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01070021CITY of CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM APN # �j- (o� — � � -- oz�t Date: Building Address: a04ag'tete �-vis e-� 3�� Q C e -'k ^© c !S��aA Owner's Name: Phone #: Contractor: � License #: Contact: Phone #: Applicant/Contractor: Fow,,kI, n� Fax #: Building Pennit Info: Bldg Elect Plumb Mech Job Description: Residential: ISS Pv4r6�. Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: �2�10.� �1 a- MECHANICAL Architect/Engineer: Valuation: c085, 3--2 3, Type of Construction: Occupancy Group: Boiler > 1.75M Btu MECHANICAL Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permit sq. foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1 M 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/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC 1000 Elec 600V <= l OOOA ELECTRICAL BELEC 1001 Elec 600V > l OOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BEIVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING O 1K FEe 1 of 3 CITY OF CUPERTINO CiTM OF PERMIT APPLICATION FORM CUPEKHNO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING / BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCONB4N1 New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK 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 BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIlZHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 a -ft ( FY OF CUPERTINO ' CITY OF PERMIT APPLICATION FORM CUPEfkTlNO Quantity Fee ID Fee Description Fee Group BREMPOWER Power Devi ce/A aratus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING / BSEISMICRE Seismic Fee Res BUILDING BSF&2FAM Single & 2 Family BUILDING BSFNA Single Family New Add BUILDING BSPECIAL Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Change BUILDING 3 of 3 4 OFFICIAL NOTIFICATION OF ADDRESS CHANGE TO: All Agencies FROM: City of Cupertino DATE: 8-7-01 RE: APN 369-01-029 f'r/yl'��°I Please note the following address change: AN ADDRESS WAS ASSIGNED TO A NEW BUILDING IN ERROR,THE ERROR ADDRESS IS 20688 STEVENS CREEK. THE NEW CORRECTED ADDRESS IS 20488 STEVENS CREEK BLVD. This new address assignment will be in effect thirty (30) days from the date of this notice. CITY OF CUPERTINO Tim Orbea Building Inspector City of Cupertino Building Department 10300 Torre Avenue Cupertino, CA 95014 (/ (408) 777-3228 (408) 777-3333 fax OFFICIAL NOTIFICATION OF ADDRESS CHANGE TO: All Agencies FROM: City of Cupertino DATE: 8-7-01 RE: APN 369-01-029 f'r/yl'��°I Please note the following address change: AN ADDRESS WAS ASSIGNED TO A NEW BUILDING IN ERROR,THE ERROR ADDRESS IS 20688 STEVENS CREEK. THE NEW CORRECTED ADDRESS IS 20488 STEVENS CREEK BLVD. This new address assignment will be in effect thirty (30) days from the date of this notice. CITY OF CUPERTINO Tim Orbea Building Inspector U 0, UZI/U1 1.7: L4 C C� OTY Of V4V0/ / /JJJJ ..aaa ..tea Lasa a..v "ITY OF CUPERTINO" ]PERMIT APPLICATION FORM APN # Date: 3col. o I . fl2°I .Jv lay 2 ov Building Address: rtt3� Owner's Name: Phone #: Ja►, m.o,54 GI Va✓Nt CCK A hRT'tilBu?5 a CF1 on�ia iwr n (05.0.5`1 v • 5361 Contractor: 00 881- License #: H VRxge_ f00881- Wrr,vR 15131►•rx4arv- 14 R:w-)VANI" S%L4fAi* III, kv. (Ww �Lt - 05111 t I bo 6 Contact: Phone #: 4A6-5,1* 0-50-.3411. z� 2�• bs IN - C441 BU=NG Applicant/Contractor: Housing Mitigation Fee NoMEN45Avc PI. �Eis7aTv-- 6"v?,erre. , hyo 511 Buildi.ng Permit Info: Bldg Elect Plumb Mech Job Description: air• Residential: 200 Commercial: N/%4 Sq.Ft. Floor Area: $/Sq.Ft_: lhq►� D+u- • i K. }I ' h f ��'sv : 2 3J a� 2 Lavv R� s v : 8 3, 21►� T 3 I �} , I o •} Low► f -;U, : F� • �-�o Architect/Engineer: Valuation: L,r�.�4 V ops �i- s l iv►G . -4 e, I a 8 S 5. 