05110162 CITY OF CUPERTINO
BUILDING DIVISION PERMIT QNT1lAff0R,1INE0RMATI0N.T
_z,...x.1'at ..,,..K?Sra•& f^N.`".�'sdRf+t„ z��, ,[' �i :
BUILDING ADDRESS: ASSOCIATED ENGINEERING & MM'VD 05110162
10968 RANnT.Ry ng
'ER'S NAME: PERMIT ISSUE DATE
BANDLEY CENTER INC 1771 TIMOTHY DR i �l /2,i /gons
PHONE SANITARY NO. CONTROL NO.
(510) 357-5729
ARCHITELT/FJVGINEFR: BURRING PERMIT INFO
BLDG FIF.CT PLUMB MECH
O 0 D
300 LICENSED coNrRACIDR'sDEcuannoN ]obDescri [ion
4�u 1 hereby uBrm that 1 un I baadj oub povitions of Chapw 9(cadmcnclnt P
N Seclimi 7")afDiviuon 3.1'LW W ae RumPTkuktru Code,sa any lir.,.A
n� mrmlramLWer REVISION--ADD SKYLIT. , MOVABLE PARTITIONS,
�i am carve « REVISE DOORS & OPENINGS, COUNTER LOCATION.
ARCHITECTS DECLARATION
I urdcrsudd my Pato ahul be ued As public retards NO NEW PERMIT ISSUED/ORIG. #05010057
i
'0 Licence Pmfesi.nal
OWNER-BUILDER DECLARATION
.� x 1 knalty AM.that,1 un cocoa,,foam ftC.ntnctW,Lircnre La�far dr
O O mlb int mma
a .(Scrim 70315.BuslreAs W Poafc tbos Code:Any chy or,Monty
5 S K which req.t.A,omit to a 1, W.bnpmne,dandir b.or mpur any Y(aa[am
prior W iu iuwrrc,A4u rryuiro dro., lkam f«a¢h prmil.Ok.ugra,daM.1
EES< Nwhc Ubr«dadpNRYnl loft pmviskruofthc Comfcla's l3ccnsc law(Chapa 9 Sq. Ft. Floor Area Valuation
yF� (.aoMnli.Z vhln �700f1)of Dlviu.n 3 of tsc Buurraa and Profmlms Code)«
9 tM M 4 Lmmp fto fsam W me laws r«the aUbSed eamption.Any violation or $102
ScNm7031.5by A”apPHnnc for.Perm,subjects line appl nw a ci,d prulty of APN Number Occupancy Type
nor more glad fisc hundred d.1Ws(5.500)_
❑1.u avdo of ttie propeaf•«oar anPbYm Akin vats u dhe4 sok mmpnsNm,
— 52633097
mil do tin work,W NL axo s isnot inte «offered fa ask(Sec.713,4,Buuoeo 00
W Poafew.n,Cox Tse Cab ub s L.x:a.Law does oat appy W.n avosr.N Required Inspections
property who bolds orlmpmnea tru n,mllvWdao welt win kimclf«though his
own emplayva.parrOded tM such Impom ba.0 ue not InwryYd«.Rood f«salt If,
hvvncr,dhe Wilding ttimpro.m.,4 said Andiron ore)ar of mmpktiov.the dtsr- .
W I10a v10 Me dW Wrticn of pint Nat be did na WIW a imprme f«pmptue of
Asia.).
❑1.u w of dine p rpory,aro eaelusively cmuaalrnt vilh Ito
,obs uct tW p*a(See 7W,Busi.odd Psafeu4ms Cadc)The Co.vca«Y U.
ceve Lav dots not apply m an rbaw a p.peay.w Wilds or Impoaa thoeon.and
w W camncu for neh p ,Jcm vllh•comnnor(a)I'vrncd puuvant to 0n Co.', S•S
❑L am Lamp urWo see .Bd PC fn aJA ruwv
ae
AOR%Elis COMPENSATION DECLARATION
1 hertby.Dasa vrule,pmuly of pdury.ae (ft fallowing deelarulmn
F1 IMWvlmdnWnaCoWkatcof ConscmbcB.I mf«W. sCompo-
num,f«r pmvW W f«by Srcum 3700 of Ne tabor code.fa ar pdormana N Ne
Ark rbieh w4 paroit 4 issued.
