcmibility-lo:notify We occupant of the rcquuc w�h gstnmeroof A� Owner or authorized agent bate Job Description INSTALL WASHER/DRYER UNITS IN APTS-INCLUDES E/M/P'S-SEE PERMIT #09030198 FOR PLAN CK COMMENTS. Sq. 32609041.278 f6 -T Issued by: Re -roofs Type of Roof Area 100 Required Inspections Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date . All roof coverings to be Class's" or better ciTr of CUPERTINO CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # 3 Z6 -Date: - 0 � I Date: Mo./C-L ZO 20O Building Address: O � � � h /� i j� � ✓��� �L 2 � Mailing Address (if differt from building addr ss): ?Q vt, e - Owner's Name: Phone #: HOA: (Exterior work only) Yes U No 0 0 2-00 If yes, provide letter from HOA Contractor: Phone: Fax: Contractor License #: Te 10 Cupertino Business License #: Contact: �a Phone: Y o $- 25Z-7643 Fax: L[og'- 02S Residential Commercial Job Description: 1:S4-1( Building Permit Info: Elect Plumb '/ Mech Bldg bZ/"- Lr Type of Construction (Usage Class): Occupancy Type: 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B [� /4-2- 4-2Va1-A, luation: 106 Square Footage: Valuation: 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 02/05/09 CITY OF CUPEi�TINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf additional stucco application B 1 WINREP Replacement windows/sliding glass door (ea 8 windows) B 1 WINMEWSTR New Window -structural shear wall/masonry (includes plan ck fee) B 1EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P l ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1 PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min when not over counter) Standard Plan Check (when no E/M/P) hourly -stand alone B 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B n ` 1 TRAVDOC Travel & Documentation B 1 BUSLIC Business License B C� 5 of 5 City of Cupertino Building Department I [Cf Y OF f 10300 Torre Avenue C V 1 E R�' I N! Phone: (408) 777-3228 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that.as owner -builder you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their .own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they, apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your. immediate family, and the work (including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. 'There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish,. the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner -builder building permit, erroneously implying that the property owner is providing his or her own labor and -material personally. Building permits. are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community.or:at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed own6i-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly y yours, Building Department, City of Cupertino Printed on Recycled Paper OWNER -BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform A. _ All the work authorized by this permit B.portion of the work C. None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A._ All of the work B. 7Z A portion of the work (complete section below) Contractor Address/City. Phone # State License # Type of work to 0 CM 01 - ( AW 39111 F Maoa* 61J4 510 L490 4411 a- 4 KLLM6-' �tz�S Ne�eYk, CA' 3. �I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner -Builder Information (reverse side). Property Owner's Signature: G1 Date: 6l l o f Job Address: jg&ff It:�n, ,th �ne eA Permit # O q 0 W1 `3 2 LIK Anv c anees to the information provided on this form sha11 be submitted to the Citv of Cupertino Build Department. ..Type of work to. - performed ���II,RfiY1 ♦��� I �I I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner -Builder Information (reverse side). Property Owner's Signature: G1 Date: 6l l o f Job Address: jg&ff It:�n, ,th �ne eA Permit # O q 0 W1 `3 2 LIK Anv c anees to the information provided on this form sha11 be submitted to the Citv of Cupertino Build Department. CY OF CUPERTINO n�,� T BUILDING DIVISION PEPMl 20875 VALLEY GREEN DR 499' OWNER'S NAME: RFT F'flTTT71lAT���- PHONE: ARCHT=iENGINEER: a LICENSED CONTRACTOR'S DECLARATION ulI hereby affirm that I am licensed under provimoes,of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prur6dom Cade. srid my license is v. in full force and effect Z License Class Lie. g . Date Contractor ARCHITECTS DECLARATION g< I understand my plans shall be used as public records to u. y Licensed Professional OWNER -BUILDER DECLARATION j < I hereby affirm that i am exempt from the Contractor's.