64 Type of Constru •o : Occupant Group: RL� . r f �.. L" P- .:9: • I vy h Flit,/ Low P4ve., 4 N o -tl; : G �e SdY c.4-tn � „v► �r,, d �,.. s ,a��t<c , Qty. if Annlicable Fee iD Fee Descrintinn Fee Groun BTEMPPERM Temporary Bldg Permit BUILIDNG BCONSTAX Construction Tax BUILIDNG BENERGY Energy BUILIDNG BENERGYADD Energy Add Multi BUILIDNG BOVERTIME Inspection Overtime BUILIDNG l BPERr4FEE Bldg Permit Fees BU=NG I BMMGAT Housing Mitigation Fee BUILIDNG BPL.ANCM. Plan Check Fee BUELIDNG BPLA14CKADD Plan Check Arid Multi. BUILIDNG BPLA14CKREP Plan Check Repeat Fee BUILIDNG BRENSPECT Reinspection Fee BUELIDNG BSCBLVD Scb Specific Plan BUELIDNG BSEISMICOM Seismic Commercial BUnMNG ` BSEIS :NACRE Seismic Fee Res BUILIDNG BSPECIAL Special Inspection BUILIDNG BSW12A Swinuning Pool BUELMNG ZADDCHG Address Change BUILIDNG BUSLIC Business License BUILIDNG U/ V A/ u 1 -L. L Y V Y U V I i I V V V U vagi v• u a. a a• v v M N EPERMITFEE Elec Permit Issuance ELECTRICAL BELE:C1000 Elec 600V <=1000A ELECTRICAL BELEC1001 Elec 600V >1000A BELE;C2013 Elect Svcs 600V <=200A BNEINMULT( IMultifamily Res ELECTRICAL ELECTRICAL ELECTRICAL BREI ABUSWAY Remodel Busways ELECTRICAL BREIAFIXT Lighting,Fixtures ELECTRICAL BREWIMISC BREMISIRAPP Misc Apparatus Rem Non -Res Appliance ELECTRICAL ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREPJIPOWER Power Device/Apparatus ELECTRICAL BREPAREC:EPT BREFARE%SAPP Rc tl, Switch &Outlets Remodel Res Appliance ELECTRICAL ELECTRICAL BP,EMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lghtng Fix ELECTRICAL BSF82FAIA ISingle & 2 Family ELECTRICAL BTEMP ITernporary Power ELECTRICAL STENIPSVCS Temp Dist Svcs JELECTRICAL MPERMITI=EE Mech Permit Issuance MECHANICAL ILL BAPPLOTHER Other Appliances MECHANICAL BBOILERI Bailer <= 100,000 Btu MECHANICAL BBOILER2 Boiler >100Kto500K Btu IMECHANICAL BBOILER3 Boiler >500K To 1M Btu MECHANICAL BBOILER4 Boiler>1M To 1.75M Btu MECHANICAL BBOII_ER5 Boiler > 11.75M Btu MECHANICAL BRENIAPPLI Appliance Install MECHANICAL BREENIHEAT lHeater Installation IMECHANICAL BRENIVENFAN lVent Fan Single Duct JMECHANICAL BMNE:WMIJLTI lNew Multi -Family Res MECHANICAL BMNE:WSF&2F New Sf&2F Res Bids IMECHANICAL BREMACC►VER Ac Unit >10000Cfm MECHANICAL BRENIAIRHAN BRENIFURN A/C Units <= 10,000Cfm Relocation Of Furnace IMECHANICAL IMECHANICAL BRENIFURNOV Relo Furnace > 10K Btu MECHANICAL BREMINHOOD Installation Of Hood MECHANICAL BRENIRELDCA Relocation Of Hood MECHANICAL BRENIREPALT RepairlAlter Heating MECHANICAL BRENiVENSYS Ventilation Systems MECHANICAL Ul/UU/Ul 13: G3 -YUO/ I /JJJJ %-III %.urrniiivU wj—, — N PPERMITFEE Plumbng Permit Issue PLUMBING / BNUIOULTI New Mulifamily Res PLUMBING BNUISFD New Singiefamily Res PLUMBING BPEIACKFLOW BPCE:SSPOOL Atmospheric Vacuum Cesspool PLUMBING PLUMBING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interco for PLUMBING BPRE:PIPE: Rei a Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSE-:WER Sewers PLUMBING BPSPRINK Lawn•Sprinkler/Backflo IPLUMBING BPS'70Rh4 Storm/Rain Water PLUMBING BPTRAP. Kitchen Trap PLUMBING BPVENT Alt Of Drain & Vent PLUMBING BPWATER Install/Alter Waterpip PLUMBING BPWHExrER Water HeaterNent IPLUMBING BPWSVC;3 Main Water Service PLUMBING Z o� a aA �Z UO O.0 U CITY OF CUPERTINO BUILDING DIVISION PEr, , "T BUILDING ADDR ESS: 20688 STEVENS CREEK BLvLJ 'M iMtNO CITY CENTER ASSOC ARCHITECT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. A Date I r •x l a x Contractor ARCHITECT'S DECLARATIO I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is -licensed pursutinl to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Busjness,atld Professions Code) or that he is exempt therefrom and the basis for the alleged "Itmption. 