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BUILLDING
BUILDING
CONTRACTOR INFORMATION:
Tfi`�'99"T tEVENS CREEK BLVD
CAL -AIR INC
PERMIT No. 02050124
rltMP.M'i`"IESAVERS
1555 S 7TH ST #K
AfT5rf21T)`-2 tTF2
'PHONE:
(408)283-2300
SANITARY NO. CONTROL N0.
ARC141TEC I'/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
1. � CJ
LICENSED CONTRACfOR'S DECLARATION
I hereby affirm that l am licensed ander provisions of Chapter 9(commencing
ONE CHILLER & P'IL� escription
of me Rusy and Professions Conde.and my hear.
c.# Lic. a
W%Z
Commcmr
II'fGCI"S UE \TION
I undemanJ mY Plans shall be u.ud as lie rtcords
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby of fro mat lam es,mo f..... the Cmnvanm's License Law for the
$16600
following mown. (Section 7031.5. Business and Professions Carl Any city or county
which mquim,% a permit to consmact,41mr. demolishrepairy structure
prier t 't c 1 req' h ppllcem for such permit to fl signedstatement
-.__
r aay.s •r'r1vs Valuation
- %
�., {H.
thathe Ierescd puri e forms War, wide Contracmr License 9
(so cog wid, Station 7000) Division J Bari Profession Cade)
of ofmca ries d
or that he is exempt therefrom mad the basis for the alleged eaemptibr. Any violation
Ir y ,3_•. ;, sf s};,1,
.. .. v
- of Section 7031.5 by any applicant for a permit subjects me applicant to a civil pemlry
than five hundred Jonas ($500).
JUIAPNRPPT97Occupancy Type
of not more
303 - ROUGH MECHANI AL
01, as owner of the propeny.ormyemployees with stages astheir sale compensation,
will do the work, and the nmcmre is not intended or offered fur sale (Sea. 7014.
Business and Professions Code: The Commnor s Litems Law does not apply to an
Cn ODS
0 FINAL EL PCZ
and who does ch work himself
owner of properly Who banes d. or improvthemon. su
5 5 -
or mroagh_his own employees. provided that such improvement, are not intended or
507- - FINAL- PLUMBING
offered for sale. If, however, the building or improvement is sold within one year of
ompletion. the owner -budder will have the burden ofproving that he did not build or
508 - FINAL MECHANI CAL
improve for purpose of sale.).
❑Las owner of the property, am Business y controlling with licensed c 1. ammemrs m
7 Business and Professions Cade:) The Contractor's
construct the projen I...1
/. n S ir�S
cat an owner of property who halide thereon.
License Law does nmr ,, a
rw1 WAS /irk Saar .IJ—w� l,
seimproves
for such Pmjmrs.with,e rommnorts) licensed pursuant m the.
such
.and wchar's
... _ _ .._ _ __ ._.. ... ... .. ......_.. .. ... _._. .
ions
Commaoh Liana Law.
o l am exempt under sec. .B& P C for this reason
1,8 2002
Nov,1�
Owner Data
WORKER'S COMPENSATION DECLARATION'
Iherebyarfimtumdnlxnahyafperjuryan,if,hefollowingdeclmorions:
p1
BUILDING
❑ I have and will maintain v Cenificmc of Consent to self insure for Worker's
Compensation, es p,.video or by Section 37W of the Labor Code, for the
performmice 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 Letter, CWe, for the performance of the work for which this permit is
issued. My Worker's Compensation Neurone! ars r and'Policy number are:
`C/robe' Porry No: UJ.i•I `1517)
•
r.� i�'ia �'::,s ).(+. hl
CERTIMNCTIO OFEXEM NYROMWORKERS'•'
,j _ COMPENSATION INSURANCE'_
-ei s .'.L7
(This section need not be completed if the permit is for one hurdmd dollars
($I00)or lass.),
- 1 certify that in the pertormance of the work for which this permit is issued, 1
shall not employ any person in any manner so as to become subject nothe Workers'
Compensation Laws of California. Date
Applicant
NOTICE TO APPLICAN'r;1f, after making this Crofficam of Exemption. you should
bedmdc subject m the Worker's Compensation previsions of the Labor Code, you must
forthwith comply wnM1 such provisions or this permit shall be deemed revoked.
