02060192CITY OF
CUPERTINO
} i
jCITY OF CUPERTINO
PEJtMIT APPLICATION FO
APN #
Date:
Building Address:
/o 26Z) Diu --
Owner's Name:
Phone #:
-s�z
Contractor
BCONSTAX
License #: C % _17
Contact: � r
Phone #: -J. 1�6
Applicant/Contractor: S,
Fax #: � O ✓�2 ^ �S
Building Permit Info:
Bldg C2 Elect Plumb Mech
Job Description:
Residential: Commercial:
Sq.Ft. Floor Area:
$/Sq.Ft.:
Architect/Engineer:
Valuation:
Type of Construction:
Occupancy Group:
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
BNEWIM JIM
New Multi -family Res
ELECTRICAL
BNUCOMME
New Comm Electric
ELECTRICAL
BNUCOIvIlV M
New Comm Mechanical
MECHANICAL
BNUCOMMP
New Comm Plumb
PLUMBING
1 of 3 �c2� a ° Lro
110, 2C
aU�
�tao
a i
O z N C
� be
a04t.
u
EL C
O
F � <
aaQC
O G
U
a3'
CITY TINO
CONTRACTOR INFOIt TION:
BUELDFNG DMSION P T
BUILDING ADDRESS: -
10200 S DE ANZA
HOWARD WRIGHT CONSTRUCTION
PERMIT NO.
0.02060192
OWNER'S NAME:
PORTAL SOFTWARE
PIER 9, THE EMBARCADERO #11
APPLICATION SUB DATE
0627%2002
PHONE:
(206)447-7672
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u u v v
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
REVISION SUBMITTED.
with Section 7000) of Division 3 of the Business and Professions Code. and my license
isenseCla« and effect,
NO NEW PERMIT ISSUED, (ORIGINAL #02010135
License Class Lia ri
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 requiresthe applicant for. such permit to.ftle.a.signed.statement
- -- -_---- --
(hc th„lsLlicensed pursuant to'the provisions of the Contractors License Law (Chapter 9
'. _ei e' inj ith,Se6ton x600) of Division 3 of the Business and Professions Code)
- _ F, „s(,1,_ 't.. Fqo, -r, r�ea . -� ,
' c,`, '+-'” ( I. n +. t �) ^ - )�A ' S � f
a t" `p° �r`y"cs' `- <i
Valuation
,
r that he is exempt,theiefro�m and the basis for the allEged e,'rempt on. Any violation
ono
"' "')' '�
'"3690
1
of Section any applicant-fora•pertnit subjects theapplicantto a civil•penalty-
:of not.more.than five hundred dollars ($500).
- -
APN Number
-- - -
.. Occupancy Type
❑ I, as owner of the property, or my employees with wages as their sole compensation,
-FOUNDATION
"" "— �' . __. _..,._._...._._._.__-.__... --- .__-..._------- --...._ .._----......_----..___--------_.-- -._.._..------
102 - PIERS Required Inspections '• • -' '_ •' --
-will"do"the'work;-and-rhe'stmcture`is"not"intended- or'offere'for sale (Sec' 7044,"'"""'-
B(tsiness: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
10 3 - UFER
or through his own employees. provided that such improvements are not intended or
_ -_•__ •._
-- - - --
..._ _
fe'red'for sale: If; however(he building ofimproveinent is sold'wiiliin one year of
_
------- - -
1'04-� - REBA -.
'dornpletion, the owner -builder will have the burden of proving that he did not build or
improve for purpose of sale.).
,
105 - ANCHOR BOLTS
❑. as owner of,the property, am exclusively contracting with licensed contractors m
;,
10,6 " ---SEWER---
construct the project (Sec. 7044, Business and Professions Code:) The Contraetor's
2 O2 - UNDERFLOOR PLUMBING '�` t•'' ' '` t �'' ''�''
• License Law does not apply to an owner of property who builds or improves thereon,
. apd-who contracts_for_such.projects_with.-a_.contractor(s)-hcensed.pursuant.to.the_
...__. _ .2 0'3'-.-----UNDERF-LOOK
Contractors License. Law. ,I •, `, t; _ t,i.c
❑Iam,exemptunder Sec" B'&PCforthisreason
t
204 - UNDERFLOOR'' -ME",-','`
.... i .
4—'D te
205 - UNDERFLOOR INSULATION
WORKER'S COMPENSATION DECLARATION
301 - ROUGH PLUMBING
--I hereby -affirm under penalry;of pefjuq'one of,the following declarations:- -
302 - TUB & OR SHOWER
❑ I lui e6 and will��maintain'a Ce'ai0cate of Consent to self -insure for Worker's
303 - ROUGH MECHANICAL
Compensation,- as provided for by Section 3700 of -the -Labor Code, for -the
perforrriance of the work for which this petmit,is issued.
