08040225BUILDING DIVISION PERMIT
BUILDING ADDRESS:
20800 HOMESTEAD RD, BLDG 34A- WEST.BUILDERS, INC.
OWNER'S NAME:
VS II A CALIFORNIA LIMITED 1608 4
PHONST v mw r
ARCHITEC IENGINEER
I O p LICENSED CONTRACTOR'S DECLARATION
01 U 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
MMnSection 7000) of that 3 of the Business and Professions Code, and my license is
o � yifull foree and eff r ,J/
z Llee:nsc G Lle.
t„ O Dam Contractor ' A y
Uj ARCHITEC'T'S DECLARATION
g a < I understand my plans shall be used as public records
DWU
L [n Licensed Professional
y S
OWNER -BUILDER DECLARATION
e 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
00 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
y prior to its issuance, also requires the applicant for such permit to rile a signed statement
E _ that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
t- $ (commencing with Section 7000) of Division 3 of the Business and Profession. Code) or
that he is exempt therefrom and the basis for the alleged eseroptioa Any violation of
Section 70315 by any applicant for a permit subjects the applicant to a civil penalty of
not more than rive hundred dollars (1500).
❑ I, 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
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 offered for 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.).
❑ I, as owner of the property. am exclusively contracting with licensed contractors to -
construct the project (Sec 7044. Business and Professions Code:) The Contrrcmes Ll -
cense Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ 1 am exempt under Sec , B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ane of the following declarations:
❑ I have and will maintain a Certificate of Consent to self -Insure for Workers Compen-
sation, as provided for by Section 3700 of the Libor Code, for the performance of the
work for which this permit is Issued.
❑ I have and tell maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is Issued
My Worlds Compensation Ir msnnce carrier and Policy number are:
Carrier. AC1217 Policy N..- a T
CERTIFICATE OF EXEMPTION FROM ORKER '
COMPENSATION INSURANCE
(This section need not be completed tithe permh is for one hundred dollars (1100)
or les)
I unify 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 become subject to the Workers' Compensation
Laws or California. Date
Applicant
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
Z forthwith comply with such provisions or this permit shall be deemed revoked.
OCONSTRUCTION LENDING AGENCY
Fr ►+ 1 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.)
aQ Lender's Name
z Lender's Address
U Q I certify that 1 have read this application and state that the above information is
V. — concet 1 agree to comply with all city and county ordinances and state laws relating to
O V building construction, and hereby authorize representatives of this city m enter upon the
r U above-mentioned property for inspection purposes
CL (We) agree to save, indemnify and keep harmless the City of Cupertino against
rA liabilities, judgments, costs and expenses which may in any way accmc against said City
U Z in consequence of the granting of this permiL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOL? RE
Signature of App rcant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by The Cupertino Municipal oda, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)7
❑ Yes
Will the applicant or future building occupant use equipment or devices which
emit harardaus air contaminants u do ncd by the Bay Area Air Quality Management
District?
❑ Ye
1 have read the ha>ardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Codc. Sections 25505.25533 and 25534.1 understand that If the building
docs not currently have a tenant. that it is my responsibility to notify the occupant of she
requirery�ts w tett be met prior to issuance ora Certificate of Occupancy.
�V�( Sib - op
Owner or authorved agent Date
(510) 525-9378
ehaimlI NU.
08040225
PERMIT ISSUE DATE
05/05/20C
SANfrARY NO.
CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB
Job Description
UNDERGROUNDWATER PIPE ONLY FOR NEW WATER
HEATERS -DOES NOT INCLUDE GAS OR ACTUAL WATER
HEATERS. NEEDS SEPERATE PERMITS FOR THOSE.
Ft. Floor Area
$15000
326090156 JJIASumber
Required Inspections
Issued by:
Re -roofs
Type of Roof
Valuation
Occupancy Type
Date 6�-,
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.
Signature of Applicant Date
All roof coverings to be Class "B" or better
I -
CITY OF
CUPEfkTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
nkt)gn9zr�
APN # 2 (0 b q
Date: l�
Building Address:
Mailing Address (if different from building address):
Owner's Name:
VII Ic, � 11 CR 1ifprnt a L�
Phone #:
�Go
Contractor:
Phone: > (0 6
`'-U
U11 L)W C -
Fax:
Contractor License #: ezS �� 5
Cupertino Business License #:
Contact:
�u� /L Y6i� �
Phone: S �� 7_, ��
Fax:
Residential I Commercial
Job Description:
ILA-1a?te-r ^^ pp
Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No D.
Building Permit Info:
Bldg ❑ Elect ❑ Plumb D--- Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A, 11-B ❑ 11, 111, V-A ❑ 11, 111, 1V V -B
I -r? -,I
Valuation: Square Footage:
5Ow.vu
Project Size: Standard ❑ Large ❑ Ma'or
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved: 61
For help, contact Build it Green at www.buildit reen.or
f
CITY of
CUPEVINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf
Fee ID
Fee Description
Fee
Permit Type
Group
1GENRES or
1 GENCOM
1BTEMPPER
Temporary Building Permit (good for
B
30 days).
