06030166 CITY OF CIIPERTINO N'%�''
BUILDING DIVISION PERMIT aCONTRACTOR INFORM ION °'.
BUILDING ADDRESS: " PERMITNO.
10885 N WOLFE RD
R'S NAME: PERMIT ISSUE DATE
KIMCO REALTY CORPORATION 1982 STONE AVE 03/29/2006
PHONE: SANITARY NO, CONTROL NO.
(408) 280-6500
ARCHITEC(ENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
as LICENSED CONTRACTOR'S DECLARATION lob Description
I hereby affirm that I am licensed under provisions of Chapter 9(Commencing ,
with Section 70(10)of Division 3 of Ne Business and Professions Code,and my licerm is
in full force and efrect. I. INDIVIDUAL CHANNEL SIGN
a✓�Z Liccn¢CI�s TS g'-�J��v
a n a Dale .31 Las i Cunuaztor s'an
qq ARCHITECTS DECLARA ION
i 2< I understand my plans shall he used as public mcnNs
JyU
�Q� Licensed Pmfessinnal -
S OWNER-BUILDER DECLARATION
0 0 1 hereby affirm(Sec Not I am exempt from Jr Cssiona o :Any c law for the
❑O fallowing mason. (unit t V17 s 5,Business and Professions Cole:Any city Or county $6000
3= which requires n pmmit re ennswet,alter,improve,demolish,ore a sigany auuerute
_i y priof m is censed e.also requires the
ovisio o for such m n's LROO se signed statement
< Nal henscing wit pusmanl to race provision of the Common's an anselaw(Chapter Code)
Sq. FL FIOOC Area Valuation
2.c (cat ha is(commencing with Semfoconon 00 the,of basis
r the
al Busaged exempt Pinfiesson.Any
CMe)or
that he is exempt thertfrom and de baso for the alleged exemption.My violation of
Sec0on 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of um eOccupancy r Occu Type
no! re than five hundred dollars($500). P Y YP
p I,as owner of the pmpeny,or my employees with wages as limit sok compensation,
will do the work,and the structure is not intended or offered farm a(Sec.7046,Business
and Pmfessimu CWC:The ConuactoYs Litems Law dose ms apply to an owner of Required Inspections .
prgpeny who builds m improvesthereon,and who dax such work himself or through his
Own employ=,provided thalsuch improsemens are notimmided Conflicted for sale.If,
however,the building or improvement is mid within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sak.).
❑1,as owner of the property,am exclusively contracting wit licensed contractors to
consumer the project(Sec.7(l44,Business and Professions Code:)The Connotation's U.
cense law docs not apply to an owner of property who builds of improves themon,and
who contracts for such pmjecm with a compactor(s)licensed pursuant in the Commcrors
License law.
❑1amexemptunder Sec. ,B&PCforthismarom
I Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of Ne following declarations:
El I If m and will no inain a Cm iliitme of Consent to self-insurefar WarkeisCumpcn-
sation,as provided to,by Section 37M of the labor Codc,for the pcdotmana of the
.,it for which this persnil is issued.
❑1 hast and will maintain Worker's Compensation losmmce,as required by Section
37M of the labor Code,for the performance of the work for which this permit is issued.
My Worfk�er's Compensation`Insurance canner and Policy number am:
Canief.y—Lkr`voQrT \VNSs%xra"4tporeyNo.:AIQ1650"1,` -
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('Otis section need not beco sidemd irthe permit is inform hundred dollars($IBO)
nr lose)
1 gnify that in the perform orm of the work for which this permit b issued.l shall not
employ any person in any manner so a to become subject to the Workers'Compeasadon
laws of California.Dow
Applicator
NOTICE TO APPLICANT:If.Hier making this Cenificam of Exemption,you mm5
become subject to the Worker's Com penurion provisions of the labor Code,you muse
J O Mf with comply with such provisions or this permit shall be deemed mOo ked.
zry CONSTRUCTION LENDING AGENCY
sc+ (hereby alum that them u a construction lending agency for the performance of
C' the work fur which this permit is issued(Sat.3097,Civ.C.)
W�Q tondo's Name '
Z:)
: z tondo's Add.
