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CITY OF CUPERTINO
CONTRACTOR INFOW TION:
BUILDING DIVISION PI, IT
BUILDING ADDRESS:
low
PERMIT NO.
19750 STEVENS CR BLV
PACIFIC
GENERAL CONSTRUCTION
02050193
OWNER'S NAME:
APPLICATION SUB DATE
EVERSHINE VI, L.P.
38350 FREMONT
BLVD
05/31/2002
PHONE:
SANITARY NO. CONTROL NO.
(510)713-9343
ARCHITECT(ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I_7 LJ L.] I -.I
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license
RETAIL
SPACE, MARKETPLACE SHOPPING CENTER
is :in,full[rrP,gagdeffect •-
LicenieCj93s}" fi_�' "Lic.tt
SHELL
ONLY
Dare"'<-".'!` .' Contractor
'•' ARCHITECT'S DECLARATION
BUILDING
B
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 7031.5. Business and Professions Code: Any city or county'
wh'.ch requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
Sq. Ft. FIOOr Area.
`/�^{'vatlon
thatbe is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code)
,
$85000 V
or that he is exempt therefrom and the basis for the alleged exemption. Any violation
of Section 7031.5 by any applican( fora permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($500).
��7 7�T y,�
3 6 Al u {.w lffnb b
l7 U U �j U
� � Occupancy Type
0I, as owner of the property, or my employees with wages as their sole compensation,
.
101 -
FOUNDAT IPgJ.9uired Inspections '
will do the work, and the structure is not intended or offered for sale (Sec. 7044,
Business and Professions Code: The Contractor's License Law does not apply to an
owner of property Who builds or improves thereon, and who does such work himself
or through his own employees. provided that such improvements are not intended or
102 —
PIERS
pffered for sale. if, however, the building or improvement is sold within one year of
103 -
.
UFER
completion, the owner -builder will have the burden of proving that he did not build or
improve for purpose of sale.).
104 -
REBAR
XC as owner of the property. am exclusively contracting with licensed contractors to
105 —
ANCHOR BOLTS
cnstruct the project (Sec. 7044, Business and Professions Code:) The Contractor's
License Law does not apply to an owner of property who builds or improves thereon,
106 -
-
SEWER & WATER
and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.
2 02 —
UNDERFLOOR PLUMBING
ofam exempt under Sec, , B & P C for this reason
203 —
UNDERFLOOR ' MECHANI CAL
,a+
caner Date
204 -
UNDERFLOOR FRAME
- RKER'S COMPEjO.TION DECLARATION .,
'`'
205 —
UNDERFLOOR INSULATION
...:. 1 hereby affirm under penalty of perjury one of the following declarations:
301 -
ROUGH PLUMBING
0 I have and will maintain a Certificate of Consent to self -insure for Worker's
3 0 2 —
TUB & OR SHOWER
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work, for which this permit is issued.
303 —
ROUGH MECHANICAL
01 have and will maintain Worker's Compensation Insurance, as required by Section
304 -
ROUGH ELECTRICAL
3700 of the Labor Code, for the performance of the work for which this permit is
issued. My Workers Compensation Insurance carrier and Policy number are:
3 05 -
FRAME
Carrier: policy No.'
3 0 6. —
HOLDOWNS .
' CERTIFICATION OF EXEMPTION FROM WORKERS'',
307 —
� INSULATION
COMPENSATION INSURANCE
:.. ..
308 —
" SHEETROCK
' (This section need not be completed if the permit is for one hundred dollars
($100)orless.)
309 —
EXTERIOR LATH
"''1 certify that in the performance of the work for which this permit is issued, I
310 —
INTERIOR LATH
shall not employ any person in any manner so as to become subject to the Workers'311
—
SCRATCH COAT
Compensation Laws of California. Date.
313 —
ROOF NAIL
1 Ill.
ll ICE TO APPLICANT If. after making this Certificate of Exemption, should
you
become subject to the Workers Compensation provisions of the Labor Code, you must
501 -
F I NAL ELECTRICAL ENERGY
forthwith comply with such provisions or this permit shall be deemed revoked.
502 -
FINAL -PLUMBING ENERGY .
"" • CONSTRUCTION LENDING AGENCY..
5 0 3 -
FINAL MECHANICAL ENERGY
I hereby affirm m
that there is a construction lending agency for the perforance
of the work for which this permit is issued (Sec. 3097, civ. C.)
5.04 -
FINAL BUILDING ENERGY
Lender's Name - ....
Lender's Address
505 —
_ .. ..
