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CITY OF CUPERTINO
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DIVISION
BUIL IN PERMIT
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BUlLLgF411PR EVENS CREEK BLVD
PERMIT NO.
03040006
0` 19ffRTENCE3' HAIR & NAILS
•
PERMITISSUEDA
04/25/2003
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
HLDO ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that 1 am licen under provislons of Chapter 9 (commencing
with Scct n 7000) of Division 3 of th'ncss fc i Co"",IiccMSc
fore e
L
TENANT IMPROVEMENT
License an Lk. N
en
Date nlrector
CONTRACTOR:
THANH HA CONSTRUCTION
AR R 1
un d my plans shall be as public records
Licensed Prufcssiona�l' 9Wr
OWNER-BUILDER DECLARATION
i
I hereby affirm that 1 am exempt from the Contractors License Law for the
> follnwing reason. (Section 7W", Business and Professions Code: Any city or county
which requires a permit to construct, alter, Improve, demolish, or repair any structure
Sq. Ft. Floor Area
Valuation
t prior to its Issuance, also requires the applicant forsuch permit to rile a signed statement
' Contractor's License Law 9
that he Is licensed pursuant to the provisions of the (Chapter
(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 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 (S500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
3162 1029.0O
Required Inspections
fl P
will do the work and the structure isnot Intended oroffered forsale(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 -
FOUNDATION
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 that he did not build or improve for purpose of
103 -
UFER
°III`•)•
104 -
REBAR
❑ 1, as owner of the property am exclusively contracting with licensed contractors to
concoct the project (Sec. 7044. Business and Professions Code:) The Contractors Li-
105 —
ANCHOR BOLTS
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',
License Law.
202 -
UNDERFLOOR PLUMBING
❑ I am exempt under Sea , B & P C for this reasa^-.
203 -
UNDERFLOOR MECHANICAL
°`"n`rDate204
WORKER'S COMPENSATION DECLARATION
-
UNDERFLOOR FRAME
I hereby affirm under penalty of perjury one of the following declarations:
205 -
UNDERFLOOR INSULATION
0 1 have and will maintain a Certificate of Consent to self-Insum for Worker's Compen-
301 -
ROUGH PLUMBING
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
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
tai
3700 of thc.Labor;Coda for the performance of the work for which this permit Is Issued.
304 —
ROUGH ELECTRICAL
My w�rkedresCper,sau su nes u are
305 -
FRAME
YOM�
��,� 0 x MPTTow0RI S'
✓ 306 -
HOLDOWNS
' COMPENSATION INSURANCE
307 -
INSULATION '
CrhIs section need not he completed If the permit Is for one hundred dollars (S 100)
308 -
SHEETROCK
or less.)
1 certify that In the fro anec of the work for which this permit is issued. I shall not
309 -
EXTERIOR LATH
employ any y manner so as to become subject to the Workers' Compensation
310 —
INTERIOR LATH
Laws
311 —
313 -
SCRATCH COAT
ROOF NAIL
App ca V
APPLICANT: If. after making this Certificate of Exemption• you should
been subject to the Worker's Compensation provisions of the Lahor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
501 —
FINAL ELECTRICAL ENERGY
j CONSTRUCTION LENDING AGENCY
502 -
FINAL PLUMBING ENERGY
I hereby affirm that there is a construction lending agency for the performance of_
5 0 3
FINAL MECHANICAL ENERGY
y tine work for which this permit Is issued (sec. 3097, Civ. C.)
Lender's Name
504 -
FINAL BUILDING ENERGY
Lender'cAddress
505 -
FINAL ELECTRICAL
D I certify that I have rad 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 relating to
building construction. and hereby authorim representatives of this city to enter upon the
FIN PLUMB G
above-mentioned property for inspection purposes
(We) agree to save, Indemnify and keep harmless the City of Cupertino against
O 8
FIN L
n liabilities, judgments, costs and expenses which may In any way accrue against said City
5
in consequence of the gmnling of this permit.
APPLICANT UNDERSTANDS �N/fF/W�ILL COMPLY WITH LL NON•POINT
Issued bY:S
ING Date U
SOURCE
14
NAL PUBLIC WORKS
Re-roofs
Type of Roof
gnatuie of Applicant/ContractorDalc
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future bulIding occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code, Scction 25532(a)7 ,
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or u/ton: building occupant use equipment or devices which
emit hazardous air contnminan as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Ya No
1 have mad the hazardous matcrisismquiremcnts under Chapter 6.95 of Linc Califor.
nia Health& Safety Code. Sections 25505.25533 and 25534.1 understand that if the building
docs not currently have a tenant, Pstjt Is my responsibility to notify the occupant of the
requirpmen hie
MgWancof a Ccn ifieste of Occu
Signature of Applicant Date
All roof coverings to be Class "B" or better
tnerorauthorizcdagcnt ,le
CITY OF
CUPEkTINO
Ci ff OF CUPERTINO
PERMIT APPLICATION FORM
2-
APN # % ,,. � �
Date:
f
Fee Group
BAPPLOTHER
Building AcYdr6ss.
