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02080030CITY OF AMME6 APN # F 1 V - 1 Fee Description Fee •u MECHANICAL 0 Building Address: PAN—! NOV a Con. Tax for BO Zone Owner's Name: Phone #: BUILDING Constax — Resi/Mobile Contractor: ELECTRICAL License #: Elec 600V > 1 OOOA Contact: 1 BELEC200 Phone #: ELECTRICAL Applicant/Contractor' Fax Energy Add Multi ZERO Investigation fee Building Permit info: BMITIGATC onim. HousiN Mit. Fee...—,, Bldg Elect Plumb Mech Job Description: New Multi -Family Res Residential: tl 644 Commercial: Sq.Ft. floor Area: ELECTRICAL $/Sq.Ft.: New Comm Electric Arduteci/Engincer: magn Valuation -mi MECHANICAL .1411 mm"m mrarmim -mm"m m111 flmrdllkm�� & & i -3 111, rd Type of Construction: t Occupanc-yarouj�;' r.9—M 1 of 3 Fee Description Fee •u MECHANICAL Construction Tax PAN—! NOV a Con. Tax for BO Zone Hotel and Motel BUILDING Constax — Resi/Mobile Elec 600V <= 1000A ELECTRICAL Elec 600V > 1 OOOA ELECTRICAL BELEC200 Elec; Svcs 600V <= 200A ELECTRICAL L.P�ERGY Energy Add Multi ZERO Investigation fee BMITIGATC onim. HousiN Mit. Fee...—,, IN Res. Housing Mit Fee New Multi -Family Res 57 New Multi -family Res ELECTRICAL New Comm Electric IL"ww-'m'I 61 magn o New Cmm Mechanical -mi MECHANICAL .1411 mm"m mrarmim -mm"m m111 flmrdllkm�� & & i -3 111, rd 1 of 3 QW2 w0c �dE 9ZU Z 02'r r-4 fZ 2 2 X W 5 a- - CITY OF CUPERTINO BUILDING DMSIONT1, PEI, ry IT 'N--` BUILDING ADDRESS: PERMIT NO. 10300 N TANTAU AV 02080030 OWNER'S NAME: COMPAQ APPLICATION SUB DATE 08/07/2002 PHONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH [ 1 LICENSED CONTRACTOR'S DECLARATION . Job Description I hereby affirm that I am licensed under /visions gns of Chapter 9 (commencing with Section 700D) of Division 3 of the Busi Professions Code, and my license INSTALL CHILLER ON ROOF I for e 4,17-041.01, en�eT Lic. # Pism n enn -, CLAR_ 10 1 7tRC "ffC V 114 I understand my plans shall be used as public records 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 $14000 which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the Applicant for such permit to file asigned statement $o y, Ua Valuation that be is licensed pursuant to -Yule pro%jaimis of the Contractor's License Law (Chapter 9 Section 700J of Division 3 (commencingwith Code) the BaSiatai&And Profession of s or that ho'is exempt therefrom And the basis for the alteged'eximption. Any violation of Section 7031.5 by any applicatt-fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 10 1"ZN VMWE)AT I ON Occupancy Type 0I, as owner of the property, or my employees with wages as Elicit sole compensation, Ing - PIERS 103 - UFER Required Inspections will do the work, and the structure Isnot Intended or offered for sale (See. 7044, Business and Professions Codc: The Contractor's License Law does not apply to an owner of property Who builds or improves thereon, and who does such work himself 104 - REBAR� or through bis own employees, provided that such improvements are not intended or ,offered'for sale: If. how4ver, the building or improvement is sold withm'orui year of 105 - ANCHOR BOLTS completion, the owner -builder will have the burden of proving that he did not build or improve for purpose of sale.). 