07110116 CITY OF i.UPER�'INO A
BUILD�:`;� DIV1310N PERMIT �������� ��������*
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BUILDING ADDRESS: PERMIT NO.
20380 STEVENS CREEK BLVD TBD T� BE DETERMINED 07110116 .
� W NER'S NAME: �� �� DA �
CUPERTINO CITY CENTER APTS � 11/20/2007
PHONE: SANITARY NO. CONTROL NO.
ARCHI'IECT/ENGiNEER:
BCJILDING PERMIT INFO
BI.DG ELECT PLUMB MECH
� 0 � 0
� o p LICENSED CONTRACCOR'S DECLARATION JOU DOSCTIp�lOi1
;� �� 1 hcreby affirm �hat I am lixnscd uafer provisians o[ Chaptcr 9(commcncing
z W with Scction 7000) of Division 3 of thc Busincss and Profcssions Codc and my �icensc is R E— ROUT E S EWR L I NE & T I E I NT 0 MNL I NE I N LTNDRG RND
�� a in full force and effa�
�� z Licenac Class �• k GARAGE .?AWH S I NC . PD B S L 112 O O 7
+ �, p Daic ' Coatrador
� RCHI7ECI'S DECLARA ON
�� U 1 undcrstand my plans shell 6c uscd as public recards
a
L O y Liccnscd Pcofcssional
,� � OWNER-BUILDER DECLARATIO
� <� I hcrcby affirm Uut 1 am cxcmpt Crom ihc Convutars Liccnu Law for thc
i p O following resson. (SccGon 7031.5, Business and Profcssiont Ca1c: Any city or county
K m� which ccquires a permit to consWC� ailcr, improvc, dcmolixh, nr �epair any struclure
� y � prior u� i�s issuancc, alsu mquims thc applicant for such permit io filc a signcd sta�cmcnt
_< that he is liccnsed pucwant to thc prvvisions a[ thc Conuactor's Liccnsc Law (Chapicr 9 Sq. Ft. Floor Area Valuation
y t- �(commcncing with Scction 7000) of Division 3 of ihc Busincss and Profcssions C�dc) or $15 0 0 0
y �.. ihat he ia eumpt thcrefrom md the basis Car rhe allcgcd eumption. My violation of
Section 7031.5 by airy applicant for a permit subjecu Uu applicant to a civil penaity of umber Occupancy Type
not mme chan five hund�ed dollars (5500� 3 6 9 010 2 6��
❑ I, u owner o[ tlie prvperry. or my employces with wages u thc'v solc compensation,
will do We worlc, and Ne steucwm is not intended or offeeed forsale (Sec.7044. Husinrss Re uired Ins eetions '
and Pmfessiona Cade: The Convactors License Law docs not apply ia sn owner of 9 P
property wiw buiida or improves �hereon, and who daes such woric himaeltar through hia
own emplaycea. Provided tha� such improvements are not in�ended or otlered for sale. IC,
hawever, the building or improvement is sold wi�hin one year of compleuon, the ownu-
builder will have ihe burden oC proving iha� he did not build or improvc fw purpate of
sakJ.
0 I, as owner of tho property, am exclusively conuacting wilh Gcenaed rnnuxtors W �
conswct �he project (Sec. 7044. Business and Protessions Code:)'Ihe Convacwrs Li- � '
ccnse Uw dacs not apply to an owner of property who builds or improves Ihemon, md , � +
who convac�s for such projects with a convactor(s) Iicensed pursuant w �he Conuactors
r [ am ex mpt under Sec. . B& P C for this �cason ��
Owner Daie
WORKER'S COMPENSATION DECLARATION
I hucby aflirtn under penalty of peryury one o[ Urc follawing declaradons:
❑ I hsae and wiil mainuin a CertiGcate o( Consent lo ulf-insuie for Workcr's Compen-
sation, u pmvided for by Section 3700 af the Labor Code, for the perf'ormaMe of thc
work for which Ihis permit is issued.
❑ I havc and will muntain Workcrs Compensation Insurance, as rcquired by Scction
3700 of thc Labor Code, Cor thc performance of Ihe wort for w6ich this permit is istued.
