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03050052-EXPIRED,� 0.n c �v or CUPEkTINO )C�tTY OF r , V - APPLICATION s APN # Fee ID Date: -- Fee Group BAPPLOTHER Building Address: 12 -V 4S r O ner's Name: Bldg Permit sq. foot Phone #: • 3 Contractor: License #: Boiler > 100K to 500K Btu MECHANICAL Contact: Boiler > 500K to 1M Btu Cupertino Business License#: Building Permit Info: BBOILER4 Bldg .Elect Plum Mech Job Description: Residential ❑ , ornm'al BCONSTAX Construction Tax Sq.Ft. Floor Area: - BCONSTAX Cost of Project: , Occupancy Group: Type of Construction: rz 1 _ Quantic Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permit sq. foot BUILDING BBOILER I Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > IM to 1.75 M Btu MECHANICAL BBOILER5_ Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING - BCONSTAX Ind/OfFComni/Quasi BUILDING BCONTSTAXBQ _ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= IOOOA ELECTRICAL BELEC1001 v Elec 600V > 1000A ELECTRICAL BELEC200 Elee Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING _ BENERGYA.DD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 TTY OF CUPERTIN(3 S'CrTVOF0CuP PERMIT APPLICATION FORM ►7�YLe ► ► ► ,low, ► BMITIGATR Res. HouBUILDINGsing 0181111IM-kyj Wo NOT • . Multi-Family'Res MECHANICAL • • MNEWSFe Newr Res R '�' •... « I gills III 3 C.41 `` Rr��•gq !�� •17� • ily Res . q r ELECTRICAL •. T i ELECTRICAL11�� New Comm Mechanical r � * • _Comm ! ili Plumb I r i BNUMULTI New Multifamily Res • • BUILDING + inspectionBNUSFD ... Overtime r ■ ♦ # Atmosphneric Vvacuum PLUMBING ■ "PLUMBING ■��iBPCESSPOOLBPERMFEE PLUMBINGBPFIXTURE Gas Piping System Fee 113 Ind Was�e Plan Cheek Fee ISUI J'".3 I Plan Check Add Multi �j BUILDING • r ♦ R R �IMPTIi��J•�iiiYGLTg1�1 • I; _.._ ® I�IIIIII:��11Rli�.l,�sr�� Sewage Dispo 3al late) R r iii # IrR . # i R• BPSTQ.KM Storm/Rain Water M=1191 616 • i1l11�:� Kitchen R •� • n �1 n Alt• IDrainR,jVent PLUMBING affim Install/Alter Water PLUMBING Water HeaterNent Main Water Service_ s Reinspection Fee 10,000 ■IIIz1a I +JAJC I • IGI MECHANICAL10,000 Appliance Install MECHANICAL BREMBUSWAY --i Remodel Busways ELECTRI AT t� �q■1j11.��;�y II■■!a �j 114 Lighting Fixtures 1 •Relocation of Furnace1 i a • r • InstallationHeater , ■ nnl 1 i •� �■q11 r i / 1- I. MUT t= 11111�11� • la��'��,Iti,IR r• I r R , i# R ♦ SIMON, •• i • ► 2 of 3 CITY OF CUPERTINO � - 0A BUILDING DIVISION PERMIT BUILDING ADDRESS: 0 4 8 R lq T R I 7RNTS BLVD WEBCOR BUILDERS PERM"NO03050052 OWNERS NAME* 951 MARINERS ISLAND :BLVD PMAIT Mtf�3n 9 / 2003 STEVENS CREEK APARTMENTS L.R� PHONE: (415)349-2727 SANITARY NO. CONTROL NO, ARCHITECTIFNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencingJob with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. TI --REVISION TO COMMUNITY RM License Class— Lic. # Date Contractor ORIG.. #01070021 ARCHITEC'T'S DECLARATION I understand my plans shall be used as public seconds Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 703 L5, Business and Professions Code; Any city or county which requires a permit to construct, alter, improve, demolish, orr repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed purstantto the pravisions of the Contractor's License Law (Chapter9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) kni'Division 3 of the Business and Professions Code) or , $50000 that he is exempt therefrom and the basis for the alleged exemption. Any violif on of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 36901029.00 0 1, as owner of the property, or my employees with wages as their sole compensation, Inspections will do the work, and the structure is not intended or offered fiersale (Sec, 70", Business and Professions Code; The Contriaetor's License Law does not apply to an owner of does himselior through his 101 - F OUNDA"Md property who builds or improves thereon, and who such work own employees, provided Eliot such improvements are not intended or offered for sale. If, 102 - PIERS 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 103 - UFER sate.. 104 - REBAR i f the property, am exclusively contracting with licensed contractors to L1:10W10 105 - ANCHOR BOLT S the project (Sec. 7044, Business and Professions Code:) The Contractor's U. cense Law does not apply to an owner of property who builds or improves thereon, and, 106 - SEWER & WATER who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. 