1BBOILERI
For the installation or relocation of ea
M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw)
1 BBOILER2
Installation /relocation of ea
M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
1 BBOILER3
Install ation/relocation of ea
M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1BBOILER4
Installation/relocation of ea
M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILER5
Installation/relocation of ea boiler or
M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1 BAPPLOTH
For ea appliance or piece of equip
M
regulated by this Code but not classed
in.other appliance categories, or for
which no other fee is listed in this
code.
1 ELECINSP
Other Electrical Inspections (per hour)
E
1MECHINSP
Other Mechanical Inspections (per
M
hour)
1PLMBINSP
Other Plumbing & Gas Inspections
P
(per hour)
1MEETINGIHR
Application Meeting
B
CITY OF
CUPEIkTIN.O
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW
SFDWL/Duplex New
B
1 ACOUSRESAD
SFDWL/Duplex-Addition/Alteration
B
I ACOUSCOM
Multi-Family/Commercial
B
CHIMNEY'S
1 CHIMNEY
Chimney
B
1 CHIMNEYR
Chimney Repair
B
FENCES
1 FENCE>6FT
Non -masonry, over 6 ft in height
B
1FENCEMAS>6
Masonry, over 6 ft in height
B
FIREPLACES
1 FIREPLMAS
Fireplace Masonry
B
1FIREPLFAB
Fireplace Pre-Fabricated/Metal
B
1 FLAGPOL>20
Flag pole (over 20 ft in height)
B
1MODUSTRU
Modular Structures
B
FOUNDATIONS
1 FOUNDREP
Foundation Repair
B
1PILECAST
Pile Foundation Cast in place concrete
B
1 PILEDRIV
Pile Foundation Driven (steel, pre-
stressed concrete) .
B
3 of 5
CITY Of
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY
1 RETSTN
Standard (up to 50 ft)
B
IRETSP310
Special Design, 3-10' high (up to 50 `)
B
1RETSP10
Special Design, over 10' high (up to
50'
B
1RETCRB<
Gravity/Crib Wall, 0-10'high (up to
50 ft
B
1 RETCRB>
Gravity/Crib Wall over 10' high (up to
50 ft
B
SIDING
1 SIDESTBK
Siding, Stone & Brick Veneer
(interior/exterior)
B
1 SIDEOTHER
Siding all other
B
SKYLIGHTS
1 SKYL<10 SF
Skylight less than 10 sf
B
1SKYL>10SF
Skylight greater than 10 sf or
structural
B
1STAIRS
Stairs -first flight/ea addt'l
B
STORAGE RACKS
1 SRACKS<=8
Storage Racks 0-8' high (up to 100 sf)
B
1 SRACKS>8
Storage Racks over 8' high (up to 100
st
B
1STUCOAP
Stucco Applications (up to 400 sf)
additional stucco application
B
4 of 5
acfv&
CITY OF
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1 GENCOM
1 WINREP
Replacement windows/sliding glass
door (ea 8 windows)
B
1WINMEWSTR
New Window -structural shear
wall/masonry (includes plan ck fee)
B
1 EPERMITFEE
Electrical Permit Fee
E
1MPERMITFEE
Mechanical Permit Fee
M
/
1 PPERMITFEE
Plumbing Permit Fee
P
1 ELCPLNCK
Stand Alone Electric Pln Ck (hourly)
E
1 MECPLNCK
Stand Alone Mechanical Pln Ck (hrly)
M
1PLMPLNCK
Stand Alone Plumbing Pln Ck (hrly)
P
1 STPLNCK-(3 Hr Min
when not over counter)
Standard Plan Check (when no E/M/P)
hourly -stand alone
B
1BSEISMICR
Seismic Residential
B
1BSEISMICO
Seismic Commercial
B
/
1TRAVDOC
Travel & Documentation
B
1BUSLIC
Business License
B
RP w^-Mtz,
5 of 5
Plan Review Process Work Book Page -12-Revised 3/25/08
'
Green Building Plan Check
Index of Green Building
Points/Categories
A.
Category
Example of an Index or Table of Green
Plan Sheet or Page
Points
Building Points Categories that must be
shown and referenced on the Project
Plans See below
B.
Site
9.
Install H.E. Irrigation, (details/spec)*
L-1
2 points
11. Permeable Paving, Note
L-1
2 points
C.
Foundation
1.
Use 15 % Flyash Concrete, (note)
S-1
5 points
D.
Structural
3.
Uses Wood I-Joist, (See Spec.)
S-2
2 points
5.
Use Truss with heels, (detail)
S-2
2 points
6.
B. OSB Sheathing, detail
S-2
2 points
E.
Ext. Finish
1.
Composite Decking, (Note/Spec.)
A-3
2 points
4.
B. Fiber Cement Siding, (Note/Spec.
A-4
2 points
F.
Plumbing
1.
Insulate all H.W. pipes, (Note/Spec.)
P-1
2 points
5.
Tankless W.H., (Note/Spec.)
A-2
2 points
11.
A 2500 Gal. Tank, (Note/Spec
L-1
10 points
G.
Electrical
4.
E. Ceiling Fans, (Note/Spec.)
A-3
4 points
H.
Appliances
1.
Energy Star Dishwasher, (Note/Spec.)
A-3
1 point
3.
Energy Star Refrigerator, (Note/Spec.
A-3
1 point
P.
Other
1.
List Green Features on Plans
A-1
1 point
TOTAL POINTS
40 points
Plan Review Process Work Book Page -12-Revised 3/25/08