❑1 bavn W will roa mar Wortrrs Compo s rdan Inmfvrc,As mqu by Secuan
37W of the Lab«Coda,for ft Pafmvna of Jr Atria f«win W W4 prxn It 4 4soeL.
My Work 1e,TCarrrpvsao.lom.coria W Policy numb
CuiaPolk] K:
G 4ZQ VNOf IXFMPION FROM ,
ERS
COMPENSATION INSURANCE
(Tb s scum need oat W canpkua trade pamk 4 for.huraJoeG dollar($100)
MI )
1 c fy that In the prolor aocn of WL Ask fa which this prrNt 4lssued,I.sail oat
=play my person in my manMl an Af to b.mtm wb*t in ae W«l2a'CoopcnfLim
laws of cahform-Dar
APIA
NOTICE TO APPLICANT:If,afer making this Cenlflrau of Escmpuon,you AWukl
l=.wbj=to ar W« a Comperomlm pmviu.au a(ate laha Code.yao muR
.JO foMviN mmply whin such pmv4lons or Nis parol,shall Ito tetrad Tried
z yCONSTRUCTION LENDING AGENCY
IWmby affirm Nat Were is.caw«,im kadint Atenry f«,Ac prrarmcnx of
lY> Ue vvric for which ih4,:noir 4 isued(sec 3097,civ.C.)
aI<ndcf.Nsmc
= z LcMcr Addw
U O 1 unify NA,1 batt rod iia.pplcaJm ane snit ibu sine sbo,c inramaJm 4
P emcc,.I Ali=to mmply roar ail tidy W emmty«dibmn s W Aute 4aa rclafint to
OU Wilding cororvc,Ion,Whereby sulh.rin mpocm[MI of Nis clay W MW upon Na
shote-mcnlioad p.pny f«Lbr, tam purpasrs
(Wc)Agra W save,indemnify Aad deep bu ditrA the City of CUPWiW against
(n HaNtitlo.}odtmcnu.costs W eapeaea which may In any way a a a«atunn nW City
V Z incmtegpvre of Ne goading.(ads ph.
'--' APPLI)EANT UNDERSTANDS AND WILL COMPLY WTIII ALL NON-POINT Issued by: Date
SOUBCE REGUy%TION�S.
L1�l�l� ( 21/o C1 Re-roofs
Sill of ApplionUCMu
53AZARMUs MATERIALS DISCLOSURE Type of Roof
Will rMa H(MIEafuune Wilding oavpam mor,or handle hanrdom mava4l
u defmW by Oe CuprniM Municipal Co,,,_CLaprec 9.11 W the Fkuth W Suety
Secum 25532(01 pYe0N All roofs shall be inspected prior to any roofing material being installed.
Will tinw applkAnt or fuuuc Wilding ocap,n,uc equipmcot«deck=winch If a roof is installed without first obtaining an inspection,I agree to remove
cmid bvallous sur cmuminaw As acfinM by Ne Bay Ansa Air OrWlry Mmstama4 all new materials for inspection.
D ,,7
❑Yo ON. !
I have rUJ ane hawdan. .H.11 rcquircnrnts unJcrCbapes6.95oflhe Calif.- ��_I^
urs �hk Suay Cot,Satlan255W,25533W2534.Imacmaod,hnlfae Wildon
Jou tanrcmly Nae.enanH am 1,4 my ropmsidluy n Mary ftorcWanl of&
'ro" \^khroada�p"° Wsualm:aracak=OfG`zrpwaT Signature of Applicant Date
Ownv«wthorirca ager, Dane
All roof coverings to be Class"B"or better
CITY OF CUPERTINO v "v *ax a�/,a.
BUILDING DIVISION PEWT
BUB.DINGADDRESS: ASSOCIATED ENGINEERING & t$ °05110162
OWNER'S NAME: PRRMITL DATE
BANDLEY CENTER
PHONE SANITARY NO. CONTROL NO.
