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01010053CCET Y OF CCUPE R TEND CITY OF LRMET Al L1CAUGN P®1VCUPEkTW0 APN # Date: Fee Description Fee Group Building Address: 1 < 1 4 Owner's Name: Phone #: 0, f!�. igSD Contractor: License #: Contact: mk G Phone M GsO-S ZS Applicant/Contractor: Fax #: 02 BCONSTAXBQ Building Permit Info: Bldg Elect Plumb Mech Job Description: Residential: b k Commercial: Sq.Ft. Floor Area: $ /Sq.Ft.: fir-, 04S � BCONSTAXR Architect/Engineer: Valuation: dS. L o BELEC 1000 Type of Construction: Occupancy Grip: �auaffi�u 1Fee ID Fee Description Fee Group 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 BELEC 1000 Elec 600V <= 1000A ELECTRICAL BELEC 1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL B EN ERcGY Enerey 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 BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING IJP � ( � � / 3 1 of 3 � 0-0 e . CITY OF CUPERTINO • BUrLDING PERMIT APPLICATION FORM Building A��r���: 1W • 6 1 erg_ u 0 Phone o:��_ J� v Contractor: , License No: %J Contact; Phone No: �h �' S 0 E:), ArchitectlEngine" ® rT- License.No: Ap p ltcant /Contract.c r : Building Permig Info (circle mne) Bldg Elect Plumb Mech Job Descrapfla Sa e'� me Resa�len.tiaIl: Commercial: Sq. Ft. Floor .�rea:����� � $ /Sq. Ft.: A N.9 (Must provRde): Valuation Type ofConstrflactnon: occupancy Group: Qfyo Qf Fee 0D lee Description Fee Group BTEMPPERM ITemporary Bldg Permit IBUILDING BCONSTAX Construction Tax BUILDING BENERGY Energy. BUILDING BENERGYADD Energy Add Multi ' BUILDING BOVERTIME Inspection Overtime BUILDING ' BPERMFEE Bldg Permit Fees IBUILDING BMITIGAT Housing Mitigation Fee. BUILDING BPLANCHK Plan Check Fee BUILDING BPLANCKADD .. Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BREINSPECT Reins ection Fee BUILDING BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING. BSPECIAL Special Inspection BUILDING BSvvIM Swimming Pool BUILDING ®DCHG Address Change BUILDING o t .,F �U( E¢..Z1, rn ¢ o v Z Z y c F n ¢ g- L0fit] X O, F ur o c F.O. H W C o c �Z1 � � c ate. 3 @y C� CITY OF CUPERTINO CONTRACTOR MORMATI BUILDING DIVISION ?ERMITO BUILDING ADDRESS: PERMIT NO. 21151 CANYON OAK WY 0101-0053 OWNER'S NAME: APPLICATION SUB DATE THE OBRIEN GROUP 01/16/2001 PHONE: SANITARY NO. CONTROL NO. ARCHITEC (ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB NIECH 1_1 u I LJ LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license S FDWL : 4945 CONDITIONED SPACE, 674 GARAGE j is in full force and effect. License Class Lic. # i Date Contractor i ARCHrMCT'S DECLARATION 1 I understand my plans shall be used as public records i Licensed Professional OWNER- BUILDER DECLARATION r I hereby affirm that I am exempt from the Contractor's License Law for the ' following reason. (Section 7031.5. Business and Professions Code: Any city or county i which requires a to construct, alter, improve, demolish, or repair any swcture, $494566 permit prior to its issuance, also r quires lbe applicant for such permit to file a signed statemeru. - - that h4 A licegsed pursuant td the provisions of the Contractors License Law (Chapter 9 S �tA Floor-Area,, �, • , r -, Valuation (commencing with Section 7000) of Division 3 of the litt�ne�s,and prpf�.csions Code) or that he is thereTrom and the basis for the all eikceemptloh. Any violation , , o ; j3;•t2 9 V 0 7� . ,0 0 eiCmpt ge4 of Section 7031.5 by any applicant for a permit subjects tht applicant to a civil penalty of not more than five hundred dollars (8500). APN Occupancy Type 101 FOUNDATION ❑ 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: The Contractors License Law does not apply to an 102 — 10 3 - - PIERS. - ' UFER Required Inspections 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 - 104 -_ REBAR - - offered for sale. If, however, the building or improvement is sold within one year of F ompletion, the owner - builder will have the burden of proving that he did not build or 105 — ANCHOR BOLTS improve for purpose of sale.). !, as owner of rty, am exclusi ely contracting with licensed contractors to 106 — SEWER & WATER construct the ojec (S c. 7 usin s and Professions Code) The Contractor's 202 — UNDERFLOOR PLUMBING License La «s t pl to an own of property who builds or improves thereon, 203 — , UNDERFLOOR MECHANICAL and w n f pro c with a contractor(s) licensed pursuant to the Co s n s 204 — UNDERFLOOR FRAME ❑ 1 B y@ P C for this reason o 205 — UNDERFLOOR INSULATION z D LARATIONz_ 301 — ROUGH PLUMBING 302 — TUB & OR SHOWER I hereby affirm under penal of perjtuy one of the following declarations: 303 — ROUGH MECHANICAL Cl 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 304 — ROUGH ELECTRICAL performance of the work for which this permit is issued. 305 — FRAME ❑ 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 306 — HOEDOWNS Issued. My Workers Compensation Insurance carrier and Policy number are: 307 - .INSULATION • . Carrier. i; Policy No.: 308 - .SHEETROCK. 3 0 9 - EX'I ER I OR" LATH cERTgTCncot�pENSAT,oN wsNUve WORKERS'. 'section 310 — INTERIOR LATH (This of be com leted if permit is for one hundred dollars ($100)orless.) 311 — SCRATCH COAT ' 1 to t ' r •e the work for which this pe 't is 'ssued, 1 313 = ROOF NAIL - shall not ply ere s S to b come su 'ec o the o rs' Compe o if 501 — FINAL ELECTRICAL ENERGY A p'' 502 — FINAL PLUMBING ENERGY N E i � ca a of Exemption, you should bec n c to the o rs ompcnsatio vi ions of the Labor Code, you must 503 — FINAL MECHANICAL ENERGY forthwith comply with such previsions or th" rmit shall be deemed revoked. t 504 — FINAL BUILDING ENERGY CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance 5 0 5 — I CAL FINAL ELECTRICAL ' a of the work for which this permit is issued (Sec. 3097, Civ. C.) 5 0 6 — GAS TEST Lender's Name Lender's Address 507 — FINAL PLUMBING I certify that I have read this application and state that the above information is 508 — FINAL MECHANICAL a tort«[. I agree t ply with all city and county ordinances and state laws relating to building con cti n, hereby authorize representatives of this city to enter upon 5 0 9 — FINAL GRADE 1 the above -me ion pr pe for inspection pu oses. g e ve, ' dt if and kee armless the City of Cuperino against 510 — FINAL PLANNING I City, i d c i uses rch may in any way accrue against said City, c u ti remit. 514 — r. F NAL A��D WORKS J AP \ ALL NON- P LINT Issuedf@ ° ' R OF NAIL Date / X s n r ate HAZARDOUS MATER( ISCLO Re -roqft4 — ROOF IN— PROGRESS Will the applicant or future building t store or die hazardous material Type Of Roof as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety Code, ' Section 25532(a)? ❑Yes 0 N All roofs shall be inspected prior. to any roofing material being installed._ Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay AwaAir Quality Management If a roof is ' talled without first obtaining an inspection, I agree to remove District? all new to ' for i cti n. Applicant understands and will comply with ❑ Yes ❑ No all n o g of ns. e d o materials uiremepts under Chapter 6.95 of the Cali f " H fet C , ections 505, 25533 and 25534. 