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CITY OF CUPERTINON.
BUILDING DIVISION PERNIIT7
BUILDING ADDRESS:
PERMIT NO.
20955 STEVENS CREEK BLVD
TBD — TO BE DETERMINED
07080003
OWNER'S NAME:.'
PERMIT ISSUE DATE
SAND HILL PROPERTY CO
1 7
PHONE: -
SANITARY NO. CONTROL NO.
ARCHTTECT/EN6NEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MEC14
LICENSED CONTRACTOR'S DECLARATION
Job Description'
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 70DO) ofDivision 3 of the Business and Professions Code, and my licenst: is
INSTALLATIN OF NEW CHAIRLIFT AT (E) COMMERICAL
in full force and effect -
License Class Lie.
BLDG SHELL EXTERIOR STAIR
Dam Contractor
ARCHITECTS DECLARATION
1 understand my plant shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law for the
following reason. (Section 7031.5. 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
is licensed to the of the Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he pursuant provisions
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$2 0 0 0 0
that he is exempt therefrom 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 more than five hundred dollar (S500Z
32631020
❑ L as owner of the property, or my employees with wages as their sole compensation,
Required iced Inspections
eq
will do the work, and the structure is not intended or offered for sale (Sec.7044, Business
and Professions Code: The Contractors 13cerse 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 improverneam are not intended or offend forsale. if.
bowever, 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-).
0 L as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec- 7044, Business and Professions Code:) The Contractors Li-
cense Law does not apply to an owner of property who builds or improves doeort, and.
who contracts for such projects with a contractnr(s) licensed pursuant to the Contractors
License Law.
Sec , B R P C ( this
0 1 am exemp tA
OwnerDam
ORY S O ON DECLARATION
-
1 hereby affirm under penalty [perjury one of the following declarations
. 0 1 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.
0 I 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 Workers Compensation insurance artier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
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 Sor which this permit is issued 1 shall not
employ any person in any manse Whe o bjece to the Worker' Compensation
Laws of California l L
Applicant
NOTICE TO APPLi : If,-4kr rkEng this Certifncam of Exemption, you should
become subject to the Workers Ctimpblitsadon provisions of the Labor Code, you must
' forthwith comply with such provisions or this permit shall be deemed revoked.
)
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is 'issued (Scc 3097, Civ. C.)
-
Lenders Name
Lender's Address
I certify that I have read this application and state that the above information is
correct 1 agree to comply with all city and county ordinances and stem laws relating to
building convection, and hereby authorise representatives of this city to enter upon the
ahove-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 m any way accnic against said City
in consequence of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date 7 u,
SOURCE U
Re -roofs. C7
.
Type of Roof .
°
Signature of icanUCon - Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle harzrdous material
i . I Code, Chapter 9.12. and the Health and Safety
as defined by Um Cupertino Muni
Code, Section 25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
0 Yes
If a roof is installed without first obtaining an inspection, I agree to remove
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
all new materials for inspection.
District?
No
Yes ( 0
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health a Safety COdc, Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenant, that it is my responsibility to ratify the occupant or the
requircmcrit.s jch mu met prior a issnanee ices cemrtce,r<�or�apa y.
Signature of Applicant Date
(/f� �j/ «
All roof coverings to be Class "B" or better
Dam'
Owncr or au rued age
CITY OF CUPERTINO !�' �a � ••��'"� "'°'"' '��' '-'
BUILDING DIVISION PERMIT C(*11�ITRAC�ITOR IAiIsURMA�ION
P
BUILDINQ ADDRESS: PERMIT NO.
20955 STEVENS CREEK BLVD CENTRAL BAY CONSTRUCTION 08060034
OWNER'S NAME: PERMIT ISSUE DATE
SAND HILL PROPERTY CO 36 CALABASAS RD 06/05/2008
ONE: SANITARY NO, CONTROL NO.