FINAL ELECTRICAL
I certify that I have read this application and state that the above information is
correct. 1 agree to comply with all city and county ordinances and state laws relating
506 —
GAS TEST l
to building
507 -
FINAL PLUMBING
construction, and hereby authorize representgtiJes of this city to enter upon
the above-mentioned property for inspection purposes.
508 —
FINAL MECHANICAL
(We) agree to save; indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said
509 -
F I NAL RA
City in consequence of -the granting of this permit.
'?:DFRST.\VDS.\VD WILL COMPLY WITH ALL XON'
10 �—
N � ING c�
.\PPL(CA\T -POINT
SOUR'G �j�6-Ll��v
Issued
Date
r-Ci�iJIT10:L��iG_
jigpatup6 of Applicant/Contractor Date
Re-roo€s0�w —
ROOF PLYWOOD NAIL
' HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
Type of k&f —
ROOF BATTENS
as defined by the Cupertino Municipal Code, Chapter 9. 12. and the Health and Safety
Code, Section 25532(x)?
604 —
ROOF IN—PROGRESS
11 Yes XNo
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without fust obtaining an inspection, I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
0Yes ANo
all new materials
for inspection. Applicant understands and will comply with
all non - point source
regulations.
I have read the hazardous materials requirements under Chapter 6.95 of the
Cahfomia Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that
if the building does not currently have a tenant, that it is my responsibility to notify the
occupant of the requirements which must be met prior to issuance of a Certificate of
Occupant
Signature of Applicant Date
All roof coverings to be Class `Br' or better
wgrorauthorized agent Date
Of"r!C;E
433,
Cupertino Union School otrict 6
10301 Vista Drive (408) 252-3000
Cupertino, CA 95014
Ceveloper 1 mpact Fee Compliance
The Cupertino Union School District has adopted Resolution Nos. 1403 and 1404, imposing
developer impact fees pursuant to Government Code 53080.
Building Permit Request
The City of / �':''�:% %' has received a request for a Building Permit described as
follows:
Residential Development Project Commercial/Industrial Development Project
Name of Developer:
Project Address
Square Footage: ! vr6tz �-*
Permit #:
Lr �
6 � �.
Date: . 7 By:
Square footage will be verified by the city
iption:
Jr
City Authorized Representative
L
to issuance of a buidling permit; fees may be adjusted accordingly.
SCHOOL DISTRICT" DEVELOPER IMPACT FEE
CERTIFICATE` OF COMPLIANCE
» The authorized representative of the Cupertino Union School District has reviewed the
City of
Cy,' E HA2 T l ti0
Building Permit Request described above and hereby certifies that the developer or authorized representative has
met the requirements of the Districts Developer Impar -Fee require nti.
Dated: / By: !
Authorizedepresentative
Cupertino Union School District
Certificate not valid without 6'� 119 � ,.
-�l 1 � �" J
District Seal, Initial, and Date Fee $
Facilities Planning — White City Yellow Requestor — Pink Accounting — Gold
nter permit status
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Permit Number
02050193
I Address I
19620 STEVENS CRK
I�¢0K l
Status "
City/State/Zip CUPERTINO CA 95014
I4* Back
Master Number
Iqj Notes
0
APN
360fl$ 0
Imo• Contractors
Project
lal
Unit
Apply Date
05131/2002 W9 Operator
nancyc
Fees
Permit Issue Date
0610512002 Operator
nancyc
I Owner Name xI
EVERSHINE VI, L.P.
Imo, Plan Reviews
Certificate Issued
1011912004 Operator
suem
Use Default
Inspections
Certificate Type
CO • CERTIFICATE OF OCCUP
Address
Home -19750 STEVENS CR BLV
Certificate Number
I,=- Print Permit
City/State/Zip
CUPERTINOAd'ustments
I
Permit Property
Zoning Applicant Contractor x
Defined Fields
It �a Holds
Permit Details
Purpose/Special Conditions
ICI Copy Permit
Permit Type
COMML-NEW IQI
RETAIL SPACE, MARKETPLACE
JJ Close Permit
DO NOT USE
SHELL ONLY -BUILDING B / REVISION $03100181
PLMB FESS PD ON PERMIT 02070149 -IN HOUSE ONLY
7r Overrides
Usage Class "
S T V N N IQI
STORES V N N
FILMED 5/ZO11- FILE ONLY
I Supplemental Fields
Applied Value `
850000
Notes
I
SQUARE FT.
1000.0
Calculated Value
50400[1 IE -11
IAttachments
US C-404 Type
327 IQI
NEW: STOREIRESTRAUNTITAVERN
Permit Form `
AUTOPERM - PERMIT
Ownership
1 -Private
Project Size
I[0 Add Default T
'ermit issued 06f05f2002
nter permit status