'
304 - ROUGH ELECTRICAL
❑ 1 have'and Will maintain Worker's Compensaiion Insurance, as required by Seetidn
305 - FRAME
3700'of the Libor'Code, foi'the performance of the work for which this permit is
306 - HOEDOWNS
issued. My Workers Compensation Insuiance`cairier and Policy number are
cattier:'"^i•1;._e--;.�:aeort:yNn:- ..._.�.. u T
-,. -_ _..._ _ _ .._.._.
-� 30-7` -, INSULP;TION-
.; CERTIFICATION OF EXEMPTION FROM WORKERS':
li. ' A -+ s3! O. Bt -; "-•SHEETROC'K �: z + •' '' ^
COMPENSATION INSURANCE _ti.
._._. _ --
" '' • EThis sicriod `need not be completed if the permit is for one hundred dollars
310 - INTERIOR LATH - - -
($100) or less.), ,
.._,�........;..._.. _: ,._:_ ....:....._..... , �,.. ..........
.:.. 3,11: _-.: SC'RATCH•--COAT= :_._..:______-.:-_,..:. _ __ :• __.::_.:.:. _::__:. _ ..._ :_-_......: _::.:.. .
F I.certify that in the performance of the work for which this' permit is issued, I
shall not employ'iiny person in any-manner'so as lo' become'subject to the"Workers'
._ c. r.. •;;t-•• - , :, r
313 - ROOF NAIL-," • -- (• • - - -
Compensation -Laws of Ckftimia'. Date
_Applicant_' • .. - .., .. .,__.. __...._.._.... --. _:.,._......_..._
... . _. 5,01... -..-FINAL_ ELECT.RI.CAL.._ENERG.Y_......... _._.........._.__._.-_ _
NOTICE TO'APPLICANT:'If, after making'this Certificate of Exemption, you should
502 - FINAL PLUMBING ENERGY'"
become subject to the Worker's Compensation provisions of the Labor Code. you must
furihwith comply =kith such provisions or this permit shall be deemed revoked.
503 F I NAL MECHANICAL ENERGY
'r •" - •' � •,!' • , CONSTRUCTION LENDING AGENCY `. ' • "
504 - FINAL BUILDING ENERGY
I hereby affirm that there is a construction lending agency for the performance
bf'the work for whicli this permit is issued (Sec. 3097, Civ. C:) '
505 - FINAL ELECTRICAL
-{•,ender°s Name -.._ . _:: _.. _. __ ._ _•,.:.. _ ....._.._: . _... .. ..:. . ... _
506
Lender s Address •' • •� :. ,...
..
1 that Ihave. this information is
507 -' FINAL PLUMBING'::., ,
certify mad application and state that the above
co
co t.- I agree to comply with all. city and county.ordinances and stare laws relating
508 - FINAL MECHAN I CAL
to building conslruciim; and hereby authorize:rcpiest:6tatives of this city to enter upon
the above-mentioned pr perty, fo� inspection purpos .
rll,
509 - FINAL GRADE
(We) agree to save. etnnify anti keep harmless the City of Cupertino against
510 - FINAL PLANNING
liabilities, judgments, costs and, expenses which may in any way accrue against said
City in consequence of the granting of this permit. ' ' ' '
514 f F A WORKS
r`\P.P.L'1CANTUNDERS't.a� IDS AND WILL COMPLY WITH Ala.'NON-PO1NT�
SOURCER£GULATIONS: .�; '- •:"; ::'-;'", ',
ISSUed by: Date
Signature mf.Appli'eanU'ontractor . i •' :. a ' : Date'", -
Re -COOPS
US MATERIALS DISCLOSURE ,
Will the applicanZor fDOure,bP Iding occupati[ store or Handle hazardous material
P
of..Roof __. _ . _ _ .
hs defined b the Cu canto Munict al Code Chapter 9.12. and the Health and Safety
y
_ _Type , _ ,..: .. _ _ _ .,,�... • ._._..
Cbile; Section 25532(a)v
13 Yes:.i.
i �'. ?i7 ,•.`
t ,.i
-All roofs sfi_ all the inspected�prior_to. any ro0ing material being installed,
Will theiapplicant,or futurebuildingoccupant use equipment or devices which
If a roof is installed: without first obtaining an -I agree,to remove M
emit hazardous air coniaminants as defined by the Bay.ArPn Sit Quality Management
District' '.' .
all new materials for inspection. Applicant understands- and will cont 1 with
ayes.:... _ _ ... '., .. ❑ Nm. . ; _ ._ . ... .. . _ ..:._-..._
P
alT non -point source regulations: P - :..
1 have:read the hsiardous materials requirements under Chapter 6.95 of the
'
Cai6inia Health'&Safety Code. Seotions 25505;25533 and 25534. ! understand that
- it the$6ilding does not curremN have.a tenant, that it is my responsibility to notify the-
'
octuparit of the requirements which must be met prior toissuance'of a Certificate of
Occupancy. .• . -
Si nature of Applicant Date
All roof coverings to be Class `tB" or better
owner.mrapthmrizea-age r' Date
_ _ . _ _ . _.. ,... ...... -OFFICE ._. _.