The URL can be used to link to this page

07030026CITY OF C;UFLKt L Liry GUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 19503 STEVENS CREEK BLVD #115 DOUGLPS ROSS CONSTRUCTION 07030026 PERMIT ISSUE DATE OWNER'S NAME: CUPERTINO HOUSING PARTNERS )NE: ARCHITECT/ENGINEER: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business "6', Prroc6ofessio Professions and y license is in full force and effect. 6 , (,/ License Class Lic• N Dam Contractor ARCHMCTS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's Uccnse Law for the following reason. (Section 7031.5, Business and Professions Cate: Any city ar 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 file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ 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 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 or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li- cense law docs not 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 License Law. ❑ 1 am exempt under Sec . B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation insurance carrier and Policy number raare: —04 Cartier. STA' C • .N/ iw . Policy No. OOV' to CERTIFICATE Oft EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) or less.) 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 Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z� W> R. A �Dz UO w F. UU H � U r� CONSTRUCTION LENDING AGENCY 1 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 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 inspccuon 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. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCP RE TIONS. ? 6 0 -7 Signaz of Ap icanUContractor 7 Dam HAZARDOUS MATERIALS DISCLOSURE Will pplicant or future building occupant store or handle hazardous material as defined by the Cupertino Munic�l Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? �/ ❑ Yes ❑ No Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Yes Nu 1 have read the hazardous materials requirements underChapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant that it is my responsibility to notify the occupant of the rcuiremcis w^hich must be met prior to issuance of a Certificate of Occup n y. Owner 909 AIMA ST SANITARY NO (650) 70--700 BLDG� Job Description REPAIF. WATER DAMAGE FROM ABOVE UNIT Sq. Ft. Floor Area 31649019 Issued by: Re -roofs Type of Roof $5000 Required Inspections CONTROL NO. BUILDING PERMrr INFO Date type All ro As 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. Signalure of Applicant Date All roof coverings to be Class "B" or better CITY Ole CUPERTINO 2 ITEMS OF 4 PERM::T RECEIPT OPERATOR: kiersaw COPY # : 1 Sec: Twp: Rng: Sub: B.Lk: Lot: APN 3L649019.00 DATE ISSUED.......: 03/06/2007 RECEIPT #......... B3000000616 REFERENCE ID # ...: 07030026 SITE ADDRESS 13503 STEVENS CREEK BLVD #115 SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER CUPERTINO HOUSING PARTNERS ADDRESS .......... CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: RECEIPT INTERFACE CONTRACTOR J DOUGLAS ROSS LIC # 25637 COMPANY DOUGLAS ROSS CONSTRUCTION INC ADDRESS 909 ALMA ST CITY/STATE/ZIP PALO ALTO, CA 94301 TELEPHONE ........: (650) 70--700 FEE ID UNIT QUANTITY AMOUNT - PD -TO -DT THIS REC NEW BAL BPERMFEE ----------------------- VALUATION 5,000.00 ---------- 115.56 0.00 115.56 0.00 BSEISMICRE VALUATION 5,000.00 0.50 ---------- 0.00 0.50 ---------- ---------- 0.00 TOTAL PERMIT ---------- 116.06 0.00 116.06 0.00 VOICE ID DESCRIPTION VOICE -------- ID DESCRIPTION -- -------- 101 ---------------------------- FOUNDATION 102 PIERS 103 UFER 104 REBAR 105 ANCHOR BOLTS 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS 307 INSULATION 308 SHEETROCK 309 EXTERIOR LATH 310 INTERIOR LATH 311 SCRATCH COAT 313 ROOF NAIL 1 RESIDENTIAL PRUJECT COVER SHEET CITY of CUPpEki1NO Assessor's Parcel Number: Name of owner. Project address. ;�v\c% N i `( +�-E Phone. " SO ' u y -f - 0`5; q -1 Contact person. �^ '"` 