My Wor s �wwauon y��e�u �c'cr and Poliry nu ber a 1
Camer. ���"'^ Poliry No.: �' ry� �^' ��
R'fIF1C TE OF EXEMPI'[ON FROM WORKERS'
COMPENSATION INSURANCfi �
(This scction ntcd not bc complctcd if the permit is for onc hundrcA dollars (S I00)
or Icss.) '
I ceni[y �hat in �hc performance of Wc work [or which this permit is issued, I shall not
cmploy any person in my manncr so as a become subject w �he Workcrs' Compcnsavon
Laws of Califomia Date
Applicam
N017CE TO APPLICAM: 1f, aftcr making �his Ccrti6catc of Excmption, yau shoulJ
become subject in Ihe Worlcer's Compensation ptovisions of �e Lalwr Cade, you must
, ,� forlhwith comply with such provisiont or this pecmil shall bc dccmcd mrokcd.
Z O CONSfRUCI'ION LENDING AGENCY
Fr � I heroby affirm Uut thcre is a consvuction knding agcncy for thc perfarmance uf
a� ihe amrk fm which this permit is iuucd (Scc. 3097. Civ. C.)
a Q L,endcr's Namc - •
� z Lcnders Addn;ss
V � [ certiCy Uut 1 have read Ihis spplication and ataSc thc above infarmatiun is
w�"� cortec� 1 agrce to comply wi�h all city d counry otifin and sute laws celaung w
0 U building consuucaon, and he�eby a n repreacnis ' of �his city to cn�cr upon U�c
� w ahove-mentioned piopcny for i c�io urppses
a (Wc) agree w save, ind nify�d lµ�cp less �he Ci�y of Cupertino against
�,E'"� � liabiliuu, judgmcnls, costs expe ich ay in any way acc[uc against said City
V z in cansequence of ihe gran ' g of is rmi 7 .
"^ APPLICAM UNDERST N A L MPLY WITH ALL N -POINT Issued by Date i � �
SOURCE REGULATIO
'� Re-roofs
Signuuro o �can o r a�
S M ALS DISCLOSURE Type of R oof
� Ihe appli t or futurc building occupant uorc or handlc ha•rardous ma�crial
kfincd �he C nino Municips odc. Chaptcr 9.12, and �he Hcalth and SafMy
:�, s��uo� zcen All roofs �hall be inspected prior to any roofing material being installed.
❑ves o
�11 thc applicant or future building aaup quipment or dcvices which If a roof i� installed without first obtaining an inspection, I agree to remove
emit hai.ardous air con�aminan�s at fi d by Ba rea Air Qualiry Managcmcnt all new m aterials for inspection.
���;���
❑ Ya �,
%
1 havc read �he hv ' aic ' s re m dcr Chaptcr 6.95 of Ihc Califor-
nia Flcalih & Satcty Code, 5, 3 . f undcrsund �hat i( du 6uilding
does no� curtently have a it ' 'biliry w notify �he occupant of thc
rcyuircmcn�swhichm � orec�r�e�aro��,p�ry. SignatureofApplicant Date
oW�e� o�,��h � �� o„� All roof coverings to be Class ��8�� or better
. �v�i�����
- CITY OF I�UPERTINO
��` REPIPE/����'���.�/MA�N SERVI�'E
CUPEI�TINO PERMIT APPL�ICATION FORM
APN # � , � Date•
.�°� � � � I � 2� � � �'" t � � �
Building Address: � 3 � �
�� �� ���
Owner's Name: �� � Phone #:
'.�,�1 �� �,tv � ����� �,�� a 5 3 � 1��
Contractor: � Phone: � I U � Q �� License �� �� � �
h'tiL . I 1 � �fo
Contact: Phone: Cupertino Business License #:
�N��ls �����sb�a
Building Permit Info:
Bldg ❑ Elect ❑ Plumb 0�
Job Description: - - �� �
� �
�(�w� ��i�� � �1�,�, � Q. l� �' 1M��v� 1�, iw�� ti
Residential ❑ Commercial ❑
Cost of Project: 1 � � �� . �..�
I
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE B ldg. Permit Fees BUILDING
BPGAS C as Piping System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE R epipe of Fixtures PLUMBING
BPFIXTURE Pblg. Fixture PLUMBING
BPWSVCS l�fain Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
CITY OF �UPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPER.ATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 36901026.APT
DATE ISSUED.......: 11/20/2007
RECEIPT #.........: BS000003292
REFERENCE ID # ...: 07110116
SITE ADDRESS .....: 20380 STEVENS CREEK BLVD
SUBDIVISION .......