1 understand that if dr ild' g t n a eat t, that it is my responsibility to notify the IO( « nt f e is to issuance e C rtiFic l r D prior of a of Y. lure o Ap (cant to All roof coverings to be Class "B" or better OFFICE <�E 10 Z Z O '^ ¢ON- C an Y soap to t Z' asah K3' O� z> C 6 U2 CI eat DING DpESIOrvN� PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 21151 CANYON OAK WY 010 OWNER'S NAME: APPLICATION SUB DATE THE OBRIEN GROUP 01/16/2001 PHONE: SANITARY NO CONTROL NO. ARCHRECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 3 f.7 c-1 L= l =J LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with full In 7WO) of the Business and Professions Code, and mylicense is in full force end of Div SFDWL: 4945 CONDITIONED SPACE, 674 GARAGE Date Clam Contractor Date SDEC A ARCHn EC DECLARATION �1 � Le® use 3 I understand my pions shall oe used ns public records MAY 2 1 2003 ' Licensed Professional DECLARATION Oat I ma exempt from I hereby .(Sinn that I oat cBusin from the Commerce's License law the s following macron. (Section 7 o L5, Business and Professions Cade: Any city or county onion o e c co b which require a permit m consumer, epee improve, demolish, or rtWir.ny swnum• B $494566 c pal01A earmd also rtquires micense gm(usee, _ ,.. provisions desmhpcmtit 9. pm of the ContenetofLLianu law (Chapter9 Nath4ercingwitpSeciit S Ft Floor -Are Valuation ,7the Divi,i (<ommemm�6 wi[h,SeciioniJOf101 of Division Jo(the h )mkaM1d Prpfpcsiom Cod<) g y He iS diertipt Tram � ON, l'"�,'. 1 S 4 2 . ( (� n 1i21�Xf Jd)'^� 1 9 `v Q 7` Q Q or tom th6n and the oasis for [he all gee a map, o .Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty' 'of n ut ... than five hundred dolmr(ss00). • 1 pry, APNN be it -.c:: •.. Occupancy e IYP 101 - F�EnJNiSATION ❑ Las owner of the property, ur my employees with wages as their sole compensation, --wllhdo she work, and the'stmnure Is not Intended 'or offered for sale (Sec -7044; ' Business and Professions Cody The Contractor's License m Law does not apply to -. .. - 103 - _ _ Required Inspections - UFER owner of property Who b re builds or improves theon and who does such work himself or through his own employees. provided that such improvements an not intended or -the offered low rule. If. IL howevee building or ird in year of ig sthath did -- .. •. n of prof will h.rc the burden of proving that he did not build or net 'un'roveforsarpose 105 - ANCHOR BOLTS im forle.er Prove or purpose o w1e.I. - - m esdusi -I contractin S -- —. _.... of a y g AI .set ym� _. _ ._106 T _ _SEWER.. & WA ER---- -- - -- --- ---....--------,- -- -' -- -- :', :,. .,; ..e1..,s -•.. he he ;« s uam s oaproperty adfssionn Code Pe Coontrractors Licenser Pn License la oes t ' L' wn f ho bailee or im roves thereon, t 203 IG UNDERFLOOR MECMHANNCAL ae .wh a Lim, Coat s P wW a contractors) licensed punumt m 204 -._ - UNDERFLOOR,,;.III..,. of B/jr PC(or thiseon 205 UNDERFLOOR"INSULATION q r D LAR ATIOON 301 - ROUGH PLUMBING -1 herebyaffrmunderpeml arper ;�ryninenemeralnwingd�e�am[m�,: 302 - TUB & OR SHOWER 01 nave and will provide n CertifSect of Consent 4a aeL arbor foe wor 303 - ROUGH MECHANICAL r o Compensation. as provided for by Section 3900 at tna Labor code, for me the 304 - ROUGH ELECTRICAL yer(arantice of the work ter which this permit is issaae. 305 - FRAME G 1 have'ana will maintain Worker's Coinp avation insurance, as required by section 306 - HOEDOWNS 3'700 of the Labor Code, for the performance of the work for which this permit is Issued. My Workers Compensation Insurance carrier and Policy number ore: 3Q•� _ INC�`ULAe1sI [!N came t, r;l r_ t piney No ns 30�,• - SHEETROCK t , t CERTIFICATION. OF EXEMPTION FROM WORKERS" ' COMPENSATION INSURANCES' "' ' ' ~' .' 