•Ltcettss Law for the 0 o following mason- (Section 70315, Business and Professions Code Any city or county m which requires a permit to construct. alter. improve, demolish. or repair any,*ructure z y prior to its issuance, also requires the applicant for such per mile a signed statement i =Q that he is licensed pursuant to the provisions of dee Contractor's License Law(Chapter 9 i t— (commencing with Section 7000) of Division 3 of the Business and Professions Codc) or RE that he is exempt therefrom and the basis for the dicjW dmnpdmr. Anyviolatfon of Section 70315 by any applicant for a permit subjects the applipriito a, civil penalty of not more than five hundred dollars (5500). ❑ L as owner of the property, or my employes with wages as their sole compensation. will do the work, and the structure is not intended or dflered torsade (Sec. 10". Business and Professions Code: The Contractor's License law dodi'doi apply to an owner of property who builds or improves thereon, and who does such work himself0f tluosgti his own employees, provided that such improvements ;aie itotintended or offered for lair- If. however, the building or improvement is sold within one yeer"of completion- die owner- builder,wilt have the burden of proving that he did not build or improve for purpose of i k I. as owner of the property, am exclusively contracting with licensed contractors to nstruct rhe project (Sec. 7044, Business and Pmfesalmts Coda:) The Contractors [ i cense Law dens not apply to an owner of property who 'builds'mr improves; doom and who contracts for such projects with a contractor(s) liaedsed putsaantto die6milaeroes License Law. ❑ I am exempt under SS(e�e / ,,8 do PSC fim mson Owner t P �/i..t J iL (/fN-�— Date �L WORKER'S COMPENSATION DECLARATION !F I hereby affirm under penalty of perjury ons of thadollowing declarations: ❑ I have and will maintain a Certificate of Consent to selr iasum fa 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 thewoik ferwbiahldibPermit is issued My Worker's Compensation hwxrance carrier and Policy number are: Cartier. Policy No.• CERTIFICATE OF EXEMPnON FROM WORKERS' COMPENSATION 1NSURAIsCE (This section need not be completed if the permit is taste hgndred dollars 15100) or less.) I certify that in the performance of the work f r which this permit -is RaructL I shall not employ any person in any manner tphec mf s et to die Workge Compensation Laws of California. 4�m /c NOTICE TOApplicant - APPLICANT. If, after making this Certificate' of Exemption. you should become subject to the Worker's Compensation provisions Of the Labor Code-. you must O forthwith comply with such provisions or this pesmil shall hc'dxmed revoked r CONSTRUCTION LENDING AGENCY r ►�-� I hereby affirm chat fiere is a construction lending agoney;for ttie performance of Y. e% the work for which this permit is issued (Sec. 3097, CIV G) QLender's Name ,z Lender's Address 0 I certify that 1 have read this application and stale that the above information is L tr correct I agree to comply with all city and county ordinances and swe laws relating to building convection, and hereby authorize represeeulivcs of.di s city to catarupon the �4 W above-mentioned property for inspection purposes (We) agree to save, indemnify and keep harmless the City of Cupertino against raj! liabilities, judgments, costs and expenses which may m any way;'aeane against said city `Z' in consequence of the granting of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH A�LL NO_N-PnOINT SOURCEAS.IG 1 D41, Signature of Appiicant/Conuractor HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupmtstom err bindle harardons malarial as defined by the Cupertino Mum pal Code. Chapter -9.12, ind'the Health and Safety Code, Section 25532(a)? ,� [/q_ ❑ Yes"v Will the applicant or future building occupant use equipment or d6vixes which emit hazardous air contaminants as defined by the Any .Arm AWQmdily Management District? & ❑ Yes �iV0 1havereadthehazardousmaterialsmquimmwntsund tampler¢.950ftheCaliror- docs not currently have a tenant that it is my reouvements whicbhiusl be met micUd issue ,"V[IX A,,f o�� e' S Owner or authorized seem Job Description INSTALL WASHER/DRYER UNITS IN APTS-INCLUDES M/E/P'S-SEE PERMIT #09030198 FOR PLAN CK COMMENTS. Floor Area 32609064.99 Issued by: Re -roofs Type of Roof Required Inspections Type Date 5. to, U All roofs shall be inspected prior to any roofing material being installed. If'a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class %" or better PERK!" NU. PERMIT ISSUE DATE 2 a a 9 S R W CONTROL N0. BUILDING PERMIT INFO BLDG ELECT PLUMB 0 0 a Job Description INSTALL WASHER/DRYER UNITS IN APTS-INCLUDES M/E/P'S-SEE PERMIT #09030198 FOR PLAN CK COMMENTS. Floor Area 32609064.99 Issued by: Re -roofs Type of Roof Required Inspections Type Date 5. to, U All roofs shall be inspected prior to any roofing material being installed. If'a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class %" or better CITY Of CUPEkTINO CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM AYN #Date• v - - - �26- O � - 0 6 q , q q 2o, :?60 Building Address: Mailing Address (if different fro buildind address): Owner's Nar--- - ko�re4- Fe j- L4 j-j'rA., Phone #: u HOA: (Exterior work only) Yes U No [X L4 Z �� If yes, provide letter from HOA Contractor: T ED Phone: Fax: Contractor License #: Cupertino Business License #: Contact: Phone: �) o ',Z 52-76 q Aq.