Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
05080036
z z 0 h W Q Uz UO OF W a U'z a .CITY OF CUPERTINO � 7:77 17 ala 31 11 "T BUILDING DIVISION PERMIT 4CON,fiUQT,0RJNF0 ATI#ON ; BUILDING ADDRESS: IT PERMNO. 05080036 10800 TORRE AVE OWNER'S NAME: PERMIT ISSUE DATE CITY OF CUPERTINO LIBRARY HIS: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDGO ELECT PLUMB MECH C= O l� LICENSED CONTRACTOR'S DECLARATION lb Description o 1 hereby afrr Nei 1 am licensed under provisions of Chapter 9 wommenaml wtth Section 7flIM)) of Division 7 of the Business and Professions Code, and my lice= ts I. fall to=andenect. HVAC SPLIT SYSTEM LiceDAM class LM'a Dam Contractor CONTRACTOR: WKW MECHANICAL ARCHITECTS DECLARATION . CITY JOB/NO CHARGE FOR PERMIT FEES Wan I understand my prow shall he and w public records