U 0 1 certify that 1 have read this application and slam that the above infommtiun is
L,F^ cancer.l agree to comply with all city and county ordinances and state laws relating to
OO building construction,and hereby authorim representatives of this city to enter OF.the
W above
-ms.judgdpmp rtycosts
for Inspection porpowhich s.
may
a
gy (We)agree to save,indemnify and kap harmless the City of Cupcnino against
Z incoties.judc of th,tossand exyesmawhich mayin anyway accrue against mid City
V,'� in eonuquen<e of the granting of this permit.
'—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL11NJJ'ON-POINT Issued by: Date
SOU REGI IONS.. 3rzj I /
I1Cb
Re-roofs
Signatan,of ApplicanVContmcmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or intone building Occupant stem or handle havallous material
as defined by the Cupen110 Municipal Code,Chapter 9.12,and the Health and Safety
de,Section 25532(.)?
❑Yesf.�No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant orfuturebuilding occupant use equipment ordcvices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District
❑secs No
1 have mad dte h Oemimis mammals aq.irtmeris under Chapter 6.95 of the Carl.,.
ria Health&Softly COdc,Sccd.m BS05.M533.d25534.1undcssmnd NaiOhc building '
does�I n��ot cccum nily hma a remain,that it is my ,m,iPoo ihillty m mdry do<upam or Ne
myu'rzm nswhichmustbeMCI prior it)ismma of aCcrdfcawof(kc panni. Signature of Applicant Date'
Dwr�,,,r anihorbed cellar, Da1C All roof coverings to be Class "B"or better
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( . • Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
`UPEkTINO
Building Department
JOB ADDRESS: t�g�5 N VJo\� Rba 1 PERMIT #
% b6o36 � 6 �
OWNER'S NAME: rnco Res.\ C�c o w, PHONE # 5\0=1q L-1-12 b
GENERAL CONTRACTOR: FAX # 1k0$-M 1100
I am not using any subcontractors: 3120. l06
Signature Date
Please check applicable subcontractors and complete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
-1 <� CITY OF CUPERTIN'a
SIGN
OUPEkTINO PERMIT APPLICATION FORM 0�30/ �j�
APN 4- Date:
Building Address:
Owner's Name: C� 1 \ \0� Phone
`\\
Contractor: n 11 om\ h 11 License#: p
Contact: / Phone#: 11IDS . C1�v X500
Applicant/Contractor: /� �\
/� er
Building Permit Info:
ld le Plumb Mech
Jo escription:
Residential: ommercia
Sq.Ft. Floor Area: q.Ft.:
Architect/Engineer: Cost of Project: I OOr�
ype of Construction: -- �— Occupancy Group:
Qty, if
Applicable Fee ID Fee Description Fee Group
BENERGY Energy BUILIDNG
BPERMFEE Bldg Permit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
EPERMrfFEE Elect Permit Issuance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Rmdl Signs, Marquee ELECTRICAL
BUSLIC Business License BUILIDNG
CITY OF CUPERTINO
BUILDING DIVISION PERMIT ; C®lyTR2,CTQR INFORMA'CIQN
'+W4 s s•sL 2. 5 ...,4I
BUILDING ADDRESS: PERMIT 1,1
10885 N WOLFE RD
—"NEWS NAME: PERMIT MUE DATE
KIMCO REALTY CORPORATION 1982 STONE AVE 03/29/2006
PRONE: SANITARY NO. CONTROL NO.
(408) 280-6500
ARCHD ECfyENGINEER: BU PERMIT INFO
BLDG ELECT PLUMB MECH
COQ LICENSED CONIRACTOR•SDECLARATION JobDescri non
�mF 1 hereby alfum tam I am licensed under provisions of Chapter 9(commencing p
i`pj with Section 7olllllrfDiyision3olthe eutiness and Profusions Code,and mylicenscu INDIVIDUAL CHANNEL SIGN
^<n in full Ince and cflect.
License Cl Y�r Un
Contractor
44 ARCHITECTS DECLARA 10th
C U 1 understand my plans shall he used u public records
a
s C Licensed Professional
3 OWNER-BUILDER DECLARATION
.� Y 1 hereby alErm that xem
I am exempt fru.the Conuamaes Ucense Law for the
p o following reason.(Section 713 1.5,Business and Professions Codc:Any city or county $6000
which reyu ,ires A permit to eminn alter.option,demolish,nr repair any silicon.
Zy prior N its issilmm.alro million he applicant for such Nnmitto Ble adignedalIIemert �.