���c� �v��ue� Fax: y dsl- ey- 3 - /0 ZS Residential Commercial ❑ Job Description: Building Permit Info: Bldg M' Elect Plumb Mech 12/ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV -HT, V -B ('1 Valuation: Square Footage: too Project Size: Express ❑ Standard El" Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the applicatioif or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen,.org Revised 02/05/09 CITY Of CUPERTINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) additional stucco application B 1 WINREP Replacement windows/sliding glass door (ea 8 windows) B 1 WINMEWSTR New Window -structural shear wall/masonry (includes plan ck fee) B IEPERMTFFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMrFFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pfn Ck (hrly) P 1 STPLNCK-(3 Hr Min when not over counter) Standard Plan Check (when no E/M/P) hourly -stand alone B 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES /]( 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel & Documentation B 1BUSLIC Business License B 5 of 5 City of Cupertino Building Department CITY OF (� 10300 Torre Avenue C I P S (� T I N J Phone: (408) 777-3228 Dear Property Owner. An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner -builder you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their.own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be financial risks for you if you do. not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law, contact the Internal. Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner -builder building permit, erroneously implying that the property owner is providing his or her own labor andmaterial personally. Building permni-ts are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community.or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino Printed on Recycled Paper OWNER -BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform A. _ All the work authorized by this permit B. _ A portion of the work C None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. -Lz' A portion of the work (complete section below) Contractor.. .. to be performed 01I 1I [oa, MITI. Ill:- .� . G'C��1'i*�}!►.� , r , 1i� : RX, ���►. i 1._ VMIMFMV rd� - �,• ���... MAMMI-01MIMMA M- 3. Z I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. ,� ..................................................................................................................................................................................... I declare under peT+�liy, of perjury that the above is true and correct. I have read and understand the Owner -Builder Information (reverse side). A/Lo Property Owner's Signature:Date: Job Address: �0a:K V O(If.GA M0 Permit # O l d 3OI 9S Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. . .. to be performed 01I 1I [oa, MITI. ���►. i 1._ VMIMFMV rd� - �,• ���... ,� ..................................................................................................................................................................................... I declare under peT+�liy, of perjury that the above is true and correct. I have read and understand the Owner -Builder Information (reverse side). A/Lo Property Owner's Signature:Date: Job Address: �0a:K V O(If.GA M0 Permit # O l d 3OI 9S Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. . u00 m °Z �Fo �aL ;u'u +COQ rarry— yapC 0 —?a zFC CITY OF CUPERTINO,�s}.�bz BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 20875 VALLEY GREEN DR #95 — OWNER'SNAME. / , l � '� PERMIT ISSUE DATE u 9 9 PHONE: A CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH M o 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 of Ute Business and Professions Codc, and my license it in full force and effect. INSTALL WASHER/DRYER UNITS IN APTS—INCLUDES License Class Lic. S Date Contractor M/E/P' S—SEE PERMIT #09030198 FOR PLAN CK ARCHITECTS DECLARATION I understand my plans shall be used as public records COMMENTS. Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following mason. (Section 7031.5, Business and Professions Code: Any city or county 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 signed statement Contractor's license Law (Chapter 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the (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 1 O 0 APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). 32609064 .95 ❑ f, as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work. and the structure is not intended or offered for sale (See. 7044, Business and Professions Code: The Contractor's License.Law docs not apply to an owner of 9 P property who builds or improves thereon, and who doessuch work himself or through his own employees, provided that such improvements am notimmnded oroffered forsale. 