(510) 357-5729
ARCHITECT/ENCINEt]U
BUILDING Mrr INFO
BLDG ELECT PLUMB MEM
OO LICENSED CONfRACCRS DECVdIATIONO O O
I 1 bcrchy off=Roar I am lirnsvm under pmWilrsu of mspor 9(¢vnr ina Job Description.
�z Na Srcum7ml)ofDlvliloc3ofBs Busiasss am hof¢siow Cotic..n my Borns is
mrwuaa.mePtt Lkt 7 - REVISION--ADD SKYLIT. , MOVABLE PARTITIONS,
z Lkcvc Cl.0
3CP Darr cm ,era REVISE DOORS & OPENINGS, COUNTER LOCATION. �1
ARCIH ECT'S DECLARATION
¢ < Immoammypw,,bwIx, r as biir .ols NO NEW PERMIT ISSUED/ORIG. #05010057
�a
Lioonsad PrWessitiond .3'L
OWNER-BUILDER DECLARATION J'
I bcmhy afnrm torr 1.m exunpi from ac Cowacfor's Liccruu Law for tho
_O0 following rrason(S Iiw 7013,Basins and Ptofmons Cock:Any city or county
$ wbarb"or=a fsrtniL n m.assmct,wmr,hnproce,dcmol'vli.or mriair any ssructmc
RombsIim sc,akurc oD Ra2 tbespi0rul a foo CnaaoatLoa oBleasigodsuauncnt
�< CherU<uliarand Pvswnrb ere govisiau Naar Crmrebr's lktrts Taw(a.pmr9 Sq.Ft. Floor Area Valuation
(m,M is c=mpih Saxon 7000)of bads$f r U Roc Buairmu.m Prafusimu Ron $102
Roar tr u cttmp Ilrselsma am Ne basis for ere ilaad e.cnption.Aey tiolallon of
Secdoo 703M by arty.ppliantfaapesmirsubjccu Roc.ppliwntoa<ivl prwhy of APN Number Occupancy Type
wt mac Nan Tac h nod datan($500)_
❑L u osnv of sot PrW^ssY,err mY'�W loyry Roder wage u Toch sole compewuoa,
alum ere watt em dx savcbm is nd insadd moRerzd r«isle(sec 7M4.Buanm9 7 . 0 U
Required Inspections
.m Pmfrsiow Cade The Conuacmrt Lorna law dao tar apply b an.of eq ns Pe
prapeny who builds or bngoc thncon,am who dousoon work Id.1ferr Romuth hos
own cmployaa,pmauded Wt s lmpratc.t,;are oatlrvendd or offerd for alt If, �p
hoo,i, r.the building mimpm.emeot is sod warm an y,ar aT mmplctian,roar owrsr-
buldcr will haat tM dadrn of pm.int that hr wtl rmt build or"Tinos for porywc of
ak.1 S
L7I,ul Re dt4PuRcry,,Brriti. W ronmamina wiN,)u CoomuorrIb J�f�
eapssras roc,sa aflee)041,Bwinm am ProfudtmaCode)TheCopuama'aLi-
ttnselawdoesna.ppty s.n omm or,ro,rry.who buibe a iro,. steam,am
Who mnaacu for such prolrrts withacmnractm(s)Iirrned puraummrtr Cmuagah
(Yen¢ aw.
