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02070149M � - �it1il t11tf� h J s a =ile Edit Actions Details Links Favorites Help Permit Information Location Infomriation Permit Number x 02070149 Address 19750 STEVENS CREEK BLVD i Status x jw` CitylStatelZip CLIPERTINO CA 95014 Master Number Notes r APNL j' 1_76§0_6 Unit y Project -_ Apply Date ` 07/24/2002 Operator conniew-O4�ner E; tity Ir;ormdt,cn Permit Issue Date 07!24!2002 Operator co iew Owner Name xEVERSHINE VI LP j -�� Certificate Issued Operator -� Use Default 0 Certificate Type Address Home 19772 STEVENS CREEK BLVD79 Certificate Number --- _� _ _- City/State/Zip [CUPERTINO ` CA 95014 L____ _ ��__,. Permit x Property Zoning Applicant EI Contractor' Defined Fields f Permit Details Permit Type LC ULP MBING �Eql i IDO NOT USE_ - Usage Class OFFICES V N R DONT USE Applied Value ' 15000 SQUARE FT. 0 Calculated Value o US C-404 Type 437 Oji ADD: NON -RES, NON-HSKPG Permit Form " AUTOPERM -PERMIT v Ownership 1 - Private v 'urpose/Special Conditions U14DERFLUOR PLUMBING -IN HOUSE ONLY (ORIGINAL #02050193, SHELL ONLY) INSPECTIONS SH BE ON ORIG 02050193 ?ILMED 5/2011 i Prosect Size ! i U 'ermik issued 07124J2002 anter permit status #p Back Contractors - t Fees ;Plan Reviews Inspections Print Permit Adjustments t! H olds Fe Copy Permit �I i Close Permit j Overrides i Supplemental Fields j7Notes ]Attachments l ,I Add Default T ' oz z z UC wE O Uz CITY OF CUP]E& TINO BU111DING 1DMSION PF&*T CONTRACTOR iNFOi4� 46N: BUILDING CREEK BLVD PACIFIC GENERAL CONSTRUCTI'T"8-2070149 oFNK TINE VI LP 38350 FREMONT BLVD APPLICATIOA'S t' ATj2 O O2 L `� PHONE:.' a • (51 �) 713 — 934 3 SANITARYVNO./ CONTROL NO. ARCHITECTIENGiNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH L___1 CJ L--7 u LICENSED CONTRACTOR'S DECLARATION cription 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing UNDERFLOOR PLUMMR with Section a7000jand e ofDivision J of the Business and Professions Code, and my license is in full force and effect. (ORIGINAL #02050193, SHELL ONLY) License Class Lic. ri Date • Contractor ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish. or repair any structure 1 5 0 0 0 prior to its issuance, also requires the applicant for such permit to file a signed statement •- - •-- - - Sq: Ft, Floor Area, • - - Valuation that he' is licensed pursuant to the prbvisions of the Contractor's License Law (Chapter 9 (commencing. with Section 7000)of Division 3 of the Business and Professions Code) or that he is exempt theiefrom and the basis for the alleged ex-14tion. Any violation , _ 3 6906008 . 0 0 of Section 7031.5'by nny'applicant'for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (x500). APN Number - - Occupancy Type 106 - SEWER & WATER ❑ 1, as owner of the property, or my employees with wages as their sole compensation, 'will do the work; add'the-structure is not intended or offered -for sale "(See.'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 301 - ROUGH P or through his own employees. provided_that such improvements are not intended or _ . SHOWER - 3 02 - TUB- & OR SHOWER - offered for sale. If; however, the building or improvement is sold within one year of •completion, the owner -builder will have the burden of proving that he did not build or ,. 502 - FINAL PLUMBING ENERGY improve for purpose of sale.). ' 506-- - GAS TEST- - Cd 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 507 — FINAL PLUMBING License Law does not apply to an owner of property who builds or improves thereon, -and who contracts. for such projects with. a contractor(s) licensed pursuant to the Contractors License Law. ❑ 1 am et un c.: - B.& P C for this reason , Date / WORKER'S COMPENSAi�011TDECLARATION 1 hereby affirm under penalty of pequry' one of the following 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 Performance of the work for which this permit is issued. ❑ 1 have and will maintain Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance df the work for which this permit is issued. My Workers Compensation insurance carrier, and Policy, number, are: ') :.. Carrier.: i Policy No.: CERTIFICATION OF EXEMPTION FROM WORKERS' t . •, , . COMPENSATION INSURANCE '(This Section need not be completed if the permit is for one hundred dollars ($100) or less,) -• - .. - . .1 certify. that in the pe c of the'worl for which is permit is issued, 1 shall not employ' pen annet�las ec u 'eyt-yo the Workers' Compen ation App c t .. . ' N( TO'APPLICANT: If, after making this Certificate of Exemption, you should beco subject to the Workeis'Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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.'C') ' Lender's Name' Lender'sAddress , 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 I to building construction, and hereby'authorize representatives of this city to enter upon the, above-mentioned property for inspection purposes. , (We) agreeto save, indemnify and keep harrrtess (he City of Cupertino against I liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting. f this' rmit. - ". t LIC 'T N RST F S' D l COMPLY KITH ALL . O E ATIOty Issued by: Date ✓ V Signa ,re of lican,'D a HAZARDOUS MATERIALS DISCLOSURE - e-Ioofs Will the applicant or fumrwbuilding •occupiAt store or.handle haurdous material Type of Roof - as defined by the Cupertino Municipal Cade, Chapter 9.12- and the Health and Safety 'Section Code.25532(a)?. ❑Yes '❑Na''l. 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 first obtaining an inspection, I agree 'to remove emit hazardous air contaminants as defined by the Bay'Area Air Quility Management District?, . , all new materials for inspection. Applicant understands and will comply With ° Y« . ". .. , all non -point source regulations., r '1 have read the, hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25537 and 25534. 1 understand -that if the.biiilding does not curtenty have a t ant; thae i[ is my -res onsibili[y tanoi y the n,'6f occu'pan't of tin requ me 'ch m t be of prior to issue a Cerci ate of Oect 71.1A -, Si nature of Applicant Date Owne d agent - ete All roof coverings to be Class `B" or better . ' nccrno r�. I CITY OF C:UPEkTINO 0 46 CITY OF CUPERTINO PERMIT APPLICATION FORM APN # Date: Fee Grou � Building Addr: n essso sic B�v,D Other Appliances Owner's 6 , 'J �� ! Phone -3 z1-3 D 8 Co. VC Ft G tk� C� sT /� License #: � 3 7 Ll z Z Contact: �AA-y?--k—' 41, Phone �511Q 2� _ / l Applicant/Contractor: Fax #: / D -3 -17 3 � 3 Building Permit Info: Bldg Elect Plumb Mech Job Description: Residential: Commercial )) BELEC1000 Sq.Ft. Floor Area: ELECTRICAL BELEC1001 Architect/Engineer: Valuation: (�� Type of Construction: Occupancy G up: If,5// BENERGY " rz Quantity Fee ID Fee Description Fee Grou � BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax – Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BNEWMULTI New Multi -family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCONIMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 1 of 3