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 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 tothe Contractor's License Law. ❑ I am exempt under Seo. B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Workees 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 3700 of the Labor Code, for the performance of die work for which this permit is issued My Worker's Compensation Insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit'iaforone 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 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 mus ' forthwith comply with such provisions or this perTilshall be deemed mvoked. ' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. Q Lender's Name Lender's Address 1 certify that 1 have read this application and state that the above information is " correct. I agree to comply with all city and county ordinances and stale laws relating to " building convection, and hereby authorize representatives of ft city to enter upon the above-mentioned property for inspection purposes (We) agree to save, indemnify and keep harmless the City of Cupertino against a liabilities,judgments, costs and expenses which may in any way accrtmagainst said City in consequence of the granting of this permit y APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. C7 Re -roofs Type of Roof Signature of ApplicanUContractor Dale HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant stem or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code. Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ONO If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or forum building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes ONO I have read the hazardous materials requirements under Chapter 6.95 ofthe Califor- nia Health & SafetyCodc, Sections 25505, 25533 and 2.5534.1 understand thatif 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 issuance of a Certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class "A." or better Date ' Owner or authorized agent " TY OF CITY OF CUPERTINO CUPEkTINO GENERAL:BUILDING PERMIT APPLICATION FORM APN #[ r -3-z c <::(-_' 0 `f �� Date• G O Building Address: % Mailing Address (if different fro buildin address): Owner's Nar--- - koi,r - Feouac ` Phone #: (`C" HOA: (Exterior work only) Yes U No IX ' J L] o � If yes, provide letter from HOA Contractor: Phone: Fax: Contractor License #:a Cupertino Business License #: Contact: j f l,,.c� c l �v'� �ei�' Phone: 9 o� x.52 764/3 Fax: L{ dS- l 3 - iG ZZS- Residential D Commercial Job Description: ;,; 6 c, Pim. (,- e ✓'C(u Ara-/ eel 9,, Building Permit Info: Bldg Nf Elect 91, Plumb Mech Lid' Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ IUIII/V-A ❑ IUIII B, IV -HT, V -B [ A -Z Square Footage: Valuation: 100 Project Size: Express ❑- Standard E�( Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the applicatioif or if applicable, include in plan set & the sheet index. Points Achieved: For help, contact Build it Green at www.buildilgreen ore Revised 02/05/09 CITY OF CUPEI�TINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1 GENCOM 1STUCOAP Stucco Applications (up to 400 sf) additional stucco application B 1 WINREP Replacement windows/sliding glass door (ea 8 windows) B 1 WINMEWSTR New Window -structural shear wall/masonry (includes plan ck fee) B 1EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1 PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK=(3 Hr Min when not over counter) Standard Plan Check (when no E/M/P) hourly -stand alone B 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1TRAVDOC Travel & Documentation B 1BUSLIC Business License B 5 of 5 City of Cupertino Building Department CITY OF 10300 Torre Avenue C U P S" L' 1 NJ Phone: (408) 777-3228 Dear Property Owner: An application fora building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner -builder you are the responsible party of record on such a permit. Building permits,are not required to be signed by property owners unless *they are personally performing their .own work. If your work is being performed by someone other than yourself, you may protect vourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' °compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice. of unlicensed persons professing, to be contractors is to secure an owner -builder building permit, erroneously implying that the property ower is providing his or her own labor and -material personally. Building permits are not, required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in yourr community.or. at 1020 N Street, Sacramento, Califon -da 95814. Please complete and return: the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The}building permit will not .be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino Printed on Recycled Paper OWNER -BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: A. — All the work authorized by this permit B. A portion of the work C. None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. A portion of the work (complete section below) Contractor.. ..Phone Number. . performed MGMNOW�= , • .. .... . 