1 3 0J9 - ` SXTERI`OR LATH Qhii'eeciioe e t be cam leted if t permit is (or one hundred dollars 310 " ='' INTERIOR LATH � ^ - SIM)arles.0 311 - SCRATCH COAT .. _.'ice rkioewmanm :p< t'i. ssped'i :.. -- ` -313 -- - ROOF NAIL,,, C-Pji ` OIL f ra to oats..Jac na o rt 501 - FINAL ELECTRICAL ENERGY ._A pli n - ._.......... 5.02.,..- _.FINAL' PLUMBING .. .ENERGY;....._._.- ._.__..__..- _..__._... _. .N E r r t eeoofExemption,youshould - bee the ra ampenaado- vi.iansofthelaWr Code, you must 503 - FINAL MECHANICAL ENERGY forthwith coat I with such provisions or tb n shall he deemed revoked. ar _ . _. "• "''' FINAL- BUILDING - -ENERGY- -,,- - • +- ^CONSTRUCTION LENDING AGENCY' ', I thereby affir ms n that thereisa cowmion lending agency forthe performance SOS - FINAL ELECTRICAL n of die work far which this Permit isissued(Sm:3W7,Clv.C.) - . _.. ___ . ..._�. 506. -_ GAS TEST Lends Name ,._ _. . - . . nit 507 - FINAL "[ /1 , enif Ir terry lba[Ina read this apvandcoand is 508 - FINAL MECHANICAL MECHANICAL ty(ndummesadsure laws reati torten 1 agrt t m ply with all city and county ommanca.nd Hate tows rtlmmg to boil dingcon. ni n, hereby .athorireut m fives of this city mcmer upon 509 - FINAL GRADE the.above -me nine'p,pc the spedkee put area. rs. ` of v,'dc mdkee rimless theCay.,hperiino,, 510 - FINAL PLANNING uabui - e c e rtes irn mar,im my war .came agajnas sere said Cit c' se u t ti a n i nnit. 514 F NAL WORKS / ❑'H ALL NGN. P INT Issued�b :2 R F D NAIL Date -/ s ° r e me HAZARp0U5 hfATERI ISCLO Re -ro 4 - ROOF IN- PROGRESS �.: W II the applicant o f lure Budd ng ant anon m die Kars mows maternal Of as defined by th C P rr n M ipal Cod Chapter 9r] 2 e d the Health and Safety _ c -Type- .Roof . �." "-' I " �"' - ' °' "- "'- "'-' -' •'�"'° Codes eon 2j53n(u). r t.:: r i•.Sa Ln r: lr')I4 U ❑va oNo 1(t ' All roofs.shall be inspected poor- to.any- roofing.material being Installed.• Wi II the applicant or future building occupant use ocii raiment or devices which - If a roof i5 ' -_- called without first obtaining an inspection, ILugree -to remove em t h Nous air c6nownirwarx m defined b5 the Bay A[[`ai1 Quality Menagemem ' Datnet all new to for i cti n. A hcant understands and will coat I with PP _ ea ,....phis •, all 11 � _ o g at ns;�. -- ,t•. e d s C mated als qui under the cru Calif ' H I Set C e, actions SOSaitilm,e A53d_lundersuif that 25533a 4.1 urn um d ifN Ild' g t n me nC tom 11.11. responsibility ro notify she' - �/ oc ra f t ¢ riot° issuance of e C ni111 a of 0 D a. y. ture o Ap Icant e All to coverings to be Class "B' orbetter DIV .��. .:..i ... - ..-OFFICE _.. .._ _. ,... _ _ ... .. r �OCpp YUt �ti 4r )Z =l vaF[ L� y' 0 I t a E x p i pj n �Z Mkt a3• 9 . CITY Off' CUPERTINO CONTRACTOR INFOR' 'LTION: BUILDING DIVISION T°R"', T C 8151 D CANYON OAK WY P PERMIT 02080088 N�BRI EN GROUP A APPLicA0 8/ 15 2 0 02 PHONE: S SANITARY NO. CONTROL NO. ARCHTTECTIENGINEER: B BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing J REVISION OVER TRUSS — — i with Section 7000) of Division 3 of the Business and Professions Code, and my license R IN HOUSE USE ONLY — (ORIGINAL #010100'53) License Class Lie. A i L i ARCHITECT'S DECLARATION 1 I understand my plans shall be used as public records 7 Licensed Professional • OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5. Business and Professions Code: Any city or county i which requires a permit to construct. alter, improve, demolish, or repair any structure 4 4 94.5 6.6 - prior to its issuance, also requires the applicant forsuch