03010208 CITY OF CUPERTINO mt,
BUILDING DIVISION PERMIT CONTRACTOR=INFORMATION -
+:�#'�' M1 Reay �i �f
BUILDING ADDRESS: PERMIT NO.
ER'S NAME: APPLICATION SUB DATE
J : D TRIST 01/31/2003
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
O dark, LICENSED CONTRACTOR'S DECLARATION
ex F I hereby affirm that 1 am licensed under prnvisions of Chapter 9(commencing Job Description
with Serio 7 Zof Divisiun 3ofds Uusin sand Pnslcrsum,Cralc..nd my limenacir
6�. imm�fam3 pfinet. i� RooF a� REPAIR TREE DAMAGE TO BLDG F
Z tic Licence Clise Lm.M '�
0= cd Date Cunvacmr tom_ ® B
ARCHITECTS RATION - ^bE®
m< 1 understand my plans shall Mused as public records
R
W Mw h Licensed Pmlcssianal
1"�'—'Oe OWNER BUILDER DECLARATION AR 0 6 2003
°1<Y 1 hereby affirm that 1 am exempt from the Conact
trors License law for the
a 00 following readmn.(Second 7031.5.Business and Pronfications Code:Any city or county BUILD
%3� m
which requires a Permit to common,alter,improve,demolish,or repair any structure
Fit pd.,1.its i.......Is."Wres the applicant for such perm it m elc a outilsutemcnt
I¢� Nal he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area $B)& }Qtlon
as i-$ (commencing with Section 7000)of Division 3 of the Business and Promssions Code)or
3— that he is exempt door mat and the basis for the alleged exemption.Any violation of .lt
Smilon 703 L5 by any applicant for a permit subjects the applicant to a civil Penally of crO 0 Occupancy Type
not more than eve hundred dull..(5500). P Y YP
❑1,ar owner of the prosody,or my employees with wages m their sole compensation,
will doth work,and the slNewrtis not intended or offered for sale(Stt.7Md,Business305
— gg
and Pmfeariotu Code:The Convenors License Law does not apply m an owner of 3 0 7 - INSULAE' `fid Inspections
pmpeny who builds or improves thereon,and whodoes such work himself or through his
own employees.provided that such impmrcmenB are not intended oroeered forsae.R. 601 — ROOF TEAR OFF
however.the building or impmvemcnt is said within one year of completion.the owner.
builder will have the burden of proving that M did not Mild or improve for purpose of 602 — ROOF PLYWOOD NAIL
.It.). 603 - ROOF BATTENS
El 1.as owner of the property.am exclusively conducting with licensed continuous to 604 - ROOF IN-PROGRESS
convict the project(Sec.70,14.Business and Professions Code:)The Contmscor s Lt
Genu law does not apply to an owner of properly who builds or improves thereon,and
who ronvacts for such projects with a contranor(s)licensed Pursuant to IM Contractors
License Law.
❑I son exempt under Sec. ,B A,P C for this reason
Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penally of perjury one of the following declarations:
❑1 have and will maintain a Ccnifcme ofConsind in gif insum for Worker's Camper.
salon,as provided for by Section 3701 of the labor Code,for the performance of the
work for which this pcand is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Second
3700 of the Labor Code,for the prliumance of the work for which this Permit is issued.
M Workker's Compensation Insurance carver and Policynumberam: e
artier: CATE OFE%EIE 'fIONyWOFROhT OlKER.S'
COMPENSATION INSURANCE
1T'his section mordant M completed due Permit N rorone hnndred dollars(llao
or les.Q _
1 comfy Nal in the pc lummnce el the work air which this permit is ismnd,l shall not
employ any person in any manner so as to la come subject to the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ce nificatc of Emoadmid,you should
become subject to the Worker's Com pe nsndon provi.ands of the labor Codc,you must
OO forthwith comply with such provisions or this Permi i shall k deemed revoked.
z h CONSTRUCTION LENDING AG17NCY
[r l hereby affirm Nat there is a construction lending agency Inv the performance of
(yi > the work for which this perm it is issued(See,3197,Civ,C.)
Q Under's Name
z Lender's Address
U C) I codify that 1 have read this application and state that the above information is
Is, F correct.I agree to comply with all city and county ordinances and stale laws relating to
0U building conviction,and hereby nothorin representatives of this city to enter upom the
above-mentioned property tar inspection purposes.
n, (Wo)agree to save,indemnify and keep harmless the City of CuPenino against
fp liabilities,judgments,costs and expenses which may in any way secure against said City
U Z in consequence of the granting of this Permit.
