080502120
74
1-1
IYi
W
0.
.'7
U
LT.
U
CITY OF CUPERTINO
'
BUILDING DIVISION PEPMUT
Al
BUILDING ADDRESS:
PERMIT NO.
20800 HOMESTEAD
T BUILDERS-
OWNER'S NAME:
PERMIT ISSUE DATE
plhp
120
A 8 8 CONTROL NO.
(510) 525-9378
ARCHITECTIENGINEFR:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7(700) of Division 3 of the Business and Professions Code, and my Hcense is
in full force and effect.
DEFERRED SUBMITTAL OF M/E/P' S, ORIG#0712.0212-NO
License aria Lle. r
Date Contractor
SANITARY REQUIREMENTS.
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 Contractors License Law for the
following reason. (Section 70315, Business and Professions Cale: Any city or county
which requires a permit to construct, alter, improve. demolish, or repair any structure
prior to its issuantx, also requires the applicant for such permit to file h signed smuncnt
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
(commencing with Scction 7000) of Division 3 of thc Business and Professions Code) or
$1000
that he is exempt therefrom and the basis for the alleged exemption Any violation of
APN Number
Occupancy Type
Section 70315 by arty applicant for a permit subjects the applicant to a civil penalty of
rich more than five hundred dollars (S500).
32609056.TYP04
C] L as owner of the property, or my employees with wages as their sok Compensation,
Required Inspections
will do the work, and the atruelare is not intended or offered for sale (Sec. 7044. Business
and Professions Cade: The Contractors License Law does not apply to an owner of
q
property who builds or improves themon, and who does such work himself or tHrough his
.
own employees, provided that such Improvements are not intended or offered for sale. It.
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
salt.).
1, as owner of the property. am exclusively contracting with licensed contractors to
coTtstruct the project (See. 7044, Business and Professions Code:) The Contractors Li-
.
cense Law does not apply to an owner of property who builds or improves thereon, and ,
who contracts for such projects with a contractors) licensed pursuant to the Contractors
License Law.
❑ I aro , B & P J for thV reason
Owner D.1 1121 JbAr'
WO ,'SMMPENSATIONIDECLARAMOWJ
I hereby affirm untV penalty of perjury one of the following declarations:
❑ I hate and will maintain a Certificate of Consent to sdf-insure for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Workers Compensation Insurance, as required by Schon
3700 of the Labor Code, for the performance of the work for which this permit is Issued
My Workers Compensation Insurance carrier and Policy number am:
Carrie: Policy No.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This swdon need not be completed U the permit Is forone hundred dollars (S 100)
or less.)
I certify trot in the performance of the work for which this permit is issued, I shall nes
employ arty person in any m r as tobr com subjectthe Workers' Compenudon
Laws of
APpB
NOTiC TO making tfis Ceti to of Exemption, you should
become sob to the Wo s Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shalt be dermcd nvoktd.
I
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.)
Lender's Name
Lender's Address
I 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
building construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and kap harmless the City of Cupertino against
j liabilities, judgments, costs and expenses which may in any way accrue against said City
iin consequence of the granting of this permit.
A STANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
OUR R 0
Re -roofs
Type of Roof
O
Si are ° i US MA DISCLOSURE Dae
Will the apillicant or future building oavpant Store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(a)? v�v__,LLL
[3 Yes ]�10
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 futare building occupant use equipment or devices which
emit hazardous air contaminants as defined by.the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yea ,j ro
I have mad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safely Cmd°, Sections 25505.25533 and 25534.1 mdcrstand that if thc building
does not current have a ten E. at t is my responsibility tojfy V occupant of the
regahcmcn ` m bt ` s" era r
Signature of Applicant Date
<< 41-
All roof coverings to be Class In" or better
Date '
Owner or Suit orizt igen
d .-( --1
CITY OF
CUPEkTINO
CITY OF CUPERTINO
REVISION/DEFERRED
PERMIT APPLICATION FORM
pEDS D�-1A
2�7fi 5-�:
APN #
��(p � Q� (p,� �
Date:
S•ZZ•o8
Original Permit #:
Ort rZOTA Z
Building Address:
20$00 ROWL6srE►4D
Mailing Address (if different from building address):
Owner's Name:
Phone #:
�
(� 5� • �3� .3057
Contractor:
Phone: 40$ • 744? . 50S
W1551- -&tfL berus Z1VC •
Fax: qDS. 74AP. 5033
Contractor License #: 187,539 5
Cupertino Business License #: 7qQ&
Contact: L VlDkN(7
Phone: t`0. 8%Z. ze-53
Fax: Slo • ,550• X81
Building Permit Info:
Bldg ❑ Elect 0� Plumb Q� Mech [�
Residential Commercial
Job Description• ,
-Perfekzb 514134117rA L OF M6PS
Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑
Type of Construction (Usage Class): * Occupancy Type:
1-A, 1-13 ❑ 11/11 II V-A ❑ 11/111
Project Size: Standard Large Major Valuation (cost of project):
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:
For help, contact Build it Green at www.builditgreen.org
a-V
CM OF
CUPEVI INO
CITY OF CUPERTINO
REVISION/DEFERRED
PERMIT APPLICATION FORM
FEE SCHEDULE
Quantity
Sq Ft
Fee ID
Fee Description
Fee Group
Permit Type
1REVCOMNEW
Revision Commercial New
B
1*
1REVCOMTI
Revision Tenant Improvement
B
1* TI
1REVSFDWL
Revision SFDWL
B
1R3SFDW
1REVRESADD
Revision Addition
B
1R3SFDADD
1REVRESREM
Revision Remodel
B
1R3SFDREM
1DEFINSP
Deferred Submittal not R-3
Ins ection
B
1*
1 DEFPLNCK
Deferred Submittal not R-3 Plan
Check
B
1 * OR
1* TI
1DEFR3PLNCK
Deferred submittal R-3 Plan Chk
B
1R3SFDW
1R3SFDADD
1R3SFDREM
2 of 3