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CITY OF CUPERTINO -
- , -•" "' " "' - "
BUILDING DIVISION PERMI0 -
BULLOA`G ADDRESS: P
PERMIT NO.
19028 STEVENS CREEK BLVD A
ANH HOANG DESIGN 0
02050171
OWNER'S NAME: A
APPLICATION SUB DATE
ALPHA INVESTMENT INC ( #A,B) 1
1272 LORELEI CT 0
05/28/2002
' PHONE: S
SANITARY NO. CONTROL NO.
(408)374 -8285
ARCHITECDENGINEER: B
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LJ
S
Jab Description
0 therebyy pp�M that1am licensedunit provisions of Chapter 9(commencing -
-
is In full fO nd C
ucey cl.a tae.. G41 - Z8�
I<n ✓`• RCHffECT'S DECCARAT ON�
J 1 understand my plans shall be used as public records
OLicensed Professional
OWNER - BUILDER DECLARATION
I hereby affirm that I am exempt from the Contin ant's License Law for the
following reason. (Section 7031.5. Business and Professions Code: Any city or county
C which requires a p
$3500
pemdt w
P
that he is licensed punatiot to the provisions of the Contractors License law(Chapmr9 S
SQ pL wI^ Or ea . • . V
Valuation
Professions C
3'7J lil'U.1,• s
of Section 7031.5 by any applicant for a permit subject, the applicant m a civil penalry �
�.�,,m�'
Occupancy Type
❑ I. m owner of the property, .,my employees with wages as their axle ccoh,haadon,
will ne she work, and the W,: statuctom ri C not sior'. d m offered for tale (Sec. on 1
10 4 — REBAR Required Inspections
owner Of property Who loilds or improves thereon, and who does such work i
intended m
or through his own employers, provided that such improvements menu art ram intended m 1
105 - ANCHOR BOLTS
offered for sale. It. howeveUhe building or improvement n sold within one year of
completion, the ownerbuildcr will have the burden of proving that he did not Wild or 3
304 - ROUGH ELECTRICAL '
improve forparpes,ofsale.). 5
505 - FINAL ELECTRICAL
❑1. as owner of the propany, annexcmai. aycomracdng with licensed contractors to -
- 514 — FINAL PUBLIC WORKS
construct the does nt (See, 7044, owner and Professions Cede:) The improves thereon,
License law does not apply man owner of property who builds errd n
nose a t
Commission, am axe License IoW. .
$J1 am exempt under Sec. , B der P C for rcnson �
� Q
Owner Date •
Q
1 hereby affirm under penalty of perjury One of the following declarations:
❑ 1 have and will maintain a Cenificate of Consent to self-insum for Worker's
Compensation, as provided far by Section 3700 of the labor Coda, for the
Performance of the Work for which this permit is issued.
O 1 have end will maintain Worker's Compensation Worance. u required by Section
3700 of the Labor Cade, for the performance of she work for which this permit is
sued. My Workers Compensation Insurance carrier and Policy number are:
Curie6" Policy No.:
' CERTIFICATION OFEXEMPTION FROM WORKERS'
COMPENSATION INSURANCE' --
. .
.. -... .. ....... ._.. ..._ .. ... ..... ___._" ....
gads section nerd not be completed if the permit is for one hundred dollars
($1 Wt or less)
'I certify that in the perfam once the work for which this permit is issued, 1 ,
,
employ Ony rson i
t/
APpliceq/ ere l
-
NOTIC AP kr g h C nfica,of Exemption, you should
fiction subjec a Workers Compensation provisions of the labor Code, you most
.:. .. " - OFFICE-
, .. .. 1 ...., ...
APPROVED
IN ACCORDANCE WITH THE CITY 06
UPERTI DES AN ORDINANCE`
Ii1L
�If�r -1 EL�ya•T�oN
Silo III =2, ` -O"
90PI
This set of piai kept on tt. - °1 at all times and it is un
lewvful to make ny changes or alteration O O
on same witho t written permission from
the building DErt., City of Cupertino. I
Ths $to-nping 6. this plan and specifications
SFSALC NOT bq held to permit or o �sion �� be an
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CUPERTINO
0 0
CITY OF CUPERTINO 6 Lv
SIGN
PERMIT APPLICATION FORM
APN # 379-H - 0 71
Date: 5 �
Energy
Zg 0 2
Building Address:
0102$ STFV�ni CR.t711- &vA S A 9� g CvP o cA . �15U14
Owner's Name:
Phone #:
^I-QNA4 IHVtSTM�T *:[--ML
&FV -qLFt�j -o°160
Contractor:
ANt} ti-o,&4461 nzalOrl
License #:
C49- &41
Contact:
1� ry l F ii-o �J Cs
Phone #:
4 0 - TY
Applicant/Contractor:
BUILIDNG
m ing rmit Info:
Bldg Elect Plumb Mech
Job D cription: I N ST�Ci -1- A t� aw S l6 h)
idential:
t; :.., Commercial,; _ _ �.