^' APPLICANT UNDERSTANq§AND WILL CO PLY WITH ALL NON-P INT Issued by: Date
SOURCE R IO /
Re-roofs
'g lure racw
ApplicanUContr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.13,and be Health and Safety
c.Sc Yes 355131.)? All roofs shall be ins ected prior to an Fort In material bein installed.
Yes �fNo P PY g g
Will the applicant or future building occupant use equipment ordeviccs which If a roof is installed without first obtaining an inspection, I agree to remove
emit hueNous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes No
Ihave n&Siddmad the n..ardnuri25505,2553ls ircmonuuMcr Chapter
erstan695 n1 @c Caldinr
aid Health&Safety Crak.Senisuv]SNI5,25577 and 255N.1 understand that if the Milling
does not cu y have a Lena .Nat it is in msporm ly m ratify the neap of the
nquimmc muss tel prior 'ss ce of cniecam of cu cg. 1 nature of Applicant Date
ts
al All roof coverings to be Class "B"or better
Owner nr authorircJ.gore 'ale
CITY OF CUPERTINO °tea
BUILDING DIVISION PERMI GONTRACTUR INFURMA
BUILDING ADDRESS: PERMIT N0.
20131 STEVENS CRERK BLVD 0101 020R
OWNER'S NAME: APPLICATION SUB DATE
J & D TRIST Q1/31/2003
PHONE: SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
pm^+00 LICENSED CONTRACTOR'S DECLARATION O O O
1 theme,affmm That 1 am licensed under n vi,ion.of Chapter 9(commencing�up P ( g Jo .Description
�< with Sectio ] of Division Jof the BasinyY anJ Professions Code,and mylicenu is
mmu rota c ��/ REPAIR TREE Q
zo'q� uansc class_�� Lic.N Foe�P'.y DAMAGE TO BLDG /�
O le F Dam Contrecmr JJ
P' ARCHITECTS AT10
3WU I understand my plans shall he used as public recordsCL
- t
t-=p Licensed Prnfcsmonal /p/Q�
OW NER-BUILDER DECLARATION
Thy<E I herchy affirm that I em exempt from the Contractor's License Law for the
d60O following mason.(Section 7031.5.Business and Professions Cale:Any city or county
m which mquires'a permit m construct,elteq improve,demolish,or repair any swcrom
prior to its issuance,also requires the applicant for such Permit o rite a signed statement
t C that he is licensed pursuant m the Provisions of the Conleacwis License Law(chapter 9 Sq.Ft. Floor Area $8'* ttion
of $ (commencing with Section 7")of Division 3 of the B usine.and Propulsions Code)or
That he is exempt therefrom and the basis for the alleged exemption,Any violation of
Section 7031.5 by any applicant for a permit subjeca the applicant a civil penally of11
not more than five hundred dollars(5500). 010 0 Occupancy Type
❑I,as owner otthe property,or my employees with wages u Their sale compenation,
will do The work,end The armour,is not intended or offered Total,(See.]044,Business 305 — FTUMEBB
and professional Code:The Communes License Law does not apply to an owner of 307 - INSULAI'��d Inspections
property who builds orimproves thereon,and who doessuch work himulfor Through his
own employees,provided thatsuch improvemen¢are not intended oroffemd ferule.If. 601 — ROOF TEAR OFF ,
however,the building or improvement is and within one year of completion,the owner-
builder will have she burden of pmving that he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
.ease.). 603 - ROOF BATTENS
❑LastheOwner ejct licensed 604 — ROOF IN-PROGRESS
cons Ladproject(Sec.]044,Business and Pre fusions Co dei The Corot d
cense law does not apply to ae owner of property who sed p or improves Neuron,and
whonse LEE a for such projecs with a conuaaor(s)licensed pursuenuo the Comreetoh
Litems Lew.
❑I am exempt order Sec. B&PC for Nisneem.
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affon under penalty of perjury one of the following declarations:
❑Ihave end will mainuin•Ccnifmate of Convent to self-inurtfor WmkeYa Compere
.tion,u provided for by Section 3700 Of the labor Cade,for the performance of the
work for which This permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,its,required by Section
3700 of the labor Code,for the pmformance of the work for which Nis permit is iseued.
M Worit I Compensation Insurance camscr and Policy
number are •
rrier.1 CERT FICA�TE OF EXE \.Pbcy WOSROFT RKERS' ��S
TION
COMPENSATION INSURANCE
This section Dead not be completed if The permit is forma,hundred dollars(SIM)
nr less]
1 certify That in The performance of the work for which this permit is issl l shall not
employ any person in any mannerso.m become subject To the Wefkers''Compensation
Laws of California.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
Oforthwith comply with such provisions or this Permit shall be deemed mvnked.