'
' ' CONSTRUCTION LENDING AGENCY
-
' I hereby affirm that there is a construction lending agency forthe performance
of the work for which this permit is issued (Sec. 3097, Civ. C.) .
-
Lender's Name .. ... ... ... ..�. .. _.: _-. .. ..
_
Lender's l
Addr
1 cenify that 1 have read this application and state that the above information is
agrees Hate laws relining
obuildi agree m comply with all city and county oNatives
representatives of this city to enter apo,
to building of
tohereby
perimze
the ebore annim ed posed
ne 1. propend for inspersion purposes.
(We) ague m save, indemnify and keep harmless the City of eat ,at
e) irli
whicham ai
liabilities, judgments, costs and cn of this eop may in any way aceroc against said
City in consequence of the granting this permit.'
D
AP0RCU "DERSTANDg AND WILL COMPLY WITH ALL ON -POINT"
' URCEREC N
Issued by: Date
Y•
�-
' SigraturcofAppliciont0 iltsh r �
Re -roofs
- HAZAR S MATERIALS DISCLOSURE'
Will the applicant w future budding occupant store or handle marmoset material
Type of Roof
as defined by the Cup.mm. Municipal Crude, Chapm, 9.11 and the Health and Safety
Coude. Section 7553n_(a17
All roofs shall be. inspected. prior to any, roofing material being installed,
theapplicantombumm building occupant ux<I��ipmen� or device which
If a roof is installed without first obtaining an inspection, I agree to remove
OWill
mit hazardous air cnmaminvms as defined by the Bay Area Air Quality Management
oiat imall
new materials for inspection. Applicant understands and will comply with
Duca , /.6 -', , , .,
all non -point source regulations:.,
" I have read the N. ., .'crisis requirements under Chapter 595 of the
mma
California Health & Safety Coude, Sections 25505;25533 and 25534.1 understand that
'
irate Wildmi 1. not rommody have v mnam,mino is myor,mnsibiliym ratiryme
.. .. ... .. _ ._ -,
occupant oral quircmcnts which must be met prior to issuance of a Can I ate of
Ocerfore"
Signature of Applicant Date
All roof coverings to be Class "B" or better
owner or anhoriaed agent Dote
.OFFICE .. . _ .._ . .
Ll
(7)
��
%.,ITY OF CUPERTINO
PERMIT APPLICATION FORM
APN #�—
0
Fee Description
Date:
10*19
NEW lumlfiuql�
W
W1 MECHANICAL
Building Address: 2-51
Bldg Pennit sq. footiii
Sj2��cn,
Boiler<= 100,000 Btu--
541:10J.-Lulawa
Owner's Name:
Boiler> 1 OOK to 500K Btu
Phone
of
Boile—r> 500K —to 1M -Btu—
Contractor:
Boiler > 1M to 1.75 M Btu
License #:
Contact:
YS,
Boiler> 1.75M Btu
Phone #:
Lk -,53
Applicant/Contractor:
Construction Tax
i mons , LN
I ITS
Building Permit Info:
Bldg 0-) Elect
Plumb
Mech
Job Description:
Constax — Resi/Mobile
-Residential: j2`Q -P-,J
vg7o
Commercial: 9c/1 r
Sq.Ft. Floor Area:
Elec 600V > 1 OOOA
$/Sq.Ft.:
Architect/Engineer:
Elec Svcs 600V <-- 200A
Valuation:
Type of Construction:
�v Add Multi
Occupancy Group:
1 of 3
Fee Description
GKq—qp—
10*19
NEW lumlfiuql�
W
W1 MECHANICAL
BBLDGFEE
Bldg Pennit sq. footiii
Boiler<= 100,000 Btu--
541:10J.-Lulawa
Boiler> 1 OOK to 500K Btu
11.0 ims I
Boile—r> 500K —to 1M -Btu—
Boiler > 1M to 1.75 M Btu
same pa.