202 - UNDERFLOOR PLUMBING w 0 U�xe ti it B & PC for this reason I am exempt c,204 203 UNDERFLOOR MECHANICAL UNDERFLOOR FRAME S COMPENSATION DICLA�0119 205 UNDERFLOOR INSULATION enft of perjury one of am following declarations,, a' underpenalty havehaVudantria'a 301 ROUGH PLUMBING I CaniflyarEe ofConscat to self -insure for Wuftr3 Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the 302 TUB & OR SHOWER work for which this permit is issued. 303 ROUGH MECHANICAL [3 1 have and Will maintain Worker's Compensation Insurance, as required by Section 3 --04 ROUGH ELECTRICAL 3700 of the Labor Code, for the performance of the work farwhich this permit is issued. My Worker's Compensation Insurance carrier and Policy number am 305 - FRAME Carrier. Policy No.: 306 - HOLDOWNS CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 307 - INSULATION '(This section need not be completed lithe permit is for one hundred doll= ($100) 308 - SHEETROCK oriess.) 309 - EXTERIOR LATH I ecifify that in the performance of the work for which this permit is issued. I shall not 310 - INTERIOR LATH employ any person in any manner so as to become subject to the Workers* Compensation Laws of California. Data 311 - SCRATCH COAT Applicant 313 - ROOF NAIL NOTICE 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 501 - FINAL ELECTRICAL ENERGY forthwith comply with such provisions or this permit shall be daerned revoked. 502 - FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of 503 - FINAL MECHANICAL ENERGY the work for which this permit is issued (See. 3097, Cie, C.) 504 - FINAL BUILDING ENERGY Lender's Name Under's Address - - - 505 - FINAL ELECTRICAL I certify that I have read this application and state that the above information is 506 - GAS TEST correct. I agree to comply with all city and county ordinances and state laws retaking to building construction, and hereby authorize representatives of this city to enter upon the PLUMBING INAL PLUMBING above-mentioned Property to, inspection purposies. 08 FIN FIN L (We) agree to sav indemnify and keep harmless the City of Cupertino against land in City men is' expenses which may any way accrue againstsaid 'J liabilities,judgments' in cones coofth gunslinger this permit. FIR!� %,FINAL I IN N 5 Date APPLI ERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: !30�4RGUIA�TI�ONS. — Alk, Re -roofs Type of Roof It S, u 1`6 tractor ica=RDOUS MATERIALS pal DISCLOSURE a plicant or future building occupant store or handle hazardous material �=s as III I a Cupeninks Municipal Code, Chapter 9.12, and the Health and Safety Code, Sectiq 25532(a)? All roofs shall be inspected prior to any roofing material being installed. 0 If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contafflinTs defined by the Bay Area Air Quality Management District? all new materials for inspection. No I have rc d a azardous materials requirements under Chapter6.95 of the Califor- ' 25505.25533 building nia I &Sy it Sections and 25534.1 understand that ifthe ave a tenant, that it is mm) responsibility to notify thc, occupant of the is, is hick must 4 be met prior to rcanccr,�f a Certificate of Occupancy. Signature of Applicant Date I -1—V .2 �0 *Date �j I All roof coverings to be Class "B" or better wna�ft "authorized agent