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02100077CIT t)F CUPEI�TINO CITY OF CUPERTINO PERMIT APPLICATION FORM/ I Fee DescriptionGroup e. 10. g,:p2:, Building Addy ss: iBCONSTAX O is Name. • # �for Phone #: Contra, or: BO _ ro License #: Contact: Phone #: Applicant/Contractor: BELEC1000--�Elec600V<=1000A ----7 uilding Permit info: Bldg Elect Plumb Mech Job Description: Residential: - Vw R , Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engineer: _ MultiI r.. R Valuation: Type of Construction: lov BMITIGATC Occupancy Group: I u�� Fee DescriptionGroup P' PPQ � r �� iBCONSTAX Construction Tax • # �for r BO _ ro MUMS Hotel and Motel BELEC1000--�Elec600V<=1000A ----7 *Elec Svcs 666-V `�InTifChL BUILDING _ MultiI r.. R BINVESTIGA Investigation fee BMITIGATC Comm. Housing Mit. Fee limitd 01 R AI ' Res. Hous ee Re r� MECHANICAL "Calur MH New Comm Electric New Comm Mechanical II MW 911MOAHt' • * C1 u�� 'i Description •Vent Fan 1le Duct ! Ventilation L Sob ecific Plan I oil ! ;t Commercial Seismic Fee ResSingle Family New Add M-- ELECTRICAL WAVES -,4kyj Temporary Bldg-' Pennit 'BTEr M► Dist Business LicensePermit Elec Issuance .{. ,. .: Issuance Mech Permit X01 * . , Plumbing Permit Issuer Ad&ess Change • r •.. il..,... !! toa.0 �kvwalmgraa Boiler 1M to 1.75 M r 4Z ed 2 W "J P <Z� Z 0 Pz—r J, -4t" ;;Fii" e2 0it- I_ E; CITY OF CUPERTINO BUILDING DIVISION PERMIT BUIL'b@"OESSTEVENS CREEK BLVD WEBCOR BUILDERS PERMIT N02100077 —9413 ENS CREEK APARTMENTS, LP 951 MARINERS ISLAND BLVD APPL"ATT'VYU'_WY 2 0 0 2 PHONE: (415)349-2727 SANITARY NO. CONTROL NO. ARCHn'ECTIENIGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing REVISION --IN with Section 70M) of Division 3 of the Business and Professions Code, and my license is in full force and effect. ORIG. #01070021 License Class Lic. # Da.Contractor-- ARCHITECTS DECLARATION 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 703 1.5, Business and Professions Code: Any city or county which requires a Permit to construct, after, improve, demolish, or repair any structure $0 prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 36901029.00 that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of than five hundred dollars APN Number Occupancy Type not more ($500). 101 - FOUNDATION n 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 Contractor's License Law does not apply to an owner of 103 - UFE Required Inspections R property who builds or improves thereon, and who does such work himself or through his own employees, provided thatsuch improvementsiare notimended oroffered forsale, If, 104 - REBAR 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 105 - ANCHOR BOLTS sale.). 106 - SEWER & WATER 0 1, as owner of The property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- censeLaw does not apply to an owner of property who builds or improves thereon, and, 203 - UNDERFLOOR MECHANICAL who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. 204 - UNDERFLOOR FRAME of am exempt under See. B & P C for this reason 205 - UNDERFLOOR INSULATION Owner— Date 301 - ROUGH PLUMBING WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER 1 hereby affirm under penalty of perjury one of the following declarations: 303 - ROUGH MECHANICAL El I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the 304 - ROUGH ELECTRICAL work for which this permit is issued. 305 - FRAME [] I have and will maintain Worker's Compensation Insurance, as required by Section 306 - HOEDOWNS 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: 307 - INSULATION Carrier: Policy No.: 308 - SHEETROCK CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 309 - EXTERIOR LATH (This section need not be completed if the permit is forone hundred dollars ($100) 310 - INTERIOR LATH orless.) 311 - SCRATCH COAT I certify that in the performance of the work for which this Permit is issued, I shall not 313 - ROOF NAIL employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant 501 - 502 - FINAL ELECTRICAL ENERGY FINAL PLUMBING ENERGY 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 503 - FINAL MECHANICAL ENERGY forthwith comply with such provisions or this permit shall be deemed revoked. 504 - FINAL BUILDING ENERGY CONSTRUCTION LENDING AGENCY 1 I hereby affirm that there is a construction lending agency for the performance of 505 - FINAL ELECTRICAL the work for which this permit is issued (Sec. 3097, Civ. C.) 506 - GAS TEST Lender's Name 507 - FINAL PLUMBING Lender's Address I certify that I have read this application and state that the above information is 508 - FINAL MECHANICAL correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize, representatives of this city to enter upon the 5 FINAL GRADE above-mentioned property for inspection purposes. 10 N IN FIN PLANNI G PL� PLAN (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 City in consequence of the granting of this permit. 5& 60 F U LI WORKS WN APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL, NON -POINT Issued by. rJJ NAIL Date SOURCE REGULATIONS. Re -roofs 604 -OF Type of Roof IN -PROGRESS Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑Yes ONo 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 Will the applicant or future building occupant use equipment or devices which omit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District, Ely- ONo I have read the hazardous materials requirements underChapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505,25533 and 25534.1 understand that if the building does not currently 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. Signature of Applicant_. Date �/ aof coverings to be Class "B" or better Owner or authorized agent Date