r]Iamexemlrundu See ,B&PCfao Nlsreasn
Dag
WORKERS COMPENSATION DECLARATION
Ioerehy aR under pa,nilry a per)nry ors of the folb tdecieuuonc
ItrK and willmrinuln.Cerufiure afCans,mbvJf-locum fa WrrtrYs Canpem
salon,a pr.vidm for by Sa.7700 of err Labor Code,fa the pmfamuna of dr
wino for which Nis mmil u.m..t
t]1 heat ssrd MR mainuio Worker's Canprossaticn 1¢mairm u ictIonA by Scrum -
a ar ac Labor Cade.for thepuforswn¢a as wort fa wbich this;North H Lsstsd _ t
My Worhefs Coma a�uvc�InNosine artier ud Polky oumbv K:
C.r . 1;Iff/Trt""� G ..��
` cA)E f�PO14y No-
Tr CERTIFl OFEXEMPIONFROM ORKERS
COMPENSATION INSURANCE
(Tits arum nerd oorbc canplcsd lac permh is fmaro humid doth(.($100) -
alas)
1 anify drat in ere pmforrvat of tM stork fa whkb this permit H Awed.l thea not
employ any portion many m.oncr m as b became subyot to Ne Won�Compcwtim
Laws a Califaoi..Das
Applksnt
NOTICE TO APPLICANT:If.snot making this Cenifoue of armption,you�d
bccatrr aubJm to thr Wore f,Cornpcwadan pmaislow a the Balm Cmc yea mug
.JO fonhwiN mmply wits such worvisiara a this permit shill ,docmd rcvbted
.CONSTRUCTION LENDING AGENCY
llmcby affirm wt them Is.answctinn lcndint atcrsy,for Roc pcffornacc of
(Yi> 0s wink for whkh ads permlt Is Iumd(Soar 7097.Civ.C.) .
W A lander'.Name
z Lerd,,s Address
U 0 1 ratify matt 1 Bu ro read this appliodm.m sure Bh.s the.bout infotmadun Is
W;^
""sero."sero. atrccb cor"', wig all 6,y and county osdinastma and=u,lam mutint to
C) bWlding convsucrlan,.nth,mby auamv<mprcunutiats of au city to onwas t
upar
0. above-menuond pmperry for inspecuan ryvpoar,
(War)alpee b MW,indcmwfy sad koep bj000r s the City of Copasino against
o-F-t (A kabiliu4ludsroromon.ancl cxpcncs which may In Ny'a'aY.o..'sinost a id City
U7 in eorost,,, c of Roe granting of his permit.
•7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURtEREGUL1kTION.�S.
Lti to _I Re-roofs
Si arc ofAppOrvtUCmvanaDato
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
W t Bk apptiunt or futwc bWlding oauyant uorc or Laino haatdow nrasriil
kV dornd by 0e Cuperri Municipal Cmc.Chapur,9.12,and the Hcala am Safety
am.se<tionu5324)? All roofs shall be inspected rior to an roofing material being installed.
pyo ON,, P P Y g g
WII the epplcar,orfwure Wildint occupant us a uipmont adevicu which If a roof is installed without first obtaining an inspection,I agree to remove
emlt hamdow air cmmmirun4 as kfirod by ere Bay Aru Air Q.W ity Mmuycmcnr all new materials for inspection.
Dsoict7
❑Yn Cl N"
I haat road to bvvd.,.mmcriels iiorcruundco CU I,&95 athe C.lifa-
la&safmy Codes o,s 25505.1]533 ad 25531.1 umrsstnM the if the Nodding
dau t euerendy Lagar a Bmank duo It 4 my reaporuibility u notify rte occupant of the
rcqu o B.hith nnvb molpriarw ivunrcof.CatiPcasol Ocnrputry. Signature Of Applicant Date
All roof coverings to be Class "B" or better
ow dr or aahori.d agent 4
Data __ _
. CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: euem
COPY # 2
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 32633097.00
DATE ISSUED. . . . . . . : 12/21/2005
RECEIPT #. . . . . . . . . : 32517
REFERENCE ID # . . . : 05110162
SITE ADDRESS . . . . . : 10268 HANDLEY DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BANDLEY CENTER INC
ADDRESS . . . . . . . . . . : 10268 BANDLEY DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ASSOC ENGINEERING
CONTRACTOR . . . . . . . : MIKE WU LIC # 27050
COMPANY . . . . . . . . . . : ASSOCIATED ENGINEERING 6 CONST
ADDRESS . . . . . . . . . . : 1771 TIMOTHY DR.
