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07020077CITY OF CUPERTINo BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMrr NO. 19656 STEVENS CREEK BLVD TBD - TO BE DETERMINED 07020077 OWNER'S NAME: PERMIT ISSUE DATE LILY SALON PHONE: SANITARY NO, CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO I BLDG ELECT PLUMB MECH O p LICENSED CONTRACTOR'S DECLARATION U F`- 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing z with Section 7000) of Division 3 of the Business and Professions Code, and my license is y in full force and effect. y ? License Class Lic. ri r•- wDate Contractor '9 ARCHITE&S DECLARATION i C < 1 understand my plans shall he used as public records .yu WO F- Licensed Professional „ t OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the Q O 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 requites the applicant for such permit to file a signed statement Zr < that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 ti 1Z- (commencing with Section 7000) of Division 3 of the Business and Professions Code) or Q .. that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 1, as owner of the propcny, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sa I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li. cense Law docs not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contw Ior(s) licensed pursuant to the Contractor's License Law. ❑ 1 am exempt under Se / , B & P C for this re run Owner 01 /F P Date V� 13+ �(7 WORKER' f3 E SATION DECLARATION I hereby affirm under natty of perjury one of the following declarations: ❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker'sCompen- 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 the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is Car one hundred dollars ($100) or less.) 1 certify that in the performance of the work for which this permit is is3rcd„1 all not employ any person in any manref sn as be o subj t to the fi ' ens Laws of California. Date V G %' L' C Applicant r� NOTICE TO APPLICANT: If, after making this Certificate of Ex ton, you should become subject to the Worker's Compensation provisions of the La r Codc, you must z forthwith comply with such provisions or this permit shall be deem d revoked. z CONSTRUCTION LENDING AGENCY H.. -i I hereby affirm that there is a construction lending agency for the performance of RS > the work for which this permit is issued (Set:. 3097, Civ. C.) W Q Lender's Name z Lender's Address U 0 1 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 to 0 U building conswction, and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (Wc) agree to save, indemnify and keep harmless the City of Cupertino against Hv) liabilities,judgments,costs and expenses which may in any way accrue against said City U z in consequence of the rantin of this permit. APPLICANT UN DS AND WILL COMPLY WITH A (. NO hPOINT SOURCE R Signature of Ap is ntraclor Date ,AZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12• and the Health and Safety Code, Section 25532(a)? 0ye h Nu 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? C] Yes MNo I have read the hazardous materials requirements underChaptcr 6.95 of the Califor. nia Health & Safety Code, �ccdons 25505, 25533 and 25534.1 understand that if the building does not currct7tly h ^fc nt, that it is my responsibility to notify the occupant of the rcyuiremcnts hiq t m'et prior to issuance of a Certificate of cupanc . Owner or authorized gent Date Job Description T.I. COMMERCIAL, INCLUDES NEW PARTITION WALLS Sq. Ft. Floor Area 36906009.MN Issued by: Re -roofs Type of Roof $50000 Required Inspections Uccupancy Type Date 2 -(3 -ate 2--` All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B” or better CITY OF CUPEKrINO CITE' OF CUPERTINO��- PERMIT APPLICATION FORINT APN #I j - 0(-VDate: � l D� Building Addres4�S/_ �� Mailing Address (if different from building address): l!y/�^ Owner's Name�: Phone #: LJ�/ 1 j��173.5 '`I', ®� S- MECHANICAL / ! 1 Contractor: License #: Contact: Phone: tW6,;'7,13iCupertino Business License#: Piz Fax: Building Permit Into: Bldg ❑ Elect ®--, Plumb En—*— Mech ❑ Job Description: D,��,, r N�944),P M4 rvhvL$ — Residential ❑ , �UI�I,�i�/ ° / L �'� Commercial ❑ L ; L s MECHANICAL Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: �;Pbob Occupancy Group: Type of Construction:. ` r - Please check this box if the project is a ❑ BCONSTAX second -story addition: Project Size: Standard Large ❑ Major ❑ BCONSTAX Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1 M Btu MECHANICAL BBOILER4 Boiler > 1 M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu 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 1 of 3 r - CITY OF CUPERTINO MY OF CUPEi�TIN® PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELEC'TRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLMOBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING _ BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING _ BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING - - RPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREN NRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture I ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance I ELECTRICAL 2 of 3 =ile Edit Actions Details Links Favorites Help j Master Number b l .I Project Apply Date i_62 /li/2007 Permit Issue Date} 02/13!2007 .�PPrmrt intcrrn•�kon�� ,.: __� -� Y_-,. ,.._� a. _ .,_>-_<__ ._�a_.,-_w.., .-v._,._ ,_ _-�,,,-.,.-Lcc-atron lrltormahorl.- �P.,=�.. ..._ - _ .,e re_ .�,�,..,-„_v___ ._,._ .z -�. .._. w.._. __._ Xn Permit Number ” 07020071- Address 19656 STEVENS CREEK BLVD S talus x- r C Closed - City/State/Zip t I t_ j Master Number a 0 .I Project APN X36906009.01 Apply Date i_62 /li/2007 Permit Issue Date} 02/13!2007 Certificate Issued- r 0612112007 Certificate Type .___ tCO—CCERTIFIU Certificate Number Q Notes a 0 APN X36906009.01 COMML-TI AM -Unit ry__...J _ s _ ----------- 'Operator ktersaw i ST V N R i Q Operator 1 iersaw Owner Name " "F ILY SALON Applied Value" 5000 SQUARE FT.� Oj Operator: rsuew-� s Calculated Value Use Default [� TE OF OCCUP US C-404 Type ' - ----- Address - WAddress•- !Business -19656 STEVENS CREEK BLVD SALT: NON RES NCtNHSKPG MI AUTOPERM - PERT, rt City/State/Zip` CUPERTINO CA 5014 rn Permit f Property „ Zoning !I Applicant `t Contractor' 11 Defined Fields Permit Details, E Permit Type COMML-TI AM DO NOT USE �_ _ s _ ----------- Usage Class x Usage I i ST V N R i Q _ FSTORES V N R Applied Value" 5000 SQUARE FT.� Oj s Calculated Value 0I US C-404 Type 14371 SALT: NON RES NCtNHSKPG Permit Form MI AUTOPERM - PERT, Ownership 1 Private Project Size ermit issued 0211312007. _ ------------ __� anter the purpose or any special conditions for this permit Purpose/Special Conditions — -- ... ;T.I. COMMERCIAL, INCLUDES NEW PARTITION � WALLS -REVISION #07050067 SINK/HARD CEILING ELECT OUTLETS FILMED 5/20111 _ 1__ Add Default T OK 4 Back FTIR Contractors Fees Plan Reviews J La Inspections 1A Print Permit Adjustments f vA Holds f' 14, Copy Permit juk Close Permit Overrides e F. Supplemental Fields LAI Notes Attachments E =,IR