08120094 - PUB105561
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Permit Inforriiation
Permit Number "
08120094
Status "
, C Closed
v
Master Number
O
Notes 1 1
Project
Apply Date'
12/15/2008
IM
Operator patg
Permit Issue Date
01/22/2009
Operator patg
Certificate Issued
06/02/2009
Operator PALM
j
Certificate Type
Certificate Number
Permit " Property Zoning Applicant Contractor " Defined Fields
Permit Details
Permit Type " 11GENCOM
Location Information
Address ' 10550 S DE ANZA BLVD
City/State/Zip CUPERTINO
APN 1136938002.01
Unit
Ok.wier Entity Information
Owner Name I 1NICHULAZ3 UtHA j
Use Default
Address lHome -19565 GLEN UNA DR +•'
CA 95014
City/State/ZipSARATOGA � CA 95070 I
COMMERCIAL GENERAL BUILDING
Usage Class " rll/III B, [Q]
II/111 B, IV -HT V-B NEW
Applied Value L 5000
SQUARE ET. 01
Calculated Value [ 0
US C•404 Type 437
ALT: NON-RES, NON-HSKPG
Permit Form " [UTOPERM - PERMIT vJ
Ownership 1 - Private _ *
Project Size EXPRESS EXPRESS y�
'ermit issued 0112212009
Inter the purpose or any special conditions for this permit
Purpose/Special Conditions
RMDIATN HQUPMNT RPLCMNT, INSTL SKID MNTD EQUIPMNT_
7.5HP PD BLOWR CATLYTC OXDZR; XURNG 1 CONTCT/RELY
&INSTL 1 OTHR
FILMED- 2011
n
[Add Default T
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3
V O K
Back
j Contractors
l Fees
Plan Reviews
Inspections
Print Permit
let Adjustments
li$�yr Holds J
�[] Copy Permit
lQ Close Permit
Overrides
l Supplemental Fields
Notes
(]Attachments
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CITY OF CUPERTINO,."
BUILDING DIVISION PERNIIT
x "
BUILDING ADDRESS:
PE$Mrr NO.
OWNER'S NAME:
PERMIT ISSUE DATE
PHO :
A009 - CONTROL NO.
ARCHITECT/ENGINEER.
BUILDING PERMrr INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
hereby affirm the I am licensed under provisions of Chapter 9 (commencing
with Section 7000+�) of Division 3 of the Business and Professions Cade. and my license is
in full force and K� g
RMDIATN EQUPMNT RPLCMNT , INSTL SKID MNTD
License CI Lie. •
Date I SUM= Contractor SciranbX
EQUI PMNT :
ARCHrrECTS DECLARATION
1 understand my plans shall be used as public records
7 . 5 HP PD BLOWR CATLYTC OXDZR ; RWRNG 1 CONTCT / RELY
&INSTL 1 OTHR
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 1031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any struaum
prior to is issuance, also requires the applicant for such permit to file a signed statement
Commmrs License Law 9
- Sq. Ft. Floor Area
Valuation
dui he is licensed pursuant to the provisions of the (Chapter
(commencing with Section 7000) of Division 3 of the Business and Professions Code) at
that he Iz exempt therehom and the basis for the alleged exemption- Any violation of
APN Number
Occupancy Type
Section 7031-5 by any applicant for a permit subjects the applicant to a Civil penalty of
not mono than five hundred dollars ($500).
36938002 . 01
❑ I. as owner of the property. or my employees with wages as their sale compensation.
Required Inspections
will do the work, and the souclure is not intended or offered for sale (Sec.7044, Business
and Professions Cade: flu Contracors License Law don not apply to an owner of
q P
property who builds or improves themim. and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sales 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.).
❑ L as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Hein and Professions Code:) The Conaactnes u-
ccnse Law don 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 Contractors
License Law.