106 - SEWER & WATER Ci f, as owner of the property, am eircjusively c*rntracting'with licensed contractors- 202 - 'UNDERFLOOR *PLUMBING_ 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, 203 - UNDERFLOOR MECHANICAL and, who contracts for such. projects with a contractor(s) licensed pursuant to the. 204 UNDERFLOOR FRAME Contractor's License Law. of am exempt undelr'Sec, B & P C for this reason 205 - UNDERFLOOR INSULATION Oyf'ner 301 - ROUGH PLUMBING WORIfER'SCO PF N DECLARATION 302 - TUB Sc OR SHOWER I hereby affirm under penalty ofpciJury one of the following declarations; 303 - ROUGH MECHANICAL 0 1 have and will maintain a: Certificate of Consent to self -insure for Workers 304 - ROUGH ELECTRICAL Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued., 305 - FRAME 0I have and will maintain Worker's'06mliensation Insurance, as required by Section 306 - HOLDOWNS 3700 of the Labor Code, for the Performance of the work for which this permit is issued. My Worker's Compensation Insurance c"et and Policy number are: �,O 7 - INSULATION Artie, r5mlol� 0 8 . . R. '',SHEETROCK Policy .: A _37 _GX_O tE"CA , FEXEMP YMPROM.WORKERS"' I , 1 309 1. - - I ''EXTERT TH, ON COMPEI SURANCE, ' qSATION 310:''- INTERTORLATH - (This section aced not be completed if the permit is for one hundred dollars 311 - SCRATCH COAT (SIOO) or less.) I certify that in t6e perfamiance'of-the work for which this permit is issued U shall not employ any person in any manner so as to become,subject to the Workers'501 FINAL - 313- ROOF -NAIL - EL8CtRICAL- **tMEAGY Crunpausatirm Laws of California. Date'_ 502 - FINAL PLUMBINGENERGYApplicant TO APPLICANT. If, After making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must 503 - FINAL MECHANICAL ENERGY forthwith comply with such provisions or this permit shall be deemed revoked. _504 FINAL BUILDING.ENERGY. CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (See. 3097, Civ. C.) 506 - GAS TEST Lender's Name Lcndees Address I 507 508 - FINAL PLUMBING., - FINAL MECHANICAL I certify that I 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 509 - FINAL GRADE • 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, costs and expenses which may in any way accrue against said 510 514 - FINAL PLANNING - FINAL UBb�C WORKS City in co uence of flue granting of this permit. PFLIC D SAT- SA WILL COMPLY WITH 'C Ci� issued by: I Date w Sig ol'Applicant/Cledtractor Date ,HAZARDOUS MATERIALS DISCLOSURE Re -roofs Will the applicant or future building occupant store or handle hazardous material -Type of Roof As defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)l 0 yes %! I : XN- All,roofs. shall, be inspected prior to any roofing,material.being, installed. Will the applica War future building occupant use equipment or devices which If a roof is installed' ithout first obtaining an Inspection! "I -agree t6 remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? 0` 0yes Na all new materials for inspection. Applicant understands and will comply with all non -point source regulations. I have. read the hazardous materials requirements under. Chapter 6.95 of the .CA iforma Hea & Safety Cede, Sections 25505, 25533 and 25534. 