Boiler> 1.75M Btu
Construction Tax
i mons , LN
I ITS
BCONSTAXBQ
IBCONSTAXH
Hotel and Motel
&LIJI"s AgN
,
Constax — Resi/Mobile
BELEC1000
Elec 600V 600A
!'BELEC1001
Elec 600V > 1 OOOA
RESUME
ELEC200,
Elec Svcs 600V <-- 200A
�v Add Multi
BINVESTIGA
11 Investi 'on fee
1 of 3
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATIC T.
CAL -AIR INC PERMIT NO, 02050124
1yffgJDl1ftEVENS CREEK BLVD
"APEARN!"SAVERS
1555 S 7TH ST 4K Aff_99k2T"OM
PHONE:(408)283-2300
SANITARY No. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INTFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
ONE CHILLER & pt�*Pescription
with Sc 7000) of Divirn 3 of the Busiys and Professions Code, and my license
is in il ree and exact.
C
Lrce
.1 Cur
TION"
ARCHITECTS D ON"
E T '0
I understand my plans shall be used z c
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following 7031,5, Business Professions
$16600
reason. (section and Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
s issuance, also requires the applicant for such Permit to file a signed statement
=
Valuation
licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000).6r Division 3 of the Business and Professions Code)
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 ($500).
:3 UIAPN M&H&P FU .7 Occupancy Type
0 1, as owner of the property, or my employees with wages as their sale compensation,
303 - ROUGH MECHANICAL
will do the work, and the structure is not intended or offered for sale (See, 7044,
U U Un nil i,_ 11�.
Business and Professions Code: The Contractor's License Law does not apply to a
net of property Who builds or improves thereon, and who does such work himself
W1 tions,
M
EL f
505 FINAL 5ff
his own employees. provided that such improvements are not intended or
= sale. If, however, the building or improvement is sold within one year of
507 FINAL PLUMBING
compilation, the owner -builder will have the burden of proving that he did not build or
508 FINAL MECHANICAL
improve for purpose of sale.).
as owner of theproperty, am exclusively contracting with licensed contractors to
construct the project (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, contracts for such projects, with. a contractor(s) licensed pursuant to the
Contractor's License Law,
0 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:
1 0 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.
0 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 cam dPolicy am
-Policy JN'oy�
CERTIFICATIOIAOFEXEM FROM
NWORKERS' .
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars
($100)orless')
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner go as to become subject to.the
rWorkers'
Compensation Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making thisTer—fificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
1.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Sec: 3097, Civ, C.)
Lender's Name
Lender's Address
• I 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, indemnify and keep'harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said
City inconsequence of the granting of this permit.
APPLICANT-U:,IDERSTANDSA\'D'�NIILL COMPLY WITH ALL AON-POINT
,�L�t,RCE�R�EG� 6
U N
Issued by: Y Date
m.
Signature of Applicant/Conq6ctor
Re -roofs
HAZARDOUS MATERIALS I
:4 58 the applicant or future building occupant
at store or handle hazardous material
Type of Roof
as defined by the Cupertino Municipal Code, Chapter 9,12, and the Health and Safety
Code, Section 25532(a)?
0 Yes
All inspected
roofs shallbe TiQT to ally roofing.,materiAl being. -installed.
p
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
If a roof is installed without first obtaining an inspection, I agree to remove
District?
all new materials for inspection. Applicant understands and will comply with
0 Yes NO
all non -point source regulations.
I have read the haza4ous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533 and 25534. 1 understand that
if the building not currently have a tenant, that it is my responsibility to notify the
occupant of lig"Mquirements which must be met prior to issuance of a Cerlifi ate of
Occupancy.
Occupancy.
an - F
Signature of Applicant Date
thoiizzod�agent Date
All roof coverings to be Class "B" or better