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 (5500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work: and the structure is not intCnded or offered for sale (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 does such work himself or through his own employees. provided that such improvements are not intended or offered for sale.l(, 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.). Q 1, as owner of the property, 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. Contractors License Law. . ❑ I am exempt under Sec.' . B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm undet.penalty of perjury one of the following 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. ❑ 1 have and will maintain Workers 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 carrier and Policy,rnumber are: Carrier I-kl t�%Dti" 1 '44 Policy No.: f7OD� L.Y? . 'CERTIFICATION OF EXEMPTION FROM WORKER COMPENSATION INSURANCE' (This section need not be completed if the permit is for one hundred dollars (S 100) or less.) I certify that in the performance of the work for which this permit is issued. I ihall not employ any person in any manner so as to become subject to the Workers Compensation Laws of Califomia. Date Applicant NOTICE TO APPLICANT: If. after making this Certificate 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. 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, Gv, C.) Lenders Name ' Lender's Address I certify that 1 have read this application and state that the above information is correct. I agree IQ 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, judg encs, costs and expenses which may in any way accrue against said City in co se once of rhe granting of this permit APPL INDERSTANDS AND WILL COMPLY WITH ALL NON -POM GULA NS. XMKJ,.�'r•o2 of pplicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE til the applicant or future building occupant store or handle hazardous material efined by the Cupertino Municipal.Code, Chapter 9.12, and the Health and Safety Codo- Section 25532(a)? J ❑ Yes I9 No 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 District? ❑ Yes No I have read the hazardous materials requirements under Chapter 6.95 of the California Health & S y Code, Sections 25505, 25533 and 25534. 1 understand that if the buil ' do of rrently have a tenant, that it is my responsibility to notify the Otto f he uir ents which must be met prior to issuance of a Certificate of �l y. 5, ox—I agent I Date UK 11NV VK1`` 4L I.1V1V: WEBCOR BUILDERS 951 MARINERS ISLAND BLVD (415)349-2727 PER.Mrr NO. 01070021 APPLICATION UB DATE SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u II u u VERONA-155 APARTMENTSpt(HIGH RISE) 9 STORIES -230,812 SQ FT Sq. Ft FloK-Area Valuation APN Number Occupancy Type 1V1 — i'VVIV LL"11V1V � 102 - PIERS Required Inspections 103 - UFER 104 - REBAR _. 105 - ANCHOR BOLTS 106 - SEWER & WATER 202 - UNDERFLOOR PLUMBING 203 — UNDERFLOOR MECHANICAL 204 - UNDERFLOORFRAME': 205 - UNDERFLOOR INSULATION 301 - ROUGH PLUMBING 302 - TUB & OR SHOWER 303 - ROUGH MECHANICAL 304 - ROUGH ELECTRICAL 305 - FRAME 306 - HOLDOWNS 307 . INSULATION 308 -' SHEE'TROCK' 3 0 9- M,& X I OR -LATH 310 - INTERIOR LATH 311 - SCRATCH COAT 313 - ROOF NAIL 501 - FINAL ELECTRICAL ENERGY . 502 - FINAL PLUMBING ENERGY 503 - FINAL MECHANICAL ENERGY 504 - FINAL BUILDING ENERGY' 505 - FINAL ELECTRICAL 506 - GAS TEST 50 - FINAL PLUMBING 5 8 - INAL MECHANICAL 5 9 - INAL DE 51 - INAL 514 RKS Issued �)•-) III Date Typec,Hgof RCgF IN -PROGRESS All roofs shall be inspected prior to any roofing material -being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Applicant understands and will comply with all non -point source regulations. i Signature of Applicant Date All roof coverings to be Class `B" or better OFFICE