1 understand that ifthes.not currently have a ternua. that it is my responsibility to notify the occu I to is in It must be met prior to issuance of a'Certificate of =.UireT Occu A c Vab Signature of Applicant Date 0 1 —V Date —Jow All roof coverings to be Class "B ' or better OFFICE .. ,... ._ 1, OFFICE - TINO CITBBUILDl DIVIISIONPERMIT CONTRACTOR INFORMATION: G BUILDING ADDRESS: PERMIT NO. 10300 N TANTAU AV 02080030 F-1 )WNEft'S NAME: APPLICATION SUB DATE 08/07/2002 HONE: SANITARY NO. CONTROL NO. Z ARCHITECDENGINEER: BUILDING PERMIT INFO O BLDG ELECT PLUMB MF.CH G w O I —I CJ u 0 i LICENSED CONTRdiand;SDECLARATION Job Description w 1 hereby ") of Nm I am licensed under inions of Chapter 9 (commencing with Section 7tglol of Division 3 o he Busin�dRofcssions cWe. and my Eanae INSTALL CHILLER ON ROOF txin f for ff ULi dor rns (� Lic.XFINALE ,�Q��ppt V •' T'RCHITECT :i,()YCLAR N SI undcrsmnd my plan.v shrill bo use) ax punlic rtmNv AUG 2 0 2002 0 Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 in exempt trent the Contractor's Licence Law for the a following reason. (Section 703 1.5. Business Cad Promo ions Code: Any city or county $14000 C — which requires it permit to conmm�, alma improve, demolish, or repair any structure _ prior to its issuance, also requires the applicant for such permino file a signed dominant rovisiof the Conctoes License Law (Chapter 9 that he is licensed pursuant to me pons ua BUILD 1 NG ," ; , �s ,,�sJ�pr a_, , 1 , t ).. s, Valuation (commercial; le ire Section 7")of Division J of the Business and Pmfcwions Code) x'(A.•;�n1.31�Y3!L�VLJ,.,tIVYlnit Y: or that he is exempt mercfmm and the basis for the alleged exempdmu Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty Vi5ftATION "'" Occupancy Type ofnntroom than live nundreddoll. (SSW), 10 jAPN ❑I, as owner of pmpeny. or my employees with wages as theirsole compensation, i Ing — P T P.P Cz 103 — UFER Required Inspections will dothework. and the-swem. is mat intended or offered for .to (Sec '7014,' Buitnen and Promisiee, Cade' The Contractor, License, Law d«a not apply in an owner of property Win Wilda or impome,i, daretwo, and who does such work himself - ' 104 — REBAR d th t h Improvements rc , t d d or through his a pl Y provided ....... ... '...-_..... .._.. .. ..... __.... ._...__. _. _ offered fo l-' If - h- - ,the budding or improvement is soldthn bncyuof 1. ,'•1 ..... 105 — ANCHOR BOLTS "' pmvr completion, me ownerbudder will buss the Wrdan of ag that to did not Wdd or improve fur puryott of sale.). 106 — SEWER & WATER oY.:a owner dr m� .......---...- ---._. ":._._ "., _..._. ... _._..... property. am exclusively contracting with licensed cominncton to _ _ ---.......".......202 -. UNDERFLOOR..., PLUMBING_....... .. ..__.,_._...._...._.-.. ' I =consumer he pmjen (See. lou. Bnsineas and Professions Code:) The Conrncmr's 203 — UNDERFLOOR MECHANICAL';' License Law does not apply to an owner of properly who builds or improves themes., nnd,wh. convicts fors.ch.prujcoa with.a comracusn,t)ueeased pursuant .toline :.... ...........-204 --'"UNDERFLOOR-FRAME.._.._...,..,-_.. ___. _.... .... ....-.----- Container', License Law. ❑ I am exempt under Sec._ ''d ''B&PC for Nis reason 205 — UNDERFLOOR 'INSUli TION ner_� "' 301 — ROUGH PLUMBING ' WORKER'S CO\Pr ON DECLARATION "I 302 — TUB & OR SHOWER " Ihereby affirm under penalty offerju;y,nnenfinernunwingaeelamtmna: 303 - ROUGH MECHANICAL ❑ I ha4e and 6iu mBinldm a Cenifca, of Consent to self -insure for Worker's 304 — ROUGH ELECTRICAL Compensation. as. provided lot by Section 37W or the Labor Codc, for the 'pert bromice or me work foo which this permi, is issued, 305 - FRAME Cl 1 have and will maintain Worker's C6,etikaion Ibsumnce, as requireE bj Section 306 — HOLDOWNS 37W of theLabor Code, for the perfmossam of he work for which this pe 3,07 INSULATION issued.My Workers C rape and re Compensation ,sec cert) Policy num�era. 5 0 308 I SHE,ETROCK_._T ._.-.._.-._._..__.._.__i., Pot YYNNQ� IFICATIONO E%CMP(IQe FROM WORKER "I IJ,s 4309' A IEXTERIOR'`LATH•t' .'E COMPENSATIONt SURANCE ,,,"„-INTER I __.—. .. ... �.�.-.- -. • � • ` (hili scdiion need hot he completed if the permit is for one hundred dollars 311 -- SCRATCH COAT � (EIWl nr less.),1.1.1. .--. —-=z--3-13 —` ROOF' NAI:L_.,.- tcentfrmai rh ped ceofm w k( nen th pe it issued.) 'Fnnu'nueempn,yspy senmamma as tobecem subjectromeworkers �"' t 'e• 5O1 — FINAL EDECTRICAL' ENERGY Co. pensatin Wws or Califumla. Dina”' " " " "' 502 --. FINAL PLUMBING—ENERGY- --- - Amilsia, - NOTICETOAPPLICANT:If, a e,makingthi.,CenlregteofExemption, y.ashoulp SO3 — FINAL MECHANICAL ENERGY ' Z become subject to the Worker's' Compensation pmvision.s of the Labor Code,'you must J fnithwithcomply 'with such provisions mthis Permit shall bed medtevoked. .___5.0A. --.FINAL BUILDING_ENERGY_. _. V] " CONSTRUCTION LENDING AGENCY "" 505 FINAL ELECTRICAL,., conmm lending ugncy forme performace t the, naw Ihereby ffitmmre - 506 GAS TEST .�, eon kfor which mi pe tisissued(s JWC 7.Cio _ -Ic Addm.. 507 — FINAL PLUMBING.",,f•F z p L &,' '_ 508 — FINAL MECHANICAL d state that me W .form tion is 1 rte th 11 live d m ppl and ,Ie, I agree , nPIY rid t stasis (upon 509 — FINAL GRADE /l////UJ`--- U he b'ty nt vex rthalioWilding construction, dh hereby representatives fib'. ryt cm pan ohne Wmentionedp ,sary for inspectionvggse - 510 — FINAL PLANNING 0. (We)ug to ve ndemmfyinl Re,, haaplcs.i the City ofCpr, o g'nxt 514 — FINAL UB C WORKS to Iwb,ld. j dgman cont, J expenses , y.insay p gain's. id ',z City in ce fib g ming ofm ismtt tAPPLfCA TDF STA S A WILL COMPLY WITH'ACI NON -POINT Issued by' Date 'OURC r0 Re -roofs ., Sgna of,Applica nano, + " -..:Dole,', . HAZARDOUS MATERIALS DISCLOSURE t nal ..Type of Roof ._ . - . -_. .. _ ,. .. ..... ..,.. andHeaMma def n d the Cupen Municipal Cod Chaplet 9 1. d 1M1 Halm and 5 f tY .' r. m on 25532(al r I -r. Code Section C io �Ye 1 �Np :_) �::) i'. ,.11. All roofs shall be inspected pnor to.any roofing material being Installed ' Willth hp( to Wturc Wild gocc Iia p • eq vbeentu a ce n �n If a roof is ins[alled'without firs[ obtaining an'inspechon,4'agree t(i remove sort, hN conadmitums, as defined by tbeBay A.Air Quality ManBmem District? all new materials for inspection,_ Applicant understands and will comply with - riY°'` •e all non -point source regulations.,, a .: I have, read the hazardous m5tedal2 requirements u^dcr.C. 6.95 of the that C5lifami,Hca &Safety C,xle, Sections 23505, 25533 and 25574. Funderttand mat or " s Cot if the Wildin - ' occupant of 'uiremems titch must be manprior to issuance oLe Ccnificate of •' :. Occu tic P°,. Signature of Applicant ate " _. PC�Y .Oti All roof coverings to be Class "B" or better woe or umorized a en Dam .. ,... ._ 1, OFFICE -