(831) 763-3811
ARCHITECffENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Its, LICENSED CONTRACTOR'S DECLARATION IP� IOU Description
tit 1 hemby&RIrm Wam t 1 Ihcesed under provisions of Chapmr 9(ro eremming tm'R with Seeuon701ID)of Dividon 3 of the Boom.ad Noticed.Cade,and my license u ORG #07080003 EXPIRED, THIS PERMIT FOR 1/2 FEE TO
'+ts N in full forte end eIT
,q? Liriese elas, L(IL—I:e.. Fi 7JK7 PAY TO RE–OPEN ORIG & INSPECTIONS TO BE ON ORG
n Fn Date Contractor
uuuyARCHrrECrS DECLARATION PERMIT
< 1 uMuvand my plans 9,11 be used u public rcuN; -
s
g G Licensed Pmfmdonal '
ahs OWNE0.-BUIIDER DECLA0.A'MON
a� 1 herehy alRrm that I am exempt from the Contractors License taw far the
s O o won.on.(Season 7051.5,Business and Pomsmad Code:Any City.1..my
K$ which requires a permit to commucL alter.improve,dcmulish,an repair any sauctum
uZi prior to its issuance,also requires thd applicant for such permit to rile a signed statement
mm< that he is licensed pursuant to the provision of the Combat liecme Law(Chapter 9 Sq.FL Floor Area Valuation
y F C (commcming with Section 7M)of Division 3 of the Business and Profession Cade)or
$30000
y that he i,dacmpt therefrom and the basis for the alleged caemption.Any violation of
Section 7031.5 by any,applicant for a permit subjects the applicant to a civil penalty of Number O
toOccupancy t more than live hundred dollars ISM 32631020 . P Y Type
0 1,as asoma ofvm pmpmy,w my employers with wages as their sole compeesadon,
wiR da Bre wart•and the structum u notimmndcd oroRered for fat(Sc.7W.Businm
and Pmfrsslon Code:The COnuactors License law dams tot apply to an owner of Required Inspections
pmpenywho build an improve thmeon,and who docs suchwork himself or through his
Own employes,provided that such Improvements am not intended aroRered fursub.If.
however,the building or improvement is sold within one year of completion,the owner,
builder will have the burden of proving that Ito did no,build or improve far purpose of
sat.).
0 1,as awacr of the property am exclusively conuaeting with licensed convenors to
cantrvct the project(Sec.7M ,Business ad Profeau.Cade:)The Contruwrs U. .
cone law dna not apply to an Owner orpropcny who bunds at improves theme,and.
whocontracts forsuch projects with a contractors)licensed pursuant to the Contractors
License taw.
0 l am Catnap,under See ,B All PC for this won
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penitY of perjury ane of due following declarations:
1 ham and will maintain a Certificate of Consent to whNnsum for Worker's Compen-
sWOn,as provided for by section 3700 of the tabor Code.for the pedmum me of the
work for which this permit is issued.
0 I have and will maintain Workers Compensation lesuren¢,as twuired by section
37W of uhu tabor Code,for the performance of um work for which this Permit is issued
My Workers Compemsxuam Insuuranro carrier and Policy rump er are
Carrier. S±RPolicy No.: ZOMBI CERI1rlclm OF EKEMPION FROM WO KERS'
COMPENSATION INSURANCE
(Ihuseetion aced tot hecompkmd if the permit is forced hundred dollars($100)
or res.)
I certify Nat in the pcfformaneo of the work fes which this permit Is issued,l shall neat
employ any penton in any manncrse as m become subject to the Workers'Compnuaahm
Laws of Califorem Dam
Applicant
NOTICE TO APPLICANT:IL after trading this Certificate of Exemption.you should
become subject to the Workers Compnvedon provision of um Lahr Cade.you must
.J z feMwith comply with such Provision of Nu permit shall be deemed mwkcd.