7 l 3 Fax. `� Net square footage of lot - Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: I' , �) / S5 F7- Are there at least two 10 foot by 20 foot cle2r spaces inside the garage? Y N Is privacy protection planting required for & e project? Y N On what floor(s) is work being done? 1y47 r1c� (r; Brief description of work. , 7,)A e CJS�AA� JJti,11 tit\ bb C Ee+TS ;4 5 Z � Code editions: 2001 CBC y _ 2001 --FC (y (Y - N)2001 CMC (Y- N) N) 2001 CPC - 2001 NEC - Effective 11/1/02 Plan Review Process Work Book Page -8 Revised 4/28/04 W OW OF CUPERTINO CITY OF CXPERTINO PERMIT APPLICATION FORM 07o3000P .-CPN # _ Date: S v 7 3rd - BAPPLOTHER Other Appliances Mailing Address (if different from building address): Building Address: ICASO 3 -5-16 & n}S C.ILti�L�L. I I S Owner's Name: Phone #: Boiler > 100K to 500K Btu MECHANICAL Contractor: License #: MECHANICAL Phone: �'-`�'�'� -�� Pupertino Business License#: Contact: �(✓ ti` _ Fax: �(v6' 3'� - KZ 3 2 5 BBOILER5 Boiler > 1.75M Btu Building Permit Info: �1- BCONSTAX Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Descriptio ' Commercial ❑ Residential Sq.Ft.: Sq.Ft. Floor Area: BUILDING BCONSTAXH Hotel and Motel Cost of Project: Occupancy Group: $ � LSD BUILDING Type of Construction: Please check this box if t� project is a I A i L'2 D A A A ^ � � r 2c% �� A b0 � � �'� ` second-storyaddition: Jr�inn+ 4z17P• Qtnnrinrci ❑ LarRe ❑ Major ❑ Quantity Fee ID Fee Description Fee Group MECHANICAL BAPPLOTHER Other Appliances BBOILER1 )=;oiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Bailer > 500K to 1M Btu MECHANICAL BBOILER4 Bo .ler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX f id/Off/Comm/Quasi BUILDING BCONSTAXBQ (:on. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC 1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 El ec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF CUPERTINO CITY OF C UPERTINO PERMIT APPLICATION FORM --- _ Quantity Fee ID Fee Description Fee Group Main Water Service BMISCELL Miscellaneous Fee BUILDING BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BREMAIRHAN BNUCOMME New Comm Electric ELECTRICAL Appliance Install BNUCOMMM New Comm Mechanical MECHANICAL ELECTRICAL BNUCOMMP N.w Comm Plumb PLUMBING BREMFURN BOVERTIME In::pection Overtime BUILDING Re Furnace > 1OK btu BPBACKFLOW Atmospheric Vacuum PLUMBING MECHANICAL BPCESSPOOL Cesspool PLUMBING BREMMISC BPERMFEE 13 ld Permit Fees BUILDING Rein Non -Res Appliance BPFIXTURE Pblg Fixture PLUMBING ` BPGAS Gas Piping System Fee PLUMBING BREMRECEPT BPINTERCEP Inc. Waste Interceptor PLUMBING Zelocation of Hood BPLANCHK Plan Check Fee BUILDING MECHANICAL BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Pla i Check Repeat Fee BUILDING BPREPIPE R i e Of Fixtures PLUMBING BPSEWAGE `sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lavin Spriinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING 1 �- _ rr_ :- P_ X To + PLT TMBING 5 1JL2UV %�1JISI 1 1 1`/ BPWATER 1116 Vl L1LL111 W • -+ - --- Install/Alter Alter Water Pipe --- _ . BPWHEATER V Vater Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER Ab- Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY -Zemodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Rl;location of Furnace MECHANICAL BREMFURNOV Re Furnace > 1OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL gREMNRApp Rein Non -Res Appliance ELECTRICAL BREMPOLE P :)le/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Real, Switch & Outlets ELECTRICAL BREMRELOCA Zelocation of Hood MECHANICAL BREMREPALT I:epair/Alter Heating MECHANICAL „_ __ a i n n r„t; o",.P ELECTRICAL 2 of 3 CITY OFCUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD I:mdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR 'Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE ?4ech Permit Issuance MECHANICAL PPERMITFEE I lumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi -Faro PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3