CITY .............. CUFERTINO
IMPACT AREA .......
OWNER ............: CUFERTINO CITY CENTER APTS
ADDRESS ..........: 20350 STEVENS CREEK BLVD
CITY/STATE/ZIP ...: CUFERTINO, CA 95014
RECEIVED FROM ....: AWFS INC.
CONTRACTOR .......: TBL - TO BE DETERMINED LIC # 00096
COMPANY ..........: TBL� - TO BE DETERMINED
ADDRESS ..........
CITY/STATE/ZIP ...: ,
TELEPHONE .........
FEE ID UNIT QUANTITY F.MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 15,000.00 223.56 0.00 223.56 0.00
BPSEWER SEWER SYSTEM 11.00 237.38 0.00 237.38 0.00
BUSLIC FLAT R.ATE 1.00 107.00 0.00 107.00 0.00
PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 608.73 0.00 608.73 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 608.73 #25541
---------------
TOTAL RECEIPT : 608.73
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- --------------------
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
Community Development
� � . . 10300 Torre Avenue
�, � T� ; Cupertino CA 95014
Telephone (408) 777-3228
, , C1T1f OF Fax (408) 777-3333
CUPEI�TINO
B1111C�111 De artment
JOB ADDRESS: - PERMIT #
� 3 �� ��-(�'e'v�.S CY�2¢,�� ' 1 ( �1( ( (
OWNER'S NAME: � S n� PHONE # s p D`�� �
GENERAL CONTRACTOR: FAX # S( (� �-� � 1�`�I
I am not usin any subcontractors: ��� �
g a � Date
Please check a licable subcontractors d m lete the followin information:
S U B C O N T R A C T O R B U S I N E SS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Fini.shing
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 ,-r'
11 � �
er/ act Signature Date
(E)2'VTR(10FU}--_�_____ (N)3" VENT THF j i 100F (VTR) (30FU) E)2'VTR(5FU)
� CONNECT TO DCISTING (CTE) (TYP.)
� ROOF
�
t (E)2"V(10FU) —b � (N)3'
�------------ - °+-(E)2'V(5FU)
1-1 /2"V (TYP.}--�p W(; L
CW BT
CTE (TYP.) 5th FLR
(E)2"V(8FU}—b `a (E)2"V(24FU)
°�(E)2"V(4FU)
� - - - - - - -"- - - - - EXISTING(E) 3"WASTE(W) (9FU)
� . w, �
CW BT
4th FLR
� (E)2'V(18FU)
(E)2"V(6FU)--b� �� 4-{E)2"V(3FU)
�-- - �
� ---- -- W�, - — (E)3"W(18FU)
L
CW gT
I - 3rd FLR
(E)2"V(4FU)—b `� (E)2'1/(12FU)
°�(E)2'1/(2FU)
i ------- � ----- (E)3"W(27FU)
W% L
CW BT
Q ��FESSIONq�
, � E� SA��pN�F?�G,/ d FLR
E 2'1/ 2FU -� °' (E)2"V(6FU) � l . M ��g6 A
� ) � �-------------- 4-(E)2'V(1FU) � �.� ,�
� �— (E)3' ,� ���`" .�
' .. ��.�:.
CW BT WC � �"' ___� C a�.�:.
CTE 1 st FLR
� (E)3"W(37FU)
_�� CTE
�(E)4"W(45FU) GARAGE �
sn..t 7in. g'—i)"MIN.—�"� sOO�° Pn°�ea I�N""esr
�Fard En�InNrs PLAN B NONE 0744
� Proj�et 7itls Dabs By Drowing Numbar
°° °jp �" CUPERTINO CITY CE �ITER 5/07/07
� � �. � � �,,. P2 ,
WN.NUT CREEK. GWF�ORNY1 94698
(925) 932-5505 FAX: (925) 932-0�
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