Z O CONSTRUCTION LENDING AGENCY
[r I hembl,aRino amt there iso construction lending agency for the performance of
lY the work for which this permit ts issued(Sc.309].Cih,C)
W Q tenders Name
5 z Lenders Addw
U Q 1 Certify that I have read this application and sem than the above information is
D.f•t corsom 1 agree to comply with all city and county ordinances and sem laws relating to
0 Wildingeonstmetion.and hereby authorim representatives ofthis city to enter upon the
shove-mcnuanrd ptopeny for inspectioneaes purposes
ft`s a (Wes)agree to save,indemnify and keep harmless Rm City of Cupertino ayint
Z in
es.qunce of tocons add exthispewhich may in any way acrnmagainat said City
V z A APPLICANT
of thegranum[of thisD WILL
^ APPLICANT UNDERSTANDS AND WILL COMP NON-POINT Issued by: Date
symadn' C�cyo s. �Ug Re-roofs
Sig ' m HAZA DcOUS MATERIALS DISCLOSURE Data Type of Roof
Will the appliant m forum building acupantne.orhamdle havuNoes material
as defined by dm Cupertino Municipal Cade.Chapter 9.13,and the Health and Safety
Code, 0y.25531(7)7
Yes e&L& All roofs shall be inspected prior to any roofing material being installed.
Will the, Brant or future building Oce and use If a roof is installed without first obtainingan inspection,I agree to remove
fT t p equipment Qu at devices whim P g
.n hnardmus air contaminants as derived by the Bay Area Air Quality Mangement all new materials for inspection.
D av ctT
❑Yes �u —
I have mad the hvardmusmamrials mVitementaunder0bupm06.95 of the Califor.
nia Health&safety Cadc.Sccuom 255115.25533 and 25534.1 vmtrsund thatifthe building
docs rot cumcnuy have s more,dart it u my mspoesibility to amdfy the occupant of the
requirehmuss to 'or to Mo.or.Cald
Signature of Applicant Date
owns ,dcv: ager DateAll roof coverings to be Class';W'or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32631020 . 00
DATE ISSUED. . . . . . . : 06/05/2008
RECEIPT # . . . . . . . . . : BS000005001
REFERENCE ID # . . . : 08060034
SITE ADDRESS . . . . . : 20955 STEVENS CREEK BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SAND HILL PROPERTY CO
ADDRESS . . . . . . . . . . : 20955 STEVENS CREEK BLVD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . : JOE SILVA
CONTRACTOR JOE SILVA LIC # 27082
COMPANY . . . . . . . . . . : CENTRAL BAY CONSTRUCTION
ADDRESS . . . . . . . . . . : 36 CALABASAS RD
CITY/STATE/ZIP . . . : FREEDOM, CA 95019
TELEPHONE . . . . . . . . : (831) 763-3811
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ----- -- ---- ---------- ---------- ---------- ----------
lEPERMITFE FLAT RATE 1 . 00 - 20.. 00 0 . 00 20 . 00 0 . 00
1MPERMITFE FLAT RATE 1 . 00 . 20,: 00 0 . 00 20 . 00 0 . 00
TOTAL PERMIT 40 . 00 0 . 00 40 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 40. 00 #4406
---------------
TOTAL RECEIPT 40 . 00
a
File Edit Actions* DataiIs ' Links Favorites Help
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�JCSc a 40i ,xAh1.. iLIJ M_ w9A0io� � IQ
lion _. ` L(Addressnform 20955 ---- -- - - - -
Permit Informs
, I
�it Number" 07060003_ !� '�, _ STEVENS CREEK BLVD -
�-;;
Status' �1 J e City/State/zip CUPERT_INO
Master Number - _ 10 •Notes =___0J APN 32631020A0 M_�
Project [q I I Unit
Apply Date" 08/01/2007 p Operator �_--"
Owner Entity Information—__�
_ ___
Permit Issue Date 08/17/2007 ] Operator CathyS �. ) .f wner Name ISAND HILL PROPERTY CO
Certificate Issued Operator ,Use Default rI Y
Certificate TypeAddress_ I ( Business-20955 STEVENS CREEK BLVD i� I
Certificate Number-
`
City/State/ZipERTINO
' CUP } CA 950;
u - - _ --=� �
iPermit` l Property ��Zoning lFipplicant / Contractor jDefrned
Permit Details- s. . _ . ... ___ ____ ,_„� ._ ...._y....._ , .,_..._. __ ,.Purpose/Special Conditions
_i
. ._
' Permit TypeCOMML-T ;� � INSTALLATIN OF NEWCHAIRLIFT AT (H) CO
i -
SHELL EXTERIOR STAIR
1 COMMERCIALTENANTIMPROVEMENT �� ��1,(71
Usage Class'
STORES V 1 H R, � `
I�ppliedValue'
SQUARE FT,. 0�'r .. -
Calculated Value 0 11W
! US C-404 Type 437 J ��- jCL
' f ADD;NON-RES,NON.HSKPG
1 Permit Form' AUTOPERM -PERMIT
1 Ownership 1 -Private
Permit issued 08/17/2007 - - - -
Y 'a
Enter permit status.