permit to rile a signed statement - - - - . - - - _ • that he is licetrSed puisulw't to the provisions of the Contractors License Law (Chapter 9 - -,- , . -... , ..S Ft. F Floor Area' -� . r ; , - - Valuation (commencing with Section-70W) of Division 3 of the Businessand Professions Code) ^ ^ tq' , of Section 70315 by any applicant fora permit subjects the-applicant in a civil penalty' of not more than rive hundred dollars (s500). A APN Number Occupancy Type ❑ 1. as owner of the property, or my employees with wages as their sole compensation, 1 101 — F FOUNDATION . will 'do the work, and the structure is *not intended or offered for sale (Sec. 7044, 1 1 O2 — P PIERS owner of property Who builds or improves thereon, and who does such work himself 1 103 — U UFE R 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 1 104 — R REBAR completion, the owner - builder will have the burden of proving that he did not build or 1 10 5 — A ANCHOR BOLTS improve for purpose of sale.). O 1, as owner of the property, am exclusively contracting with licensed contractors to 1 1 0 6 — S SEWER & WATER - - - - c construct the pmject (Sec. 7044. Business and Professions Code:) The Contractor's 2 202 — U UNDERFLOOR 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 - - 2 03 — U UNDERFLOOR - -- MECHANICAL - - - -- - -- 01 ann exempt License Law. 2 204 — U UNDERFLOOR '- FRAME Owner' Date 2 205 — U UNDERFLOOR INSULATION WORKER'S COMPENSATION DECLARATION 3 301 — R ROUGH PLUMBING 1 hereby affirm under penalty of perjury one of the following declarations: 3 302 — T TUB & OR SHOWER 0 1 have and will maintain a Certificate of Consent to self -insure for Worker's 3 303 — R ROUGH MECHANICAL - Compensation, as provided for by Section 3700 of the Labor Code, for the 3 304 — R ROUGH ELECTRICAL Performance of the work for which this permit is issued. 305 — F FRAME ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3 306 — H HOLDOWNS issued. My Worker's Compensation Insurance carrier and Policy number are: • •3 O T — • •INSULATION_ -', �• - • '• - ' -• - = -- - -- ' _._., .. . Carrier. '' ' Policy No.: - - • • '- " - CERTIFICATION OF,EXEMPTION FROM WORKERS' ` 3 0 9 - - - EXTERIOR -LATH-.- (This section need not be completed if the permit is for one hundred dollars 3 310 ' — I INTERIOR LATH (a100)orlessa 3 311 .- . .SCRATCH--COAT. 1 certify that in the performance of the work for which this permit is issued, I 3 313 — R ROOF NAI L. • • ' '_� i ''' -' - Compensation Laws ofCalifomia .Date 5 501..- F FINAL ELECTRICAL ENERGY ' NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should 5 502 — F FINAL PLUMBING ENERGY ' become subject to the Workers Compensation provisions of the Labor Code, you must SOURCE'REGULATIONS. Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant score or handle hazardous material as defined by the Cupertino Mue icipal Cade, Chapter 9.12, and the Health and Safety Code, Section 255320)? 13 Yes' - El No , Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Yes ❑ No 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not cutremly have a tenant, that it is my responsibility to notify the occupant of the requirements which must. be met prior to issuance of a Certificate of Occupancy. Owner or authorized agent Date lssucutotyu — 1JQLC —4--i Re -roo .r`wr DI-1 1 1 MIA 0 �4 - RO IN-PROGRESS. (/ Type o oof �... _.. :.. A11.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. Applicant understands and will comply with all non -point source regulations: Signature of Applicant _• _ .. -Date All roof coverings to be Class "B" or better OFFICE'