The URL can be used to link to this page

03020027�ccZ y+t�00 <ZV n�H 5 ? Z�Q 3�m s Oyu 3LLF' A N � ❑ c Lu v �— �za c4 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRAGTOTI±?RN[TIt BUILDIN W pDRESS: STEVENS CREEK RIAZT) PERMIT N'03020027 0o 3 0 2 0 0 2 .% OWNER'S NAME: PERIvf1T 6 5% U 6/ 2 0 0 3 SONG LEE UIZNO'S SUBS PHONE: SANITARY NO. CONTROL NO. ARCHITECTfENGI NEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH L_J 0 0 0 LICENSED CONTRACTOR'S DECLARATION Chapter 9 Job Description I hereby affirm that 1 am licensed rider provisions of (commencing with Section 700 ) of Division 3 of the Bus and Professions Code, and my license is in full force. rid ffect. , �` % �S / �: License Qlass —�' Ctc. it (, TENANT IMPROVEMENT Date /' Conor CONTRACTOR: RTJN ARCHITECT'S D ATION 0uddErsta�td my plans shall be used as public records Li nscd afolsional // OWNER -BUILDER DECLARATION �h,Jy affirm that 1 am exempt from the Contractors License Law for the follo%tt X anon. (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 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's Litxnsc Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 1 0 0 0 0 0 that he is exempt therefrom and the basis for the alleged exemption. Any violation 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). 3 1621029.00 ❑ I. as owner of the property, or my employees with wages as their sole compensation, RR d Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his 101 - FOUNDAT own employees, provided that 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 chat he did not (wild or improve for purpose of 103 - UFER sale')' 104 - REBAR ❑ 1. as owner of the property, am exclusively contracting with licensed contractors to 10 5 - ANCHOR BOLTS construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li- cense Law docs not apply to an owner of property who builds or improves thereon, and 106 — SEWER & WATER who contracts for such projects with a conuactor(s) licensed pursuant to the Contractors License Law. 202 - UNDERFLOOR PLUMBING ❑ I am exempt under Sec. , B & P C for this reason 203 - UNDERFLOOR MECHAN I CAL Owner Date 204 - UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION 205 — UNDERFLOOR INSULATION 1 hereby affirm under penalty of perjury one of the following declarations: 301 — ROUGH PLUMBING ❑ 1 have and will maintain a Certificate of Consent to self -insure for Workers Compcn- cation, 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 ❑ I have and will maintain Workers Compensation Insurance, as required by Section 3 04 - ROUGH ELECTRICAL 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Wo/rkjers../C�om�p'eps�at; n lnsurana carrier and Policy nu be lnn , 305 - FRAME � ca}rief✓�1.�'W. +� Nay P°'icy - - ✓_ 306 - HOLDOWNS CERTIFICATE OFEXEMPTIONFRO RKERS' COMPENSATION INSURANCE 307 - INSULATION (Thisscction need notbecomplctcd ifthe permit is for one hundred dollars($100) 308 - SHEETROCK or less.) 309 - EXTERIOR LATH 1 certify that in the performance of the work for which this permit is issued, 1 shall not 310 INTERIOR employ any person in any manner so as to become subject to the Workers' Compensation — LATH Laws of California. Date Applicant t 311 - 313 - SCRATCH COAT ROOF NAIL NOTICE TO APPLICANT: If, after making this Ccnificate of Exemption, you should become subject to the Worker's Compensation provisions of the labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 501 — F I NAL ELECTRICAL ENERGY 502 - FINAL PLUMBING ENERGY CONSTRUCTION LENDING AGENCY 1 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 (Sec. 3097, civ. C.) Lender's Name 504 — 505 - FINAL BUILDING ENERGY FINAL ELECTRICAL Lender's Address 1 certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinaries and sate laws relating to 506 - GAS TEST �r building cons ap.on, and hereby authorize representatives of this city to enter upon the Ir FINAL PLUMB I G above-mcniponcti property for inspection purposes. 8 FIN L (y.c) agrees to)save, indemnify and keep harmless the City of Cupertino against liabilitigs,judgmcrtrs cons and expenses which may in any way accrue against said City in consequcncc oddthlC granting of this permit. C, _ r I APPOCAN-F gigbERSTANDS AND WILL COMPLY WITH ALL NOt�-PAINT Issued by:51 NG Dater SOURCE RECD ATIONS. / /I r ' Re -roofs Type of Roof Si urgrof fiplicant/Contractor a HAZARDOUS MATERIALS DISCLO RE ' th applicant or future building occupantstore or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code. Section 25532(a)? roofs shall be inspected to any roofing material being installed. 0 yes <NoAll ❑Yes No prior 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 contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Ycs ,,9 N° 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health &ticiaCodc,Sccdons25505,25533and 25534.1understand that ifthe building does not cul-rently hays a tenanL. that it is my responsibility to notify the occupant of the rcyuirerne ta rhich ust be met prior to issuance of a Certificate of Occup3¢c�' Signature of Applicant Date �� All roof coverings to be Class "B" or better Owner or ut recd agentbate 7> a w� - am,__ CITY OF (�UPERTINO CUPERINO PERMIT APAI �TION FORIM APN �- �A �1 I Dat, V dr: As v _ BELEC1001 Elec 600V > 1000A 71 5_ TE vam 5 c iR EEK 6 L VP . TR W_ ! GN PLA a O (n is am'e• So�cG LEE i p e (�ctii ?,vl, -hon C40 93. 900 - Contractor n D Swip License T Contact Mr -Y BENERGYADD Phc<<e _ 5400 , Applicant/ • BINVESTIGA Fa-. 1 Build, Penntt Info BMITIGATC Comm Housing Mit Fet B1dc, E1Cct P_un�b i✓ Job D cnption BMNEWMULTI _ ential BNEWMULTI New Multi -family Res Sq Ft )` looi Asea I + b Z BNUCOMME i S/sq rt Arclutect/Engmeer BNUCOMMM I '•'aius� <� Type of Co lstruction BNUCOMMP --- —�: Jccapaac.C. • �t`� 7 -tee 13 9 QU2-1iit-' Fee ID BAPPLOTHER BCONST.',_X BCONSTAX BCONSTAXBQ BCONSTAXH BCONSTAXR BELEC 1000 � >Eee 3�esc±iptir,� I Other App lianees Construction Tac j Ind/Oft%Comnz/Quasi Con Tax for BQ Zone Hotel and Motel Constati — Resi/Mob,le Elec 600V <= 1000_-`_ _ - --� Fee Gr9up I _ I MECHANICAL _ _ --BUILDING _ ! BUILDING I _ _ j _ _ BUILDING _ _ BUILDRIG _ BUILDING --- - I ELECTRICAL _ BELEC1001 Elec 600V > 1000A ! ELECTRICAL. - BELEC200 j Elec Svcs 600V <= -100_-`_ _ _�_ ELECTRICAL BENERGY j Energy_ j BUILDING BENERGYADD Energy Add Multi — BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm Housing Mit Fet 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 Z/° ��