❑ 1 am exempt under See , 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 Workers Compen-
sation, 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 Workers Compensation Insurance, as required by Section
3700 of the Labor Cade, for the performance of the work for which this permit is issued
My Worker's Compensation Insurance carrier and Policy number am
1ce
�7
Carrier. ArOt/t 1K/.S (,.n Policy No.: 00 S C COQ
934%
CERTIFICATE OF PTION FROM WORKERS'
COMPENSATION INSURANCE
(This scc don need not be completed If the permit is for one hundred dollars (S 100)
sir 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 Certific= of Exemption, you should
bccome subject to the Workers Compensation provisions of thc Labor Coda you must
forthwith comply with such provisions or this permit shall be deemed revoked
)
j CONSTRUCIION LENDING AGENCY
1 hereby alTum that theme is a construction lending agency for the performance of
the work for which this permit is issued (Sec- 3091, Civ. Q
' Lsndcrs Namc
,
[.enders Address
I Certify that I have read this application and state was the above information is
' cored, 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, indemnify and keep harmless the City of Cupertino against
j liabilities,judgmenM costs and eiprnses which may In any way accrue against said City
' in consequence of the this
granting of permit
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date ��
C%
SOURCE REGULATIONS.
_
I,
'
Re -roofs
Sign of Applicant/Co or ate
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Willi the applicant or future building occupant sum or handle hWaMoaa material
-
as defined by the Cupertino Municipal Code, Chapter 9.1Z and the Health and Safely
Code, Section 25532(a)T
All roofs shall be inspected prior to any roofing material being installed.
❑ yes
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future ilding occupant use equipment or devices which
emit hazardous air contaminant fined by the Bay Am Air Quality Management
all new materials for inspection.
Disuict?
❑Yn ❑No
I have read we hazardous materials requirements under Chapter 6.95 of the CaAfor-
ma Health & SafctyCode, Sections 25505, 25533 and 25534. I understand del if Oat building
does not currently ve a tenant that it is my responsibility m notify the OCcUPWt of we
mqubcmcns w ust be met mice of a Certificate of Ce
Signature of Applicant Date
All roof coverings to be Class 'A" or better
Owner
or authoriztd agent 15.1tc
-
i
CITY O
CUPERTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
APN #
36 q - % -- 00 So
Date:
a �—
Building Address:
10560 Sat. k De AwZA BWO. CAA pF-9-Tt00 Gp q5o t�l
Mailing Address (if different from building address):
3O 1 7 V- lc-,O ¢.E Std I T E 100 V-lk4(,"o Co R- o A GA g b i o
Owner's Name:
Phone #:
lJ i c-M 01-K 61W
l C4) 3q 1 - go 61
rContractor:
At,1Tqie- 0&1 CORQ ORATlOQ
Phone: (g16) o400
Fax: Cq1 gbl - 0430
Contractor License #: 6 5 414 9lb
Cupertino Business License #:
Contact: NN /,,ropfeE1 .PqL Q-
Phone: (AI (v) 'S%4 -0753
G Et,- - ( 5301 4co - 55 w
Fax: q t b - Oei3D
Residential ❑ Commercial
Job Description: �eL J%61ho1k QtW?V4e,ti+ fe l"wtW+
l h 64G II A101k oc r. c 4 momj4ed Pttj ? *w-vt+ : 1.6 hp PD B6Ac(
k-w 1 " V% ovke CorJULA- / (jell 04 QKA WLe.+an i v% Ova &04g c
Building Permit Info:
Bldg ® Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A, 1-B ❑ II/11IN-A ❑ I I/III B, IV -HT, V-B
Valuation: Square Footage:
S�000
Project Size: Express ® Standard ❑ Lar e ❑ 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.builditereen.org
Revised 10/20/08
Community Development
10300 Torre Avenue
n1 Cupertino CA 95014
Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PERMIT # p
1 0 s5 o P 1 cN c I� cA �Q
OWNER'S NAME: ` PHONE # Q 1 G 1 - 04
GENERAL CONTRACTOR ` tor w4� CA.A r,% +i wk 6i s> FAX # (,1 l 6 C, t — 0 4 3t>
I am not using any subcontractors:
Signature
Please check avnlicable subcontractors and complete the followi.nR information:
Date
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