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02070153C _ OZd �°�S 5 azo olS (,-t TY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPER:11NO APN # Date: "341 `i � �' •!� �•1 i, � w Building Address: Owner's Name: Phone #: ;'�r�a G G.F+✓I✓ � � n�Tt'�+�� � _ � ry j`� 4� �,' 3 3..r - Contractor: License #: BUILDING BCONSTAXBQ Contact: Phone #: BCONSTAXH Hotel and Motel Applicant/Contractor: Fax #: Constax - Resi/Mobile BUILDING 'BuildikPermit Info: Bldg Elect Plumb Mech Job D cription: Re ' ential: C CR -CX 'a E i1- Vj!, � j14,=\(t nvs Commercial: q.Ft. Floor Area: $/Sq.Ft.: Architec"tTilgineer• Valuation: iP Li.itlrQ— BENERGY Type of Construction: Occupancy Grou . I Quantity Fee 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 Energy 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 1 of 3 r# ���� FA" �0F0_F �Z �vaW Z rn Qom. sN" z oZ- v_,I_va f� a`�ziv Oa txu3tiy H O N N J 1< >>< 2 < tn_N I—zQ i EE a3— CITY" Of CUPERTI.............. ........M.. ........ ....... ..., BUILDING DIVISION PER BUILDING ADDRESS: 20488 STEVENS CREEK BLVD WEBCOR BUILDERS TMN,r,E:ARTMENTS, A CALI LIMITEh2755 CAMPUS DR PHONE: ARCHITECTIENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby aft -inn that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class _,,.. _. Lie. p Date_ Contractor ARCHITECT'S 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 7031.5• Business and Professions Code: Any city or county 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 a signed statement that he is ficcrisO pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with. Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exCmption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). 1...11, as owner o(the property, or my employees with wages as their sole compensation, will do the work. and the sim ntre 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 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 offeredfor sale. If. 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 sale.). [.-11. as owner of the property. am exclusively contracting with licensed contractors to 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, and who contracts for such projects with a Mluacior(s) licensed pursuant to the Contractor's License Law. ❑ 1 am exempt under Sec._..._...._....._......................._..m......_..._....-.—. B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: C:7 1 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 performance of the work for which this permit is issued. ❑ 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 issued. My Worker's Compensation Insurance carrier and Policy number arc: Carrier:__,_______`__ Policy No.: CERTIFICATION OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (SI00) or leSs.) I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to hecome subject to the Workers' Compensation laws of California. Dale Applicant NOTICE TO .APPLmICANT: NT: If, alter making this Certificate of Exemption. you should become subject to the Worker's Compensation provisions of the Labor Code, you most forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) j Lenders Name j Lender's Address 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 to budding 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 City in consequence of the granting of this pemrit. Signature of ApplicanVContractor 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(1)' ❑ Yes ❑ 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 I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505.'-5533 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 Owner or awhoriaed agent Date (415) 349-2727 PERI1,IIT NO. 02070153 APPLICATIONS B DA 07/U25 2002 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH I_ .1 LJ I _ I REVISION FOR CONCRETriWALL ORIGINAL #01050104, NO NEW REVISION #02040157 Sq. ,fl., Floor Area, 3 6 94T QT!L9�0 101 102 104 105 509 514 515 Issued by:� Re -roofs Type of Roof PERMIT ISSUED. $ 9 7 0 7 3 Youation - FOUNDATIl&*ired Inspections - PIERS - REBAR - ANCHOR BOLTS - FINAL GRADE - FINAL PUBLIC WORKS - FINAL HEALTH DEPARTMENT Date ancy 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 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 0 T�S4.Y4jv,"Et S K I L L I H G WAAU MAGHUSSON Consulring StrMural S A A X S H I A E and IMI Englaeea 1301 Flflh Arena, Sidle 3200, Seonle, INA 98101-2699 Ph. 206/292.1200 fuNUM-1201 higi/wwskilling.com TO Massoud Modjthedi FROM Brent McAtee PROJECT Verona SUBJECT Stamped, Signed Calculations to Accompany Bulletin #1 Facsimile # PAGES (w/Cover) 10 FAX # (408) 999-6638 DATE August 1, 2002 PROJECT# 75511.00 CC: Michael Gould FAX# (510) 267-3199 Cc: FAX # EE: FAX # CC: FAX # If you do not receive the number of pages indicated above, or if any pages are illegible, please call our office at (206) 292-1200, or notify us via fax at (206) 292-1201. In answer to your questions regarding holddown embedment length and concrete stem wall anchorage. please reference detail 3/S5.06 of Bulletin #1 and detail 8/S5.01 of the original drawings respectively. As discussed today. this should complete the backup information requested regarding Bulletin #1.