Sq.Ft. Floor Area:
$ /Sq.Ft.:
Architect/Engineer:
Valuation: 3 t7
Type of Construction:
Occupancy Group:
Qty. if
ADnlianble
Fre M
Fee T�
�7
BENERGY
Energy
BUILIDNGu
BPERMFEE
Bldg Permit Fees
BUILIDNG
BPLANCHK
Plan Check Fee
BUILIDNG
BSEISMICOM
Seismic Commercial
BUILIDNG
EPERMPI FEE
Elect Permit Issuance
ELECTRICAL
BREMSIGNAD
Rmdl Signs Add Branch
ELECTRICAL
BREMSIGNS
Rmdl Sings, Marquee
ELECTRICAL
BUSLIC
Business License
BUILIDNG
�7
CI PENNO
DNG
CONTRACTOR INFORMATION:
BUI DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
19028 STEVENS CREEK BLVD
ANH HOANG DESIGN
02050171
OWNER'S NAME:
APPLICATION SUB DATE
ALPHA INVESTMENT INC (#A,B)
1272 LORELEI CT
05/28/2002
'HONE:
SANITARY NO. CONTROL NO.
(408)374 -8285
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CON he'd R'S DECLARATION
I hertIs Rrm chat 1 am licassed undo provisions of Chapmr9 (commencing
with section ofj�Deitwision lof Ne Bound ProfessionsoCodn, nd my titan
N "�°
INSTALL NEW SIG
isinffall far ad eft.. Lice# `��}1-2.80
0 9 2003
Co li..A
✓`
JAN
RCHITECr'S DECLARATION
I understand my plans shall be used as public records
WILDING
Licensed Pmfessiotml
OWNER - BUILDER DECLARATION
I hereby affirm mar 1 exempt from me Contractor's License Law for the
following reason (Section ]o3 L5, Business and Professions Cos :
1. Code: Any city or county'
de o
which requires a permit to conarmct, alter, improve, demolish, repair any structure
improve, demolish,
$3500
fi
tech Permit License
pdorwim tensed gales rtgoims movisio
- - - - - -
soffor
aw(Chapter9
Ihapheislicensedpursrtibmto the provismnsoftheCon .anorsLicenselaw(Chapmr9
(coarmencmg with Section.70f1(1)nf Division 3 of the Btrincss Professions Code)
or ea.
ppI g �T ��'`' ° 9' "
f'S, %� i' t
Valuation
'
and
or that he is the basis for the alleged exemption. Any violation
fi sany
�gg
�t: 3.75�11'.b`/.1i:.0.0_rr,f.:_ ._(t'ti:
31.5 F wrur
of Section ]Ol L5 by any epplican'1for a pemds subjects me applicant to a civil permhy
•of not more than five hundred dollors(S500).
�.�,,r��,�,
101 APNFOOND5ATION
'° r'' Occupancy Type
° h as owner of the property. or my employees with wages as their sole compensation,
- - Required Inspections' '
104 - REBAR 9 p ' -
-will - e the work, an as Coal n YS not chir', i en offered for sate (see . to an
Cale: The roommaoeo License Law does not apply w an
pro
owner property
owner of property Who builds m improves thereon, mpr who does such work himself and
or through his own employes, provided that such improvements menm art not intended or
105 -..ANCHOR, BOLTS__., -� _ _. __ _- .. -_ _._—
sold within one year of
':offered for sale.wer havetorimen
_
,�1sy,: (. ,. ..
Wilder will
completion, the ownerbuilder will have the burden of proving char he did not build or
of proving
304 - ROUGH ELECTRICAL'
improve forpurposva( solo)'
505 - FINAL ELECTRICAL — -
as r -. _ ,.. exclusively _... an - - _ _ _ . _ ....
cant with J<omm�tam°
❑1,mownecofthepS..7.emBuinsa g
_ .. - .._._..... . -.... ___._..__ _.._-_.. ..., ..
