08100012F.
J,J Ji� Jl,rwJJJ ri�,:,J - -_!J:711I�,�
le Edit Actions Details Links Favorites Help
U� f ',err
Permit Number " 08100012
Status' C - Closed
Master Number
Project
Apply Date " 10/02/2008
Permit Issue Date 10/22/2008
Certificate Issued
Certificate Type
Certificate Number
Address' I 19750 STEVENS CREEK BLVD
City/State/Zip CUPERTINO CA 95014
IQI Notes 1 APN 36906008.02
IQI Unit
Operator patg
Operator SylviaM (Owner Name'I EVERSHINE
Operator Use Default []
Address Home -19750 STEVENS CREEK BLVD
City/State/Zip CUPERTINO CA 95014
Permit ' Property
Zoning Applicant Contractor " Defined Fields
Permit Details
Permit Type "
1 M IQI
SALE OF MERCHANDISE
Usage Class `
II/III B, IQI
II/III B, IV-HT,V-B NEW
Applied Value "
300
SQUARE FT.
0
Calculated Value
0 IldI
US C-404 Type 437 IQI
ALT: NON -RES, NON-HSKPG
Permit Form' AUTOPERM - PERMIT
Ownership 1 - Private
Project Size STANDARD -STANDARD
'ermit issued 1012212008
anter the purpose or any special conditions for this permit
Purpose/Special Conditions
REV ADD'L ANCHRG TO SHLVNG, TYPCL IN RETAIL FLR(PH
I AREA) ORIG $07100052
PLANS ATTACHED TO ORIGINAL 07100052
FILMED 5/2011
I[OAdd Default T
Ia/0K
IMS Back
Jr.. Contractors
:_,;i' Fees
Id Plan Reviews
I� Inspections
Inti Print Permit
It.,_�'Adjustments
li ® Holds
[7:1 Copy Permit
J Close Permit
Overrides
I' Supplemental Fields
L' 1J Notes
E-JAttachments
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19750 STEVENS CREEK BLVD
CONTRACTOR: CONEX
PERMIT NO: 08100012
DEVELOPMENT CO
OWNER'S NAME: EVERSHINE
2369 COLORADO BLVD
DATE ISSUED: 10122(2008
OWNER'S PHONE: 4088637346
LOS ANGELES, CA 90041
PHONE NO: (323)344-1212
❑ LICENSED CONTRACTOR'S DECLARATION
r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. #
r— F_ r
MECH RESIDENTIAL COMMERCIAL
Contractor Date
1 hereby affirm that [ am licensed under the provisions of Chapter 9
JOB DESCRIPTION: REV ADD'L ANCFIRG TO SFILVNG, TYPCL IN RETAIL
(commencing with Section 7000) of Division 3 of the Business & Professions
fLR(PHASE I AREA) ORIG #07100052
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
Sq. Ft Floor Area:
Valuation: $300
performance of the work for which this 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 the work for which this
permit is issued.
APN Number: 36906008.02
Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. 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 FROM 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
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature 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:
1 hereby affirm that I 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 compensation,
will do the work, and the structure is not intended or offered for sale (See.7044,
Business & Professions Code)
I, 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 Health & Safety Code, Sections 25505, 25533, and 25534. I will
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:
Health & Safety Code, Section 25532(a) should 1 store or handle hazardous
I have and will maintain a Certificate 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 I
performance of the work for which this 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 Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agent: Date:
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, 1
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.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
I certify that 1 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 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
costs, 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 -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
a4pl-
CITY OF
CUPEkTINO
CITY OF CUPERTINO
REVISION/DEFERRED
PERMIT APPLICATION FORM
C)k/vc) c)lc;2
APN # � / off. 0a
(p
Date: Y01-2-16o
0I2188
Original Permit #:
e? j 0005-2-
Building Address: -
5(!�IJl�Po1F,> D & L
Mailing Address (if different from building address)
Owner's Name:
Phone #:
p4r 26a i Awl-
46Z '2�G 3 -- 34(o'
Contractor:
Phone: (zl
Fax:
Contractor License #: L} 41
Cupertino Business License #:
Contact: C_.,p,�t ,t -
Phone: 4bg 4-72, IS'
Fax:D S 30
Building Permit Info: �b
Bldg Elect ❑ Plumb ❑ Mech ❑
Resi ential ❑ Commercial
Job Description:
DivVri OAA ArNGR C-*tF_LVI N(gr , 'Yy pi GAS t N WA t L
Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No
Type of Construction (Usage Class):
* Occupancy Type:
1-A, 1-B ❑ . II/III/V-A ❑ II/III B, IV -HT, V-B)�f,
�" 1
Valuation (cost of project): 2
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 10/01/08