3. Z I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. I declare ender penalty of perjury that the above is true and correct. I have read and understand the Owner -Builder Information (reverse side). ALProperty Owner's Signature: Date: Gko f Job Address: &UxR 1 taw AAtye, * 99 "6IU. C� Permit # a q o 3 0 Anv chances to the. information provided on this form shall be submitted to the City of Cupertino Build Department. ..Phone Number. . performed , • .. .... . I declare ender penalty of perjury that the above is true and correct. I have read and understand the Owner -Builder Information (reverse side). ALProperty Owner's Signature: Date: Gko f Job Address: &UxR 1 taw AAtye, * 99 "6IU. C� Permit # a q o 3 0 Anv chances to the. information provided on this form shall be submitted to the City of Cupertino Build Department. CITY OF CUPERTINO- BUILDING DIVISION " �L1s1' . R. t> '111,�??,�,, iJ r� - - BUILDING ADDRESS: PERMIT NO. 20875 VALLEY GREEN DR #32 0 BE DE OWNER'S NAME. PERMIT ISSUE DATE PHONE: S A CONTROL NO. ARCHITECTIENOINEER: BUILDING PERMIT INFO BLDG ELECT MECH PET 0 0 0 LICENSED CONTRACTOR'S DECLABAMON lob Description I hereby affirm that i am licensed under proinsons oftChapich9 (commenclog with Section 70W) of Division 3 of the Business and'ProfGado: and mylicense is ` in full force and effect. INSTALL WASHER/DRYER UNITS IN APTS—INCLUDES License CCoontrractor ' M/E/P'S—SEE PERMIT #09030198 FOR PLAN CK ARCHITECTS DECLARATION' 1 understand my plans shall be used as public records ' - COMMENTS. Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contriletoes License Law for the following mason. (Section 703 I.S. Business and Professions'.Code: Any city or county which requires a permit to conswct, alter, improve: damolrsb, or repair any Structure prior to its issuance, also requires the applicant for such permit to file a signed statement ConuactbeiL 14w (ChaPmr9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the cense (commencing with Section 7000) of Division 3 of the Business'and Professions Code) or $100 that he is exempt therefrom and the basis for the alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjecti.die applinnt to a civil peealty of net more than five hundred dollars (5500). 32609064 .3 2 ❑ Las owner or the property. or my employees witti wags as their sok compensation. Required Inspections eat"apply (1 will do we work and the structure is not intended «offered forsale (Sec. 7044. Business and Professions Code: The Contractor's License Law does oto as awner'of P property who builds orimproves themon, and who doeifinkliworki"Wf orthrougli his own employ=, provided that such improvements ate Inctimanded oroQeted.forsak.ff. however, the building or improvement is sold wilhin;onte yatof eampktioo 01e rrwrner builder will have the burden of proving that he did%not brdW'or;improye for purpose of 7) with liaised conlractas to L as owner of the property. am exclusively contracting construct the project (Sec. 7044. Business and ProfessionCa&—) toconhactaes Li- cense Law does not apply to an owner of property who bulids or improves thereon. and , who contracts for such projects with a canractor(s) licensed pursuant to thabontractods License Law. ❑ Inn exempt under See . B cit P C farthis reason Owner gate 5 b bel WORKER'S COMPP.NSAMON DECLARATION I hereby affirm under penalty of perjury one a(dis following dedafations ❑ I have and will maintain a Certificate of Concerto aelf-huare for Worme3 Crmtpen- sation, as provided for by Section 3700 of the Isbor Cade, l r the porfonoarrco bf the work for which this permit is issued. ❑ I have and will maintain Worker's Compensadmi aimanee.`as required. by Section 3700 of the tabor Code, for the performance of the 'woricfer which this permit is issued My Worker's Compensation Insurance carrier and Policy number are: " Cartier. Policy No:: CERTIFICATE OF EXEMPTION FROM WORKERS' . COMPENSATION (This section need not be completed tribe permit ilbrone hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit Is ism" I shall not employ any person in any manic u 4 bo sebysl to Ilse Warlars: Compemadon Laws of Caiifomia. Date -- Applicant .. it A..... 44'42: NOTICE TO APPLICILRf If, after making this' -ertificito of Exemption, you should become subject to the Worker's Compensation provQrmiof the Labor Code yormust forthwith comply with such provisions or this pestnit shall he deemed miniked. " CONSTRUCI•ION LENDING Ab&CY Y i 1 hereby affirm that there is a construction leading agency for the parfannance of: the work for which this permit is issued (Sec. 3097, Civ. C), i Lender's Name Lender's Address I certify that I have read this application and'statd lhauthe ibove ioformadua.is ' correct. I agree to comply with all city and county oN iaaocesaadstate laws•rehtting to building construction, and hereby authorize represismatki of.0us cilyto enter upon the above-mendoned property for inspection purposes. - (We) agree to save, indemnify and keep harmless die City of Cupertino against j liabilities judgmcats, costs and expenses which may in`iny way accrue against said (Sty in consequence of the granting of Ibis permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALLNON-POINT Issued by: Date �, Q SOURCE RE ULATIpNS. t Re -roofs _. Type of Roof AA � 1�n�.