514 - FINAL PUBLIC WORKS
she at ISa. 7W1 Business and Profession, Code:) The Contractor's
- •, t . , .
License
License mc5
does nm apply men owner, of property who builds or impmvs thereon,
_
m
.ad who commens for-such Protects with a conwesor(s) licensed.pursuam to this
C vazwh .
exempt
exempt under Sa:- t � . B & PC for M1is reason
..
Owner.',.. Date •. -
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty, of perjaiy one of the following declarations: -
° 1 have and will maintain a Certificate of Contend to self - insure for Worker's
Compensation; as provided for by- Section 9700 of the labor Cade, for the
performance of she work for which this permit is issued.
111 have and will mainuin Worker's Compcnsmion Insurance, as required by Section
'
3700 of the Labor Cale, for the performance of the work.for which this permit is
issued My Worker's C p ns ti d
on Insurance comer anti Policy ' number am:
Cnme IY I ^gyp t ),tf, r (!`f Pdlhcy No:
' '
rr'
CERTIFICATION OF EXEMPTION FROM WORKERS
I
' COMPENSATION INSURANCE c
- -_._ ... ..- _._ - -. ... _. ..__ _. - -. ...... . -...._
.• (Thcs section"need not. complete fshe . . ... ..... ...
Ic permit is tot one hundred dollars
.. _... ._., -. ...,..... 1
(SID(d or less)
I d n fy shai ih Perf anon,- �Ijthe o k f w h h th pemc t i. tied 1
- - _ ' ! if.
d II t rapt y any r o m lylP[IFalr i Ira b) t Wo kers
C tape��fiso on Les Cal 000000JJJJJJffffff s c. d
APPIwaA
NOTIC a kc g Cen l¢am ps should
c me
Iwfiom n bjcc o t Workers Compensm on prov s tins of the 1 obor CWe, you muds
n sla. Y o t
(onhwim cornDlY wim such pmvisions or his permit shall be deemed revoked.
_.. _._.__....__k
CONSTRUCTION LENDING AGENCY'
-'
I hereby afrou mat dram is a c.a -vo nioo lending agency far tha la rfumiaace
r
of she work for which this permit is issued (Sec. 309], Civ. C.) '
-lad N - ...
_.. .__ ._..._ _ _. .__._ ..: ..... ..... ...n -_. _... .-
Land Address
- 1 NatIh arc thatthe bo f Tonis
I agree all city and county admances and scam laws
c. to comply all city andi county ordinances
Wit g con d he
rte Wilding ronamcGon. and hereby authorize reprtdenmtives of this city w emer upon
enter upon
,the abme me11. td propvny fnr,Iny and keep p ficases.
(We) tdgme save. indemnify and hamayto tae City of Cupertino against
t
liabilities judgments, casts amt expenses which may in any way accme against soil
City in consequence of grgming of this permit.
l°PLICA _GIN ERSTAND,S AND WJLL COhIPLI'WITH AL NON -DINT
OURCE REG "'' / • ,_}' p
Issued by: Date
ATIO. .,
,Signal a plimrtJ nmracwr ,..-
Re -roofs
.Dare;
HAZARDOUS MATERIALS DISCLOSUR
c Will the sppl c nt o f c re hued ng nocaparilsman u handle hinNous material
7�pe Of Roof _ _. - _... .-..
a dern d by m Cupcm o M ipal Cod Ch pt 9 1? and ch H Ira and Safety
Cod Sauon 25532(e)
°Y"
r yc.7 ,,; . - •. . \ , av s t t
�s
All roofs. shall be inspected prior,to roofing material being. installed
WII the applicant future Wilding upans use equipment or devices which
-any -.
If a roof is installed' without first obtamirig an' inspection; I agree to remove
'earth d Management
D tare contaminants ms a.e r ac me Bay A aA r Quality Man
, r v r
all new materials for inspection. Applicant understands and will comply with-
all non - point source regulanons -`..
I have read me Intrinsic.,. materials fequiremu en under Chapter 6.95 of the
6.
llfomia Health & Safety Code. Sections 25505, 35533 and 25534. 1 understand that
i(tae building does nm currently haveatenam. thin it is my msponsibillry m'nmify me
-
or p ns of the qurc emswm tan mesp riot w .Dance of a Cenlfcate of
_
_
6
Signature of Applicant Date
All roof coverings to be Class `B" or better
net a mor;aN a am n,e
:. - ...� .. ..... .... .. - .. - OFFICE. .. ... . _ .. ........._ .... ... .._