11060027CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20030 STEVENS CREEK BLVD I CONTRACTOR: US SHEET METAL I PERMIT NO: 11060027
OWNER'S NAME:
1 SANTA CLARA, CA 95050 I PHONE NO: (408)292-1314
❑ LICENSED CONTRACTOR'S DECLARATION
License Class. Lic.4 1
Contractor QYJ 58,,607 Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, 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 Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
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 keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -poi t sourer egulations per the Cupertino Municipal Code, Section
9.18.
Signature ---= Date 65 -1
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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 & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, 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 Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify 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 Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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 keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
BUILDING PERMIT INFO: BLDG F ELECT r PLUMB
MECH r RESIDENTIAL r COMMERCIAL r—
JOB DESCRIPTION: SHAN INDIAN RESTAURANT - INSTALL TYPE H HOOD
FOR
EXISTING COMMERICAL DISHWASHER
Sq. Ft Floor Area: I Valuation: $1500
APN Number: 36903004.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
( r3 /
Issued by: \ v � _Dater 3 _ '/
RE -ROOFS:
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 "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Ow er oorized agent: �1- ,
Date•
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of Nwrk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans'shall be used as public records.
Licensed Professional
____ _ CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
191
ADDRESS: 20030 stevens crk blvd.
DATE: 05/24/2011
REVIEWED BY: bobs.
UNITS
APN:
BP#:
'"VALUATION: 1$1,500
*PERMIT TYPE: Mechanical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY Commercial Building
USE:
I
PENTAMATION 1CMAP5
I PERMIT TYPE:
wmac I
install type II hood for exisiting commercial dishwasher.
SCOPE
APPLIANCE /EQUIP TYPE
FEE ID
Plbm,,r<';
QTY
UNITS
BP FEES
Hood, Mech. Exhaust
1MCHOOD
t�J;iw<
1
#
$126
PME Unit Fee:
$126.00
PME Permit Fee:
$42.00
Ar
Work Without Permit? 0 Yes E) No
$0.00
TOTALS:
Travel Documentation Fee: ITRAVDOC
$126.00
Strong Motion Fee: 1BSEISMICO
Nt)TF-- Thovp foo.c aro hared nn tho nrolininary information availahle and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS fFee Resolution 09-051 a,f 7/1/IDZ
Mech. Plan Check F1.0 hrs $126.00
Plbm,,r<';
Ek", PhUr
IMECPLNC I Mech. Permit Fee: 11PERMIT
Fc(
Other Mech. Insp. 0.0 hrs $42.00
f?t"ii;, °r,{,ui� Tf;.;n.
t�J;iw<
PME Plan Check:
$126.00
Nt)TF-- Thovp foo.c aro hared nn tho nrolininary information availahle and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS fFee Resolution 09-051 a,f 7/1/IDZ
FEE
QTY/FEE
MISC ITEMS
T'h-m
PME Plan Check:
$126.00
PME Unit Fee:
$126.00
PME Permit Fee:
$42.00
Ar
Work Without Permit? 0 Yes E) No
$0.00
Travel Documentation Fee: ITRAVDOC
$42.00
Strong Motion Fee: 1BSEISMICO
$0.50
CE7hrs Admin./Clerical Fee
$39.00 IADMIN
Bld€) Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$337.50
$39.00 TOTAL FEE:
$376.50
Revised: 04/29/2011