{ .STV
O LSA Name: FR TCS KA -1V HAILS'
Phone'
,
Contractor:
`TL0+� 4 H p e_0 Ns'T(z Ql Oo
License #:
Contact:
RO-H 14 MN --H , (409) Wo_? 06
Cupertino Business License#:
Building Permit Info:
Bldg Elect Plumb ISD Mech
Job D scription:
Residential ❑ Commercial
Sq.Ft. Floor Are :
$/Sq.F
Cost of Project: r
Occupancy Group:
Type of Construction:
MECHANICAL
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBLDGFEE
Bldg Permits . foot
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 > 1.75M Btu
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
BELEC 1000
Elec 600V <= 1000A
ELECTRICAL
BELEC 1001
Elec 600V > l OOOA
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
I of 3
UTY OF CUPERTINO
CUPEkTINo PERMIT APPLICATION FORM
Quantity Fee ID
Fee Description
Fee Group
BMITIGATR
Res. Housing Mit Fee
BUILDING
BMNEWMULTI
New Multi -Family Res
MECHANICAL
BMNEWSF&2F
New Sf&2F Res Bldgs
MECHANICAL
BNEWMULTI
Multifan-ffly Res
ELECTRICAL
BNUCOMME
New Comm Electric
ELECTRICAL
BNUCOMMM
New Comm Mechanical
MECHANICAL
BNUCOMMP
New Comm Plumb
PLUMBING
BNUMULTI
New Multifamily Res
PLUMBING
BNUSFD
New Single Family Res
BUILDING
BOVERTIME
Inspection Overtime
BUILDING
BPBACKFLOW
Atmospheric Vacuum
PLUMBING
BPCESSPOOL
Cesspool
PLUMBING
BPERMFEE
Bldg Permit Fees
BUILDING
BPFIXTURE
Pblg Fixture
PLUMBING
BPGAS
Gas Piping 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 SprinklerBackflo
PLUMBING
BPSTORM
StomVRain 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 cfm
MECHANICAL
BREMAPPLI
Appliance Install
MECHANICAL
BREM 3USWAY
Remodel Busways
ELECTRICAL
BREMFIXT
Lighting Fixtures
ELECTRICAL
BREMFURN
Relocation of Furnace
MECHANICAL
BREMFURNOV
Relo Furnace > I OK btu
MECHANICAL
BREMHEAT
Heater Installation
MECHANICAL
BREMINHOOD
Installation of Hood
MECHANICAL
BREMMISC
Misc Apparatus
ELECTRICAL
BREMNRAPP
Rem Non -Res Appliance
ELECTRICAL
BREMPOLE
Pole/Platform Fixture
ELECTRICAL
u
2 of 3
CITY OF
CUPEkTINO
CITY OF CUPERTIN%j
PERMIT APPLICATION FORM
Quantjty, Fee ID
Fee Description
Fee Group
BREMPOWER
Power Device/Apparatus
ELECTRICAL
BREMRECEPT
Rc tl, Switch & Outlets
ELECTRICAL
BREMRELOCA
Relocation of Hood
MECHANICAL
BREMREPALT
Repair/Alter Heating
MECHANICAL
BREMRESAPP
Remodel Res Lkppliance
ELECTRICAL
BREMSIGNAD
Rmdl Signs Add Branch
ELECTRICAL
BREMSIGNS
Remodel Sips, Marquee
ELECTRICAL
BREMTHEATR
Theatrical Lighting Fix
ELECTRICAL
BREMVENFAN
Vent Fan Single Duct
MECHANICAL
BREMVENSYS
Ventilation Systems
MECHANICAL
BSCBLVD
Scb Specific Plan
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSPECIAL
Special Insection
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 Issuance
PLUMBING
PPLBG
Plumbing Fee sq foot
PLUMBING
ZADDCHG
Address Chane
BUILDING
3 of 3
AdEr
CITY OF
CUPEliTINO
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: (408) 777-3228
FAX: (408) 777-3333
BUILDING DEPARTMENT
OFFICIAL NOTIFICATION OF ADDRESS CHANGE
TO: County Assessor, Fire, Sanitary District & Health Dept.
FROM: City of Cupertino
DATE: June 03, 2003
RE: Address Change
Please note the following address changes. The plans and plan check information for
the following permit numbers had the incorrect addresses on them:
Permit # Control # Incorrect address Correct address
03020027 11940 19929 Stevens Creek 19959 Stevens Creek (Quiznos)
03040006 12056 19979 Stevens Creek 19969 Stevens Creek (Hair/nails)
Please change your records to reflect the correct addresses. If you have any questions,
please call me at (408) 777-3246.
Sincerely,
Susan Winslow
Administrative clerk
I'noted on Nocycled Papp;