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08100180 - PUBFie E it Actions Details Links Favorites Help (� r - 1 ri rl_7 , rn r is Permit Information Permit Number " 108100180 Status' v Master Number �� Ea2) Notes 3' Project Apply Date' 10/28/2008 - Operator patg Permit Issue Date 08/11/2009 Operator patg _ Certificate Issued Operator Certificate Type Certificate Number Location Information Address " 1699 S DE ANZA BLVD OK City/State/Zip CUPERTINO CA 95014 14m8ack l APN RUGII 0120.01 Unit Contractors -- -- 01�,mer Entity Information IWFees Owner Name " ,ATAM SANDHU _ _- — _ Plan Reviews Use Default j Inspections J Address Home -1699 S DE ANZA BLVD - J� Print Permit l City/State/Zip CUPERTINO CA, 95014 ,Adjustments Permit" Property Zoning Applicant Contractor" Defined Fields Permit Details Permit Type " 1 M TI ---- - - --. MERCHANDISE TENANT IMPROVEMENT Usage Class ' II/III B, [-' II/III 8, IV -HT V-B NEW —_ Applied Value " �— 100 SQUARE FT. 0, Calculated Value 0 01 US C-404 Type 437 0' ALT: NON-RES, NON-HSKPG Permit Form " LAUTOPERM -PERMIT Ownership 1 -Private Project Size STANDARD - STANDARD �► 4 Permit issued 08/11/2009 Enter permit status 'rJ Holds J Purpose/Special Conditions - - - [[] Copy Permit l REVSN FOR ROLL -UP DOOR RELOCTN(STRUCTRL); l Close Permit J ORIG#08040176 l 7/13/09 ADDED $126.00 SUPL PLAN CK-CORRECTED INVOICE l Overrides IN FILE- SUHW Supplerr�entalFields 7/1/9 PD FEES TO RE -OPEN PERMIT_ Notes l S/19/09 PERMIT APPLICATION EXPIRED 4/28/09- WILL NEE IKIAttachments TO PAY PLAN CK FEES $122.00 TO RE -OPEN PERMIT_ STILL lCJ NEEDS TO RESUBMIT PLANS TO BLDG_ SUHW FILMED-2011 Add Default Text D CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1699 S DE ANZA BLVD CONTRACTOR: TBD - TO BE DETERMINED PERMIT NO: 08100180 OWNER'S NAME: ATAM SANDHU DATE ISSUED: 08/11/2009 OWNER'S PHONE: 4084063158 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.H r F r MECH RESIDENTIAL COMMERCIAL Contractor Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REVSN FOR ROLL -UP DOOR (commencing with Section 7000) of Division 3 of the Business & Professions RBLOCTN(STRUCTRL); Code and that my license is in full force and effect. ORIG#08040176 1 hereby affirm under penalty of perjury one of the following two declarations: 1 have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Valuation: $100 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION APN Number: 36610120.01 Occupancy Type: 1 certify that I 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 inspection purposes. (We) agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date Issued by: Date: ,N OWNER -BUILDER DECLARATION l hereby affirm that 1 am exempt from the Contractor's License Law for one of RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. if a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for I, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: Date: I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1 hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the 1 have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9,12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(a) should 1 store or handle hazardous material. permit is issued. Additionally, should 1 use equipment or devices which emit hazardous air 1 certify that in the performance of the work for which this permit is issued, I shall contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9,12 and the not employ any person in any manner so as to become subject to the Worker's Health & Safety Code, Sections 25505, 25533, and 25534. Compensation laws of California. If, after making this certificate of exemption, I l become subject to the Worker's Compensation provisions of the Labor Code, 1 must Owner f'iorized agen . �p forthwith comply with such provisions or this permit shall be deemed revoked. Date:--� / APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9.18. 1/11 1 understand my plans shall be used as public records. Signature ` �_ Date �� Licensed Professional 0 h i)ol �ko ar CUPEkTINO CITY OF CUPERTINO REVISION/DEFERRED PERMIT APPLICATION FORM APN # ` � /0 / � O. 01 Date: Original Permit #: V Building ddress:� 9 PIV4 C,�z Mailing Address (if different fr buildi ddress). �hh aC VAX e- Owner's Name: Phone #: Contractor: Phone: Fax: Contractor License #: Cupertino Business License #: Contact: Phone: M CST / t 4 q2-<- ��g R �o� Fax: `S � q4 Y— / 5'<?- Building Permit Info: A e Bld n— Elect ❑ Plumb ❑ Mech ❑ Residential Commercial El Job Description: T� Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑ Type of Construction (Usage Class): * Occupancy Type: 1-A, 1-B ❑ II/III/V-A II/III B, IV -HT, V-B Valuation (cost of project): 4 / G� V Project Size: Express Standard Large Major Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved:_ For help, contact Build it Green at www.builditgreen.org Revised 10/01/08 a0FC1CITY OF CUPERTINO CUPEf�TINO REVISION/DEFERRED PERMIT APPLICATION FORM FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type 1REVCOMNEW Revision Commercial New B 1* 1REVCOMTI Revision Tenant Improvement B 1* TI 1REVSFDWL Revision SFDWL B 1R3SFDW 1REVRESADD Revision Addition B 1R3SFDADD 1REVRESREM Revision Remodel B 1R3SFDREM 1DEFINSP Deferred Submittal not R-3 Ins ection B 1DS 1DEFPLNCK Deferred Submittal not R-3 Plan Check B 1DS 1DEFR3INSP Deferred Submittal Inspection B 1DSR3 1DEFR3PLNCK Deferred Submittal R-3 Plan Chk B 1DSR3