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02050095CI BMD c CUPE DrVISSIIONN® 1m1V1DA4nrlr (CONTRA(CTOIR WIFOIiB.IKAUlLt V., BUILDING ADDRESS: CREEK BLVT CRW INDUSTRIES U 11111 NO. 02050095 'MV OURETAS 1157 DELL AVE. AU}ttl ogXM02 . I PHONE: O ce ZO ARCHITECT(ENGINEER: �UW FZUa Z LICENSED CONTRACTOR'S DECLARATION Z I hereby affirm that t , licensed u er provisions of Chapter 9 (commencing m with Section 7000) of Divisio of the B ess nd Professions Code, and mxli ense t Y g j is in f l f ce a ffe a �( : Ce w ¢ L ense ss ic. # % 3 [— to Co a or 4 HITECT'S D RATI O rn 0 J I understand my plans shall be used as public records to no Licensed Professional je o OWNER - BUILDER DECLARATION — H I hereby affirm that I am exempt from the Contractor's License Law for the" F Z G following reason. (Section 7031.5, Business and Professions Code: Any city or county 59 F C which requires a permit ro construct, alter, improve, demolish, or repair any structure a 3 prior to its issuance, also requires the applicant for such permit to file a signed statement that ,o pursuant to the provisions of the Contractor's License law (Chapter 9 (commencing with Section 7000) of Division 3 of the Bu ;iness and Professions Code) or that he is exempt therefrom aid the basis for the alleged exemption. Any violation of Section 9031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (8500). 04 Z 0 �z 9U Cb � U Z ❑ 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 (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, ifie building or improvement is sold within one yea of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ 1, as,gwner of the property, am exclusively contracting with licensed contractors to construct 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, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sec. , B & P C for this reason Owner' Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury,one of the following 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 performance of the work for which this permit is issued. ❑ 1 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 is ued. M Worker's Compen on Insum a carrier and Policy number are: /{� t cy No.. = 0 1 Ok 00 � ' CER CATION OF E MPTION FROM WORKERS' COMPENS IONINSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that'in the performance bf the work for which this pennif is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant.. NOTICE TO APPLICANT:, If, after making this Certificate of Exemption, you should become subject to the Workers 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 L'ender's Address 1 certify that 1 have read this application and state that the above information is correct: I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorite representatives of this city to enter upon the above - nientioned property for inspection urposes. agree to save, indemnify and ke harmless the City of Cupertino against liabili s, j aunts, costs and expe w ' may in any way accrue against said Ciry in c seq ce of the erantin¢ o This oe it. (408) 378 -2477 UNITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUivIB MECH FIRE REPAIR (NO4HANIftTCH EXISTING) $100000 I 101APN NOMNiDATION Occupancy Type 102 - PIERS HAZARDOUS MATERIALS DISCLOSURE" a Will the applicant or future building occupant stbre or handle hazardous material as defined by, the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25932(a)? . ❑Yes El No . Will the applicant or future building occupant use equipment or devices which emir hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Yes ❑ No I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 2-V33 and 25534. 1 understand that uildiftla.koes not currently have a tenant tat i is my responsibility to notify the occupa of dhe'Vepuirements whici* must be t pn r to issuance of a Certificate of l u j - U r r- r, Required Inspections 104 - REBAR 105-= ANCHOR- BOLTS 106 - SEWER & WATER 202--- UNDERFLOOR PLUMB -ING- 203 - UNDERFLOOR MECHANICAL. 204 -.UNDERFLOOR FRAME 205 - UNDERFLOOR INSULATION 301 - ROUGH PLUMBING 302 - TUB & OR SHOWER 303 - ROUGH MECHANICAL 304 - ROUGH ELECTRICAL 305 - FRAME 306 - HOLDOWNS 307 - INSULATION 308 - -- SHEETROGK 309 = "EXTERIOR LATH 31.0 - ..INTERI -OR -LATH. - 311 - SCRATCH COAT 313 - ROOF-,NAIL . 501 - FINAL ELECTRICAL'''ENERGY 502 - FINAL PLUMBING ENERGY 503 - FINAL MECHANICAL ENERGY 504 - FINAL BUILDING ENERG� 505 - FINAL ELECTRICAL 506 - GAS TEST 507 - FINAL PLUMBING 508 - FINAL MECHANICAL 509 - FINAL GRADE 510 - FINAL PLANNING 514 - FINAL PUBLIC WORKS Issued by, Re -roofs Type of Roof 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 tonals for inspection. Applicant understand_ s and will comply with Caff n p source regulations. �� \,, ��\- \, \ _,-s, — f � - C) Signature of Applicant Date Z All roof coverings to"be Class `tB" or better OFFICE !L - CITY Of CUPERTINO WEITY OF (CUPERTINO * 02- CJ)--C&97r PERMIT APPLICATION FORM APN # r � Date: — Fee Group APTFEE EACH STORY OVER 3 Building Ad es s: S HOTELFEE S C Owner's Name: (j OFFICEFEE Phone #: BAPPLOTHER Other Appliances MECHANICAL Contractor: ` � ^ � License #: 902q%� BUILDING Contac u_af ��:3 P ne #tJ BUILDING Applic Contr or: 4 ax AUILDING BCONSTAXH Hotel and Motel BUILDING Building Permit Info: BCONSTAXR Constax — Resi/Mobile BUILDING Bldg lect P1 ;b-')I Mech J escription:i BELEC1001 , Residential: drrjjL , Sq.Ft. Floor Area:�� /� $/S .F Enerev Architect/Engineer Valuation: Energy Add Multi Type of Construction: Occupancy Crr up: Investigation fee ire BMITIGATC Comm. Housing Mit. Fee a 1 Quantity ]Fee ED Fee Description Fee Group APTFEE EACH STORY OVER 3 HOTELFEE EACH STORY OVER 3 OFFICEFEE EACH STORY OVER 3 BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAX13Q Con. Tax for BQ Zone AUILDING 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 9 ENIERG Y Enerev 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 BNEWMLTIM New Multi - family Res ELECTRICAL 1 of 3 1075,91 I