�� 5 6 bQ `� Sn ureofApphcamJ0nuactor Date HAZARDOUS MATERIALSsDISCLOSURE Will the applicant or futum building occupant -store or bapole hazardous material. as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety Cork. Section 25532(a)7 Yes U14`0 All roofs shall be inspected prior to any roofing material being installed. 0 If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or mune building accupam use equipment or devices which emit harardous air contaminants as defined by the Bay AicaAirQuality'Managcoant all new materials for inspection. District? - ❑Yes 1 have mad the hazardous materials requitcmentvunderchapter05 of the Califor- nia Health &SafetyCode, Swdom 25505, 25533 and25534.1 unddiiiid d atif the building docs not currently have a tenant, that it is my responsrbBuylo:putify,,* occupant of the; rcg iremcnts wh• h must mel prior to issuance ofa, Certificate of� Signature of Applicant Date Ll 55 1 All roof coverings to be Class "A" or better Date Owner or authorized agent .s'.t, CITY Of CUPEkTINO CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM Ann r2 A I CSU APN # t r v v l 0' -3-26— OC('— 0 `f , z Date:li���L� -2o, 2U� Building Address: O vc-llfel-1 Mailing Address (if different fro buildinj address): Owner's NarnA-/1� - Phone #: � ��� V��CG �(ri4� �V • \ 1 V _ HOA: (Exterior work only) Yes U No Ex y U ZS 3- r -c., If yes, provide letter from HOA Contractor: T6.6 Phone: Fax: Contractor License #: Te Cupertino Business License #: Contact: Phone: L -i ©g X52-_ Fax: y v?- t'? 3- f0ZS Residential Commercial ❑ Job Description: r% �I/l s `l�cc 1 f �%G � I.LQ f/ � � / � ,l�L v � ✓- lt, . Building Permit Info: Bldg if Elect Plumb Mech 12/ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A E] II/III B, IV -HT, V -B Nf A --Z Square Footage: Valuation: too Project Size: Express Ej Standard FV Larae F-1 Mninr I-1 Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it Points Achieved: to the applicatioa or if applicable, include in plan set & the sheet index. For help, contact Build it Green at www.builditgreen_nr¢ l /Z Revised 02/05/09 et',`1 CITY OF CUPERTINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) additional stucco application B 1 WINREP Replacement windows/sliding glass door (ea S windows) B 1 WINMEWSTR New Window -structural shear wall/masonry (includes plan ck fee) B IEPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M I PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min when not over counter) Standard Plan Check (when no E/M/P) hourly -stand alone B 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES �]( 1`\ IBSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1TRAVDOC Travel & Documentation B 1BUSLIC Business License B !3r� CZ ce 5 of 5 Dear Property Owner: City of Cupertino Building Department 10300 Torre Avenue Phone: (408) 777-3228 An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner -builder you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unlesss-they are - personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law_ , contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner -builder building permit, erroneously implying that the property owner is providing his or her own labor and- material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your con-munity.or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino Printed on Recycled Paper OWNER -BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform A. _ All the work authorized by this permit B. _ A portion of the work C. --�,/ None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. —ZA portion of the work (complete section below) Contractor .. of work to. - performed MIMMARAWIrEM IMM. RE IM- 1 0 • OMAN . a I it i_ I . `I i 1 _ 3. __Y_ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. I declare ��*ider penalty of perjury that the above is true and correct. Owner -Builder Information (reverse side). Property Owner's Signature.- job ignature:Job Address: Cam V I have read and understand the Date: Permit# ��l Oq�3018y- Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. .. . .Type of work to. - performed 1 1,15 i L1► 11 1 11 � I declare ��*ider penalty of perjury that the above is true and correct. Owner -Builder Information (reverse side). Property Owner's Signature.- job ignature:Job Address: Cam V I have read and understand the Date: Permit# ��l Oq�3018y- Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department.