O
z y CONSTRUCTION LENDING AGENCY
F I he minty affirm Net there is a constmcoion lending agency for The Performance of
tYs
the work for which this permit is issued(Sec.3097,Civ.C.)
aQ Lenders Name
2 z Lender's Address
U Q 1 cenify that I have read This application and sate that dm above Information 4
w FcmnCCL 1 agree to comply with all city and county Ordinances and some laws relating TO
C) V building construction,and hereby authotim mpresentatives of this city to enter upon the
ISI shove-mentioned Property for inspection purposes.
w (We)ague To save,indemnify and keep harmle.the City of Cupertino against
,.y y
in bi
consequence
costs and of thisexpenses mit.
APPLICANTmay in any way acme against mid City
ico
U eof the
UNDERSTANUAND WILL COMPLY WITH ALL NON-P INT Issued by: Date (/./
SOURCE R O
S �(,�i
Re-roofs
Sg lure ApplicanUComractor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hmardous material
u defined by Ne Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25533(a)? All roofs shall be inspected prior to an roofing material beim
Yes �Nm P P y g g installed.
Will thea applicant or future building Occupant use c If a roof is installed without first obtaining an inspection,I agree to remove
PP 6 p equipment or devices which g
emit hazardous air condominiums m defined by the Bay Area Air Quality Management all new materials for inspection.
Dislrin?
❑Yes �'No
Ihave r&Safet Code,ho SAousmam05.25ls quimmens,1.1 u Chapan595 if the Gelding
ria Health&Safety Qsde,Smtiorm 25505,25513 ad 35534.1 understand NmifNe building
dins not cu y have a moa Net it is my res'.. ly re motif tbe nompan of the
rtquircme i mull elPdor iu ceot nifmateo cup cg, I hature of Applicant Date
mer or authoriacd agent p,m All roof coverings to be Class "B" or better
SUBMITTAL
ff COPY
• RECIEIVED
JAN 3 1 2003
BY:
APPROVE®
IN ACCORDANCE WITH THE CITY OF,
CUPERTIN ES AND 0 INANCES
GATE
SIGNED
Thi a set of plans a d specifications MUST
ne kept on the job at all times and it is on
lawful to make any changes or alterations
on same without written permission from
the building Dept., City of Cupertino.
• The stamping of this plan and specifications
SHALL NOT be held to permit or to be an
approval of the violation of any provisions
.,f any City Ordinance or State Law,
® „ Attachment A
Resolution No. 9559
City of Cupertino
Stevens Creek Boulevard Specific Plan Fee
A fee of$.044 shall be applied to all construction projects located in the Stevens Creek
Boulevard Specific Plan area as defined by Ordinance 1699. The fee shall be paid upon
application of a building permit. The following construction projects are exempt from
the fee.
• Internal remodeling that does not add additonal building area or does not substantially
alter the appearance of the exterior of the building. '
• Dwelling units located in a-housing development that is deemed "affordable" as
R?'l d' fned by the City of Cupertino Housing Mitigation Manual.
• Buildings owned and operated by a non-profit organization as defined by Internal
Review Service code.
• Parking Garages and structures that are located substantially below finish grade.
Substantially,below grade-means that portion of a garage structure in which the,
vertical di'st'ance from finish exterior grade to the bottom of garage ceiling is less than ?
the vertical distance from finish exterior grade to the garage floor.
• The fee shall not be applied to building permit applicants who have submitted
complete applications for plan check as of January 31, 1996.
g/planning/attachA
00
N4 i
1.
Page I of I
RE ',T5-VED
JAN 3 1 2003
BY:
40,
fileJ/F:\Avalon\jobs\02270STR\Photos\P]030085.JPG 1/31/2003
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(�' 'PITY OF CUPERTINO
CUPEkTINO PERMIT APPLICATION FORM ° 3
APN#
Date: 2
Builclirig Address: / J
Owner's Name: Phone
T•1— 's YO
P) 37/- ,0-77,0
Contractor: License #:
Contact:
Vc.102sl_11 o �lo Cn , 7009�;79'kvHPhone - _ v
1� ;'c� � a
Appli t/Contractor:
�/c S t� 'C
ZRc
ding Pe it Info:
Elect Plumb ech
De ption: �dential �^
o rci
Sq.Ft. Floor Area: $/S
Architect/Engineer: Valuation:
• Type of Construction: Occupancy rou
uantit Fee ID Fee Description Fee Group
BAPPLOTHER Other A liances 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
BELEC1000 Elec 600V<= IOOOA ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD -Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTINew Multi-Family Res MECHANICAL
BNEWMULTI I New Multi-famil Res ELECTRICAL
• BNUCOMME I New Comm Electric ELECTRICAL
BNUCOMMM INew Comm Mechanical MECHANICAL
BNUCOMMP I New Comm Plumb PLUMBING
1 of