.-
•
[APermit Fees
File .Edit Actions Details"Links Help ,
l
rPermit Information
•mitNumber 07080003 Status Open ____J
".,APN 32631020.00 -1–iI - L cJ
Address IM955'STEVENS CREEK BLVD
Owner Name SAND HILL PROPERTY CO
Fee ID ^Contractor ID TUn!ts
-1��
Quantity, �FeeAmount ' Tot.
.. . 0 277.56
� Fel
BPPERMIT FEE PFEE 277.56 _ 370.40 Cr
BREMMISC FLAT RATE 1.00 27.58
--- —
BSEISMICOM VALUATION 2000D.00 4.20 Tot'•
EPERMITFEE FLAT RATE 1.00 38.37
MPERMIMC FLAT RATE 1.00 38.37 /I
4
Fee Information l-Cred!Clnformahon � — After Fact—
I _ After Fact f,1 .
•e a Information-
t ' T Multiplier' 1':DO
i Fee ID BPERMFEE i1 � BLDG PERMIT FEES .
! r
UnitsVALUATION l��!Continuous -
I Quantity 20000 0 l
Fee Amount 277.56
Contractor ID
•
CITY OF CUPERTINO
JWrNA-NT IMPROVEMENT
city-O
*CUPERTINO PERMIT APPLICATION FORM
APN #3,2 63 oa o, D D Date:
Building Address: (a
Mailing Address (if different from building address):
Owner's Name: Phone #:
SAN Irl GSO 3 9" /S0 z7
Contractor: Phone #:
Fax #: / "SZ 3 4
Contractor Lidense#: 67�soz
Cupertino Business License #:
Contact: Phone #: 74S— c f
P-op— 2!�-(S Fax #: g3
Alternate Contact: Phone #:
Fax #:
Valuation (cost of project):
Job Description (be specific):
Www
Tenant Improvement Includes Re-Roof: Yes ❑ No eyes, number of squares
Tenant Improvement Includes Structural Yes E] No Yom-
Type of Construction (Usage Class): Occupancy Type:
1-A, -6- m 11/111,V-A 11/1118I� HTYBG �t/�
Project Size: Standard ❑--- Large❑ Major❑
Aicreen Building: Attach LEED Checklist to plans and identify in sheet indcK.
EED Points Achieved: ��._
*** For Office Use Only*** Over The Counter ❑
CITY OF CUPERTINO
CITY OF GENERAL BUILDING APPLICATION
• CUPERTINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1 WINMEWSTR New Window-structural shear B
wall/masonry (includes plan ck fee)
1 EPERMITFEE Electrical Permit Fee E
` 1MPERMITFEE Mechanical Permit Fee M
I I PPERMITFEE Plumbing Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1 PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P
/ 1 STPLNCK-0 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
IBSEISMICR Seismic Residential B
/ 113SEISMIC0 Seismic Commercial B
ITRAVDOC Travel & Documentation B
IBUSLIC Business License —B-
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