< that he is licensed pursuant to Ne provisions of the ConvectorLs ease law(Chapter 9 Sq.Ft. Floor Area WlD 'On
Y1- (commencing with Section 701Y))of Division Sof Ne BuO..nd Prolcanians Code)or
Q .•
that he u exempt therefrom and Ne beau far the alleged exemption.Any violation of
Section 7031.5 by any,applicant for a permit subjects the applicant 10 a civil penalty of
not more Nan five hundred dollars($50)).
Dm eC CC ancy Type
❑1,in owner of the pmpmy,in my employees with wallet u deb ani,compeuation.
will do Ne work,and Ne structure is not intended moffeted for saki(Sec.7014,Business
and Professions Code:The Consumes Li«sue law does ran apply in an Owner of Required Inspections /
property who builds or improve thereon,and who doessuch work himselfor through his
awn employees.provided Out such improvements are notintended moRered far We If,
however,Ne building or improvement is sold within one year of completion,the owner.
builder will have de burden of playing that he did not Wild or improve for purpose of
sale.).
❑1,As owner of the property,am exclusively compacting with licensed contsuon to
construct the project(Sec.7(44,Business and Professions Code:)The Contactors U.
come Law does not apply no in owner of property who builds or improv thereon,sand.
who contracts for such projects with a contractor(&)licensed pursuam to the Consacloes
License Law.
❑1 am exempt under Sec. B S P C for Nu mason
19, Data
WORKER'S COMPENSATION DECLARATION
1 hereby,affirm under pemlty of perjury arc of de following declarations:
❑I haw and will maintain a Certificate of Consent to self-insum for WorkcesCmrpen-
sation,As provided for by Section 37M of the labor Cade,for the performan¢of the
work for which this permit is issued.
❑I Mw and will maintain Workers Compensation Insursnce,As requited by Section
37W of Ne labor Code•for the performance of the work fin which this permit Is issued.
My Wmkeea Compensation Insurance carrier and Polity number tae:
Carrier,I 1nstAr'ane Pnl;ay Na.:AlQ165bZ`
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Nis section lend Out he complied lithe permit is furan.hundred dollars(SIM)
or leu)
I cenifv Net in the Performance of the work for which this Farmi,is issued.I shall not
employ any person in any manncrso as m become subjectm the Wmkers Cmarasxtimn
Laws of C3Hfirrnu.Date
Applicant
NOTICE TO APPLICANT:If.after making this Cenifcate of Exemption,you should
become subject in the Worker-3 Compensation provisions of the labor Codc,you mux
.JO foMwiN comply with such provisions in this Permit shall W dccm.d invoked.
z CONSTRUCTION LENDING AGENCY
[-t I hereby affirm that more is a construction lending agency lot the performance of
C de work for which this permit is issued(Sec.3177.Civ.C.)
Wti Q Lendces Name
Under's Address
V Q I certify that 1 have read Mi,application and Anne that Ne above Infowmadun is
Iy F corteck I agree to comply with all city and county ordinances and site laws relating in
0[-j building construction,and hereby a.hmiw represemmivu of this city to enter upon the
alovcmcntioned ms.prapertyw for impectionA.purposes.
H G (We)agree to eve.indemnify and keep harmless the City of Cupertino against
fq fi.bilin
of Me granting
ex penseemit. may in anyway ace.e Against said City
V z in consequence of Ne gmming of this permit.
APPLICANT UNDERSTANDS ANDWILL COMPLY WITH ALL 01c(,
Issued by: Date
7SOp REGULATONS .3r;I O�
i
Signal..Of ApplicaDOD Date Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Mai Applicant or forum Wal Co occupantmore .handle HeAch and Seely
As dcfin.d by Ne Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
.Scithomzss3z(a7 _
lYeA � No All roofs shall be inspected prior to any roofing material being installed.
� � ':
Will theapplicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
call
rdm
havaoair contaminants ss do fined by the Bay Area Air Quality Management all new materials for inspection.
District,
❑Yin �No
I have read the haArdsos materials requirements under Chapter 6.95 order Cahlor.
nu Health h Safety Code,Send.25585,25533 and 25534.1 undemmd this ifde building
docs not cunendy have A enact,Nat it is my rnsponedulity a notify tie no.,or Ne
reyurenuwh hmwb mclpormss n afaCnfn¢ofIf;
IC.b� Signature of Applicant Date
Owner or Authorized agent 3„e All roof coverings to be Class"B”or better