CITY/STATE/ZIP . . . : SAN LEANDRO, CA 94577
• TELEPHONE . . . . . . . . : (510)357-5729
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT' THIS REC NEW BAL
BPLANCKREP HOURS 6.00 522.84 87.14 435.70 0.00
BUSLIC FLAT RATE 1.00 105.00_ 0.00 105.00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 627.84 87.14 540.70 0.00
METHOD OF PAYMENT AMOUNT NUMBER
--- ------------- ------------ ____________-_____
CHECK 540.70 1154
TOTAL RECEIPT 540.70
•
L _
`( *CITY OF CUPERTIN4 p So /o d J
•CUPEtZTINO PERMIT APPLICATION FORM J
C) S!! /6�
APN # Date:
326- 33 - �. . - n5
Building Address: Mailing Address (if different from building address):
O-wner's Name: I
L � �I T� 'Q C Phone#:
` 1 t � a)
Contractor: License#: 6
So ErIGI��C121tJ CofJ$ of,) 7✓0 8i L
Contact: Phone:.Y o-_3 1 -51Z� Cupertino Business License#:
lk Fax:Sfo 7,51-51.-1- ^c
Building Permit Info:AD� M*jL4"TS vWe f,�kTl71o� or
S, I ,vUf-- 'DavRS X IN/fi-S.
12> ✓ SC_ cout(62 UdUr0Q0, WGWC JA-yr- L"dvT,A-1Po s tziYa�crt iZccc� nntsca fl J s
Bld Elect R Plumb Mech 19 CePRr4 c�
Job Description:
Residential ❑ Commercial
Sq.Ft. Floor Area: jf q.Ft.:
Cost of Proiect: Occupancy Grouu:
Type of Construction: Please check this box if the project is a
/ lv
second-story addition:
Project Size: Standard ❑ Laze ❑ Major ❑
Quantity Fee ED Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu DIECHANICAL
BBOILER3 Boiler> 500K to IM Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 "M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/ uasi BU]LDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax-Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA investigation fee BUILDING
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r^�
*CITY OF CUPERTIN(
OF PERMIT APPLICATION FORM
CUPERTINO
uanti Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BNIITIGATC Comm. Housing Mit. Fee BUILDING
BNUMBE New Comm Electric ELECTRICAL
BNUC01\,2 1M New Comm Mechanical MECHANICAL
BNUCOMPAP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmos heric Vacuum . PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERAIFEE Bldg Permit Fees BUILDING
BPFIXTURE Pb1g Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHI{ Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEVVER SeNvers PLUA11BIIVG
BPSPRINK Lawn S rinklerBackllo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pipe PLUMBING
BPNVHEATER Water Beater/Veut PLUAIDING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREMLAJRHAN A/C Units <= 10,000 cfm MECHANICAL
BRENIAPPLI Appliance Install MECHANICAL
BREMEUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMEURN Relocation of Furnace MECHANICAL
BRBMgURNOV ReloFurnace> IOKbtu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREAUNHOOD Installation of Hood MECHANICAL
BREMNIISC Misc A22aratus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREM POLE Pole/Platform Fixture ELECTRICAL
BREA'IPOWER Power DeAce/Apparatus ELECTRICAL
BREM -RECEPT Rc tl, Switch & Outlets ELECTRICAL
BRE1\1REL0CA Relocation of Hood MECHANICAL
BRENIItEPALT Repair/Alter Heatin MECHANICAL
BREM RESAPP Remodel Res Appliance ELECTRICAL
2 of 3
ATY OF CUPERTINO
CIWOF
PERMIT APPLICATION FORM •
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL
BREMSIGNS Remodel Si Marquee ELECTRICAL
BREMTHEATR Theatrical Ligbting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BRENIVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISAIICOM Seismic Commercial BUILDING
BSEISAIICRE Seismic Fee Res BUILDING
BSPECLAL Special Inspection BUILDING
BSWIM Swimming Pool BUELDING
BTEA,1P Temporary Power ELECTRICAL
BTEAIPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERNIITFEE Elec Permit Issuance ELECTRICAL
MPERMTEE Mechanicals . foot MECHANICAL
MPERAIITFEE A4ech Permit Issuance MECHANICAL
PPERTMTFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Chane BUILDING
•
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