08030147- PUB 5
`o o a) a)
v ) € a-
c OL 7 N a)SL fo p N 1100_ 0 p O > a p y0
O m BTU w d 0- Q 2 U U O cn 2 Q
1%. 'iia i_p •"11 X �� �5�., '.__s 4� i,�?''„ ,' �,' °�Lj
�0
v
� O
CD 0
co Q
O
0
U
In U)
N N
5
P4
� x
F
A
O
� O
Yt �
LLI F
H
Q
m m �,
�L U o o per,
LLJ J
W LWLi J J 0 P4
S L C:
UU LLi Qu
LO LO W = F O
z 2: oc N
WW U
W a)cr) F L}
CL
w z w z LO O L a A
cn cn - a
w w
OD OD O p C LJ 0 LO a O H
3 U W
1 N x
f -- - - - - - -- - -.
a _ -
x W _
a� m W �o
cn as LO
Q O N
Q p Q U
IcrI v
LL-
_0
Lv
ar
t. _. o a�
.ti
OL a
o` 0
to
a U �_
N
a 0I
w [� s
OL a a II ICI 1O"I a
m o_ y
a O O O J w u n
Ir IR
O
_ CD
OL w o o s c
>1 a J I o
cLi LL Q M W
_ V.00 c
r-- _ o a a O O - w (D o 0
w O v t —
Ji o o " " a o u 7 a >
MO U N N N N
0 O — C? J vY a
kA
o � C r U — - a a' -r o
m o a c:
o a 0 w LA
Zr—° 7 w v o %`o t cr a
15 T) as u a
-LIN
U v �_ a`D ai a ci (ato `v D
i. wl a a`) 0 0 0 � w CL � Q cn U O w O 0- +v +�
_4 a? �_ a- Lo cL Q o- L U U U t
_ y
lLl >- W
CITY OF CUPERTINO
BUILDING DIVISION PERMITPERMrr NO.
� 'Tk� TC?
Rules MIESkEVENS CREEK BLVD TBD — TO BE DETERMINED 08030147
OWNER'S NAME: PERMIT ISSUE DATE
STEVENS CREEK LLC 03/25/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHrrEC(ENGINEER: BUILDING PERMrr INFO
HLDC ELECT PLUMB MECH
u00 LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
z with Section 7000)of Division 3 of the Business and Professions Code,and my license is COMM'L TI TEMP PERMIT GOOD THRU 4/25/2008
Z y in full force and rdI
j Z License CT Lic•N
DateCon r
ARCHITECTS 'C
ON
< I understand my plans shall be used as public me ,
3yU
`U.H Licensed Professional
�0 3 OWNER-BUILDER DECLARATION
t I hereby affirm that 1 am exempt from the Contractor's License Law for the
❑O following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
y Z} 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 Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
X t-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $10500
y 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). 20289 STL�u� EK BLVD Occupancy Type
❑1,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
and Professions Code: rs The Contractor's License Law donot apply to an owner of Required Inspections
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
sale.). .
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li-
cense law does not apply to an owner of property who builds or improves thereon,and
who concocts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑1 am exempt under Sec ,B&P C for tots reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Workers Compcn-
sation,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 Compemadon Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued. '
My Workers Compensation Insurance artier and Policy nWber am:
Cartier. S" PolicyNo.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 7FJF�
(This section recd Trot be completed if the permit is formic hundred dollars($100)
or Icss)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any mannerso as to become subject to the Workcrs'Compensation
Laws of California Date
Applicant
NOTICE TO APPLICANT:lf.after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
0 forthwith comply with such provisions or this permit shall be deemed revoked.
z— CONSTRUCTION LENDING AGENCY
F-r rA I hereby affirm that there is a construction lending agency for the performance of
04 > the work for which this permit is issued(Sec.3097,Civ,C.)
CWn Q Lenders Name
Lenders Address
V 0 I certify that I have read this application and sate that the above information is
V. correct.I agree to comply with all city and county ordinances and sale laws relating to
CV building construction.and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
C>, (We)agree to save•indemnify and keep harmless the City of Cupertino against
►F-u ty) liabilities,judgments,costs and expenses which may in any way accrue against said City
V Z in consequence of the granting of this permit
APPLICANT UNDERSTANDS A WILL COMPLY WITH ALL NON-POINT Issued by: Date -Z 1
SOUR a
IISA
Re-roofs
Signature ol'Applicant/C for ate
DO A
I TERIALS DISCLOSURE Type of Roof �.
Will appli t or fat. ilding occupant store or handle h- ous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,.1 agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District? �
❑Yes Mi
1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Cade,Sections 25505,25533 and 25534.1 understand that if the building
docs not currently have a tenant that it is my responsibility to notify the occupant of the
requirements which mutt he prior iss of acertir=tcofOccrpan Signature of Applicant Date
Owner or authorized agent Date'
All roof coverings to be Class'A�'or better
v� u
CITY OF CUPERTINO
CITY OF
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# ( o ' G� • 0o Date:
Building Address:
20289 5i-"e4s G/e $lid
Mailing Address (if different from building address):
1975 Hamiffiovl A\19-, St-e. 33 -5p vi lose, CA 15125
Owner's Name: A G F- 9 Phone#:
20 269 - 20 289 54-6ven5 CXezk-BWJ- O8 - s69 - 29 2D
Contractor: Phone:
7441-of Fax:
Contractor License #:
Cupertino Business License#:
Contact: H"e-sk IDaLtJ I S F. Phone: 408- 836-8746
Fax: 408- 2 88- 15349
Residential ElCommercial
Job Description:
T2m,��>ra Pe,/,nta f D v TeviG wt Imfra ve-m e rg
Building Permit Info:
Bldg l' Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1 FR, 1 1F ❑ 11, 111, V-1HR ❑ 11, 111, 1V V-N Q
Valuation: _ Square Footage:
Project Size: Standard 0 Large ❑ Major ❑
I
I
CITY OF CUPERTINO
aA f
CUPE�-rirv0 GENERAL BUILDING
i
PERMIT APPLICATION FORM
I
f
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
113TEMPPER Temporary`Building Permit (good for B
30 days)
11313OILERI For the installation or relocation of ea M_
boiler/compressor to &including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw)
IBBOILER2 Installation/relocation of ea M.
boiler/compressor over 3 horsepower
to &incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
11313OILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
11313OILER4 Installation/relocation of ea M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
-1BBOILER5 ' Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
i
which no other fee is listed in this
code.
i
IELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
i
l 1PLMBINSP Other Plumbing& Gas Inspections P
(per hour)
1MEETINGIHR Application Meeting B
I
i