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05010177CITY OF CUPERTINO 0 0 z Q W gL In x .. ' `' " t 777 "'�`'� ,, G`ON", GTORINFORMA'I ON„ BUILDING DIVISION PERMIT .,...., ver ."r'$r. BUILDING ADDRESS; SILVERIE III INC, DANIEL PERMIT NO. 05010177 OWNER'S NAME: PORMIT LiiUB DATE E: SANITARY O. OL NO. ARCHiTEC (ENGINEER: BUILDING PERMIT INFO BLDG ELECr PLUMB MECH t� 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job De5CilpIIOD 1 hereby affirm Nat 1 am licensed under pruvWon of Chapter 9 (commencing wWScetion 10M) of Division 3ofthe Bud and PmfeWon Co .sndmylicomis in full force and teff O REVISION--TRELLIS/CANOPY/PRECAST PLANTER ueenmCI LIC Dam Comnmr NO NEW PERMIT ISSUED/ORIG. #02040076 ARCHITECTS DECLARATION I undenund my plans"( he used M public records 2/1/5 MASSOUD SPENT 4 HRS ON PLAN CK -ADDED EXTR Licensed Professional OW NER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Conuamor's License Law for the following moans. (Section 703 1.5, Business and Proleessiom Cade: Any city or County which requires • permit m cmnurun slur, improve, demelivh, ng orPalr any tomarre oar w its issuance, auto requires dm applicant far such pngmit to rile a signed statement Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provision of the Contractor', License law (Chapter 9 (Commencing with Section TOW) of Division 3 of the Business and Profession Code) or But he ut eaempt thmfrom and the basin far the alleged mcmrath— My violation of APN Number Occupancy pe ' Section 7031.5 by any applicator far a permit subjeeu We apparent to a Civil penalty of est mom than five hundred dollars ($500). ❑ 1, As owner of the Property, or my employee with wages u Nei role compensation, - 9.00 Re uiredIns actions will dothe work. and NesrructumisnotIntendedorofendforsale(Sec.7044.Businea and Pmfetlon Code: The Contractor's Liam Law don rot apply to in ower of q P property w ho bui lds a lmptow thereon. and who does suc h work himself or through his awnemployces, provided that such improvemenu see not amended oro@ord frame. If. , however, the building or Improvement is mid within one year of completion. the owner. builder wail have the burdn of preving Nat W did not build or Improve for purpose of sam). Contractors 1- Peroneum, with :) The ❑ 1, a ower of the Property, am onus and Construct Ne (See. 7014, Business and Code:) The Cmmem. projm std of property who wilds or improv mown, And, La rty who cense taw data not apply to ts 1 for such pnkeu with aconaAcror(q licensed pursuant w dm Contranroh with a whence i\ Laces License Law. \) ❑Tun escmpt under See ,Bk PCfn this rtuen er Dau WORKER'S COMPENSATION DECLARATION , 1 hereby afRno under penalty of Perjury con of tian following declarWon: haw and will maintain a CeNOnte ofComcnt to self -Insert for Worker's Compen. n. M Provided for by Section 3709 or the labor Code, for the Performance of the for which this permit is Issued. I have and will maintain Workeri Compensation Imwana, u requited by Section of the Labe Code, for the perfemance of the watt fmwhich this Permit u hoed. Worker's Compensation Insunmm carting and Policy number age: I er. /a nAnf� Polity No.:,&4_0rowb ' CMFICATE F EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thusection mad notbecompleted if the permit ufinem hundred dollen (51 W) or bang) 1 cenify Nat In the performance of the work for which this permit u issued. l shell not employ any penin in any manner an u to became subject to the Workas'Compeasa0n . Laws of California. Dam Applicant NOTICE TO APPLICANT. If. aAct making this CeniEcam of Exemption, you should become subject to dm Worker's Compcwdon provision of the labor Code, you most foMwith Comply with each provision or this Permit shall W decreed revoked. CONSTRUCTION LENDING AGENCY I hereby Amon wt manor ut a ComWmtin lending ascmy for the petformamx of the wart for which N4 permit u issmd (Sec. 3097, Civ. C.) tondo's Name Ian&;,s Mdress 1 MOW, that 1 have mad this Application AM sue Nat the above information u correct. l Agra to comply with all city And county On intone And sum laws totaling m Wilding construction. and hereby suthorin rtpmaenutivea of this city to enter upon mm above -menet M property for impaction pugwsea (Wc) a me tesave, indemnify and kap ham0ess the City of Cupertino egalnst ad liabilities; emu,com And expenes which may In my toy acme agalma Ctty in eco he of the ting of this perms APPL A DE TANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOUR TI S� Re -roofs Type Of Roof f440S Signature Appli nawar Dem N ARDOUSMATEUAISDISCLOSURE Will apPlinnr tirfuruor Wilding accounts uortmheMk huudau material As deffined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, SccWn 25532(m)7 `, ❑Yes R Nu All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, l agree to remove Wthe applicant or f)))ut[[[ure building occupant use equipment or devices which hwardnuu u s a1, cmunninandcrined by the Bay Area Air Quality Management all new materials for inspection. a ict?14 ❑Yes No I dmsmucridsmyuimmenu under Chapter G95 of the Califon. nix Neal ctiau25.505,23333aM 2557I.IuMemand thalifmc wilding d tea ace, Nat its my mop ralhility to notify the occuPant or the P myarcmmtpderwlnuanceonCerdReay a p fry, RS Signature of Applicant Date 9 All roof coverings to be Class "B" or better Owme ..roma a agnt CITY OF CUPERTINI, e CUPERTINO PERMIT APPLICATION FORM APN #'�' t .., Date: G Building Address: 4A��ee)►� C Mailing Address (if different from building address): ,�048 6 Boiler <= 100,000 Btu MECHANICAL Owner's Name: Boiler > 100K to 500K Btu Phone #: BBOILER3 Boiler > 500K to 1M Btu MECHANICAL Contractor: License #: Contact: �L� Phone: �j� j �1� ��11 Cupertino Business License#: �� k Fax: Construction Tax Building Permit Info: BCONSTAX Ind/Off/Comm/Quasi Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Descriptio ;eco—+-�/�� l Z-Tr�j;1'��J BCONSTAXH Residential 1�:�� Commercial ❑ Sq.Ft. Floor Area: BUILDING $/Sq.Ft.: Cost of Project: ELECTRICAL Occupancy Group: Type of Construction: ELECTRICAL Please check this box if the project is a Elec Svcs 600V <= 200A ELECTRICAL second -story addition: ❑ Energy BUILDING BENERGYADD Project Size: Standard Large ❑ Major ❑ BINVESTIGA Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M 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 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 1 of 3 CITY 0 CUPERTINO CITY OF CUPERTIN4 PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCONUvll\4 New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BULLDING 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 Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREAIRHAN M A/C Units <= 10,000 cf MECHANICAL BRENL PPLI 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 BRENINRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 ail. ITY OF CUPERTINO CUPE{�T{NOITYoPERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 BSPECIAL Special Inspection 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 Mechanical sq. 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 ,., C(TY OFI UPERJINO Build JOS ADDRESS: Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 g Department PERMIT # OWNER'S NAME:' PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: S Please check applicable subcontractors and co A ature Date lete the following information: SUBCONTRACTOR BUST] ESS NAME BUSINESS LICENSE � Cabinets & Millwork_ Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile , T -%j Date C O er/Contractor Signature