08060075 (2)PERMIT #
PROJECT
DATE �i-10 bd
LK
ADDRESS %�241/-ari-h; C1 Qk�,d
APPLICANT L ems,,, , AOWNERo-
PUBLIC
WORKS
RES. (LVNG)
(GARAGE)
COMM. SQ. FT. (NEW) T.I. SQFF. RES. REMODEL
CONTACT Ll-eCKC—A ^-'t-FJ-- PHONE# r'Q�fv FAX 2-6/f
VALUATION (Cost of Project)
mil va-M
REQD. PAID
CONSTRUCTION TAX (Y) (N)
SCHOOL FEES (Y) (N)
HOUSING MITIG (Y) (N)
HEART OF THE CITY (Y) (N)
ISSUED B DATE
TOTAL FEES � `� -'J1 L
l00
i<a
z
to F yyU
a. N
s0�
N
00
7—rn
_ZY
2�0
Dz
z: C
CITY OF CUPERTINO
BUILDING DIVISION PERMITPERMIT
C'Cli'TRiC�4R�f�>Cl�l,i
BUILpIJ�C�,ApT'T FOOTHILL BLVD
TBD — TO BE DETERMINED
NO
08060075
OWNER'S NAME:
PERW71SSUEDATE
FOOTHILL CONDO ASSOC.
06/10/2008
PHONE:
SANITARY NO, CONTROL NO,
ARCHI7EC17ENCTNEER:
BUILDING PERMIT INFO
HLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of chapter 9 (commencing
with Section 7000) ofDivIsion 3 of dIC Business and ProfleSSiOnS Code. And my license is
RESTRIPING PARKG STLS FOR HANDICAP, EXISTING COMM
in full fora and effect.
License Class Lic. #
BLDG
Date Conttxlor
ARCHrfEC 'S DECLARATION
I understand my plans dual be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors 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 requires the applicant for such permit to rile a signed statement
that he is licensed to the of the Comraemrs License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
pursuant provisions
Section 7000) of Division 3 of the Business and Professions Code)
$ 12 0 0 0
(commenting with or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
3 4 2 4 9 0 2 4 �$ Number
Occupancy Type
Section 7O31.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
,
❑ 1, is owner of the property, or my employees with wages as their uric compensation,
Required Inspections
es
win do the work, and the structure is not intended or offered for sale (Sec.7044, BusinessR
and Processions Code: The ContractorLicense Law does not apply to an owner or
q p
propeny who build& or improves thereon. and who does such work himself or through his
own employees, provided that such improvements are not interafetl or offered for sale If,
however, the building or improvement is sold within one year of completion, the owner -
builder in have the burden of proving that he did not build or improve for purpose of
sale.).
❑ I. as owner of the property. am exclusively tonhacting with licensed contractors to
construct the project (Set 7044, Business and Professions Code:) The Contractor's Li-
cense Law does out 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
Lense icLAW.
❑ 1 am teem er Set , B & P C for this reason
Ow AQ_PDate r rQ
WOIMER'S COMP SATION DECLARA7I0N
1 hereby affirm under penalty o perjury one 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 Labor Code, for the performance of the
work for which Otis permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which dais permit is issued.
'
My Workers Compensation Insurance carrier and Policy number am:
Carrier. Policy No.:
CERT MCATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section reed not be completed if the permit is for one hundred doll= IS 10G)
or less.)
I certify that in the perronnance or the work for which this permit is issued. I shall not
employ any person'n to become subject to theWorkers'Compensation
Laws of DApplicatmt
�maa=mrs�o&s
_NOT7C
ter making this Certificate of Exemption You should
becomesmiflect to the Workers Compensation provisions of the Labor Code you must
forthwith comply with such provisions or this permit shall be teemed revoked.
CONSTRUCr10N LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Set 3097, Civ. C.)
Lender's Name
Lender's Address
I certify that 1 have read this application and state that the about information is
correct. 1 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 in any way accrue against said City
in consequence of the granting of this permit.
APPLIC NDERSTAN AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date L
SOURCE ON
�' 117�OP
Re -roofs
Type of Roof
g'n of ApplianVContractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicancc t or future building occupant store or handle hamrdous material
as dermcd by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code. Section25532(a)7
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes u1mr-
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Mmagcmcm
all new materials for inspection.
District]
��
❑Yes WN.
1 have read time hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & SafctyCodc, Sections 25505. 25533 and 25534.1 understand Out if the building
dens not carte sly have a tenant, Out it is my responsibi ity to the occupant of the
rcquircm which must be t or to issuance of a cenireate of Occupancy.
Signature of Applicant Date
G— f(2
All roof coverings to be Class'}'' or better
O err o agent Date wthonzcd
tTY
q7""
CUPERTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
APN # ._3 i A q �' ��
Date: Io _ 6
Building Address:
1 q O l i /v .
Mailing Address (if different from building address):
3 �S C�2 ►� Gv �r
5�2 �% • ►1 DEC
Owner's Name:
Phone #:
He-o ,.11 t4-oK-v &sl)
MF- I5-
Contractor:
Phone:
r,>
Fax:
Contractor License #:
Cupertino Business License #:
Contact:
Phone:
Fax:
Residential Commerc' 1
�—�
Job Description: e10��
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A, 1-B ❑ IUIII/V-A ❑ II/III B, IV -HT, V-B E�t-�
�L ^ 3
Valuatio� O 0-1
Square Footage:
Project Size: Standard Lar e ❑ Major ❑
Revised 5/21/08
CITY OF
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf
Fee ID
Fee Description
Fee
Permit Type
Group
1GENRES or
1GENCOM
1 BTEMPPER
Temporary Building Permit (good for
B
30 days)
IBBOILERI
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)
I BBOILER2
Installation /relocation of ea
M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
I BBOILER3
Installation/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
1 BBOILER4
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
IBBOILER5
Instal lation/relocation of ea boiler or
M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH
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
IMECHINSP
Other Mechanical Inspections (per
M
hour)
1PLMBINSP
Other Plumbing & Gas Inspections
P
(per hour)
I MEETING I HR
Application Meeting
B