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02090143CITY OF . CUPEkTINO CITY OF CUPERTINa : d ?° Z 0 : PERMIT APPLICATION FORM APN # * Fee Description Date: BAPPLOTHER Other Appliances MECHANICAL: Building Address: Construction Tax BUILDING Owner's"Name: Ind/Off/Comm/Quasi Phone #: BCONSTAXBQ Con. Tax for BQ Zone BUILDING Contractor: Hotel and Motel License #: BCONSTAXR Constax — Resi/Mobile BUILDING Contact: Elec 600V <=1000A Phone #: Applicant/Contractor: Elec 600V > 1000A Fax #: BELEC200 Elec Svcs 600V <= 200A ELECTRICAL Building Permit Info: Ener2v BUILDING Bldg Elect Plum Mech Job Description: "� Investigation fee Residential: — ,-� �� BMITIGATC 0 e ii 1: Sq.Ft. Floor Area:. '$/Sq.Ft..Tr BMITIGATR ./ . \1=1 BMNEWMULTI New Multi -Family Res Architect/Engineer: BNEWMULTI Valuation: },+ ELECTRICAL BNUCOMME New Comm Electric Type of Construction: BNUCONMIM Occupancy Group: : MECHANICAL BNUCOMMP New Comm Plumb QuantLq FG 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 BELEC1000 Elec 600V <=1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL' BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Ener2v 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 BNUCONMIM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING /Jo ?4vi-oc;-� Zss44_. �X(�776 CITY of CUPEkT1NO Quantity Fee ID Fee Description Fee Group -BNUMULTI New Multi -family Res PLUMBING BOVERTIME Inspection Overtime BUILDING . BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFiXTURE Pb1g Fixture PLUMBING BPGAS Gas Pipmig System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD " Plan Check Add Multi BUILDING _ BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING. BPSTORM Storm/Rain Water PLUMBING BPTRAP ' Kitchen Trap PLUMBING BPVENT - Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER . A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN. A/C Units <=10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL -BREMBUSWAY. Remodel Busways ELECTRICAL BREMFM Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT - Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREM[NRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch &, Outlets ELECTRICAL BREMRELOCA Relocation of Hood . MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREIVIRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmd1 Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR . Theatrical Lighting Fix ELECTRICAL 2 of 3 CITY OF CUPEkTINO ' - a CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group . BREMVENFAN Vent Far. Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSF&2FAM Sin le & 2 Family BUILDING BSFNA Single Family New Add BUILDING BSPECIAL Special section BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power' ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING BBOILERI Boiler <=100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75 M Btu MECHANICAL 3 of 3 2 zS V a -z CITY.OF CUPERTINO suiLn><lvc niv><s><oN PE IT CONTRACTOR �INFOR TION r F' I!?1tpD 1 TTEVENS 'CREEK BLVD WEBCOR BUILDERS PERMIT65090143 LINO CITY CENTER ASSOC 951 MARINERS ISLAND BLVD APPLICff9NS2V%IG002 PHONE: ( 4 15) 34§-272.7 SANITAlR1Y7NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH r- I r—U L__J L_ CICENSED.CONTRACTOR'S DECLARATION ' •�. �, �, I.bereby. affirm that I am licensed under provisions of Chapter 9 (commencing REVISION ^ IN HO U J _ t"tI�LY with'Section 5000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. NO NEW PERMIT ISSUED '(#01070021) License Class o Date CContractor nt MECH COPMT SPLIT SYSTEM -OF EXISTING FANS ARCHITECT'S DECLARATION � t - 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 - which requires a permit to construct, alter, improve, demolish, or repair any structure I " prior to its issuance, also requires the applicant forsuch permit to rile a signed statement tltdthe is-licbt)sed.putsuinGto the piovisions of the Contractors License Law (Chapter 9 - - - - -f] -- f1llatlOn S Ft:hloorA.: t • : r. '�� GGs 2 6 % 3 % 2 W41 (comr{tencrn with Section,f000 ;ofDivrsron 3 of the Busmess.and Professions Code ,rea; ;, .; ,, I f�M •q' ; or that & ii ezempf therefrom and the basis for the alleged exempiion. Any violation .-'of Section -7031.5-by any-applica t for permitsubjects-theapplicant to a•civil penalty of not more than five hundred do ars ($500). 3 6 9 � y��'�,p,l�j�p¢>, SNLF 4`IYl '1a ,.., .: OCCllpanCy T�pe ❑ I, as owner of the property, ur my employees with wages as their sole compensation, - .. ....... .... ... .. ..........._-....._....._..-.. .. .. __ .. _U 1kJUND uired- --will-do-the-work,- and the structure is not'Inteaded'or offered fat -sale (Sec:7044,-' ' )}usiriets and•Pioressions Code: The Contractors License Law does not apply to an ' owner of property Who builds or improves thereon, and who does such work himself 102 - PIERS or through his own employees. provided that such improvements are not intended or. .;offered foc sale: If, lroweder; the building or Improvement rs soldwitfiin one year of 103 'completion, the owner -builder will have the burden of proving that he did not build or 104 - REBAR improve for purpose of sale.). -...._-___...__........._.......__......__...-..._105-' ---ANCHOR. _BOLTS .q'iowngr:of th'e ---prope._.._.y,..a.__.. ............_...___........ .-as;am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractors .... r.,. _ :'::!:'��: i t'' FC'• - 106 - SEWER & WATER ;;;: ,; _.•- ,. ',;;:--;' ' License Law does not apply to an owner of property who builds or improves thereon, __and .Who contracts. for.suc'h.pmjects_.wih.a..contractor(s)licensed_puorsrutahnjt.,toa , ,. • _.2-U-...UNDERFLOOR-.PL.UMB_I.NG-...-. _,._:._ ...._.:._ _..._._... sthe- .ContLicense. La., am exempt under Sec:❑[ `.: 203 HNICAL UNDERFLOO ,sME ,': r .... Owner, 'WORKER'S COMPENSATION DECLARATION 2 04 - UNDERFLOOR FRAM 205 — UNDERFLOOR INSULATION -1 hereby affirm under,penalty.of perjyiry one of the .following declarations: - 301 — ROUGH PLUMBING ❑ I have and'ivill'maintain a'Certficate of�Consent.to self -insure for Worker's 302 - TUB & OR SHOWER Compensation, as- provided. for by Section ' 3700 of the Labor Code, for the 'perfniinanceofthe'workfowhich,thispermit,isis5uea„;, 303 - ROUGH MECHANICAL . 304 - ROUGH ELECTRICAL 111 have and "will maintain Worker,'s Compensation. Insurance,'as-recjuirod by Section 3700 of'tie Labor Code; for the performxnce_of thz'work' focwhich'this'permit'is 3 0 5 . - FRAME - issue& Ivly %Yorkers Compichsatlon Insgrance canter and Polirynu .,mber are: ' ' 6 _..-....HOLDO.WNS......... - --.-:_ -.•,- _::.. Lamer.:l"`C PollcyNo...•.. ' 3: :. INSUI;ATION '•` `t(: CERTIFICATIONOF EXEMPTION FROM WORKERS" .' - , ; , .. ,,... COMPENSATION INSURANCE' :” '• ,; - 'r - ''• SHE (This section need not he `completed if the permit is for one hundred dollars 309 XTERIOR LATH (S l00) or less.) ,..,, ;; - .•. , _ ....:.-. __..3-10:.._:.::..INTERIOR_:,,LATH=��-._-z...:,- _ certify that in he,perfomjanco of rite work'for,which [his'pemtit is. issued I — - .. 311 SCRATCH 'shall'not employ'agy'person in any manner so as m, liccome subjec[;to ttie Workers' , • . .., '• Coin erisaiion Caws of California: Date; " "' wi o Califo ......_:.- . — R OOF NAIL tl NOTICE TOAPPLICANT: If, after'tnakin this Certificate dfExem tion ou:should . s, p•. .,y 501 - FINAL ELECTRICAL': ENERGY • • " ' become subject to the Work6r's Compensation provisions of the Labor Code, y°u must foidrwiih'c_b*ly'wi(h• such provisions or this permit shall be deemed revoked. ! __.......... ... .........._...___......5'0'3'-_.. 502 - FINAL PLUMBING ENERGY FINAL ..MEC -"ENERGY: _...__. ._ , ... ';r `." t"CONSTRUC'T16N LENDING AGENCY" ' i hereby.5rr ,i, that mete, is aconstiucti°n lenamg agency for ine.ppfforinance 5 04 - FINAL BUILDING ENERGY o m'e'Work forvihich t}Iis" erml[ is Issued Sec.3097, Civ.'C. ,.,....." ` Leoder`s Address!' `'• '' : , - " 505 FINAL ELECTRICAL - 506 � GAS TEST I certr that I have read this application and state that f, pp above information is 50 - INAL PLUMBING mrtecr, I agree w comely with all; etty. and, county ordipances.and,state laws relating j{! to hu"'Ing constnfction: and hereby'aumorize representatives ofihis city to.enter upon and 'the 5 8 -. INAL HANI CAL - .I above-mentioned for inspection purposes. (Wz)'agree'to save; indeniolfy and kit p harmless the Ciiy of Cupertino agaitist : 5 - I NAL liabilities,judgments, costs. and expenses which may_in any way accrue agajnst said bf the'granting of this permit. �. .' ' " ` 'A$EiTCANT 510 - F IVt�LCitytrionsequence W U\DfRSTANDS'AND WILL'CO.1' P.. WITH'ALL NON -POINT' SOGRCE R$bLLATIONS;. ISSUed r — PRKS Date rnaure-ofA 4ca tl, Date ' YiAZARDQUs' ' A . . r.: -, ..: •' _ "-' TERIALSDISCLbSURE._;,`, - •�.;•.: :. 7` Wtll the applicanC&tature, bdrldiog bceupant Store or handle-Gardous.material — _ b3 — RVFBATTENS - Type Of asdgf ned by the Cupertino, Municipal- Code; Chapter.9,12, and the Health and Safety YP —.. R"I N = PROGRESS I Cobe;•Seciion 25532(a)7;; '-.;'-;:..::•'. _ :_, .5 .' �' _ :1t." ..'I... is .. ,.:;❑Yes: .,-::.,.; •..t ;❑No•, .- .. - - All roofs shall_be, inspected .prior to any.ro-afing .materiaLbeing.installed..... ...:....... Will the applicant or future building occupant use equipment or devices which If a roof is insfalle'd' without first obtaining an inspeetid> I agree to remove emit hazardous air contaminams as defined by the Bay Area Air Ouality'Management' District'%.: . ,. ... , ... - . .: .' _.. , ' ..- all new materials for, inspection., :A.pplicant understands, and will comply with . - ONo'" ' alI nan-point source regulations„ 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 tfte•¢uilding does not currently havea tenant: that it is my responsibility to notify the occupant of the requirements which must be met prior, to issuance of a.Ceriifcate of bccupancy. .:.. .' :. " • ture of A licant Date Signa PP All roof coverings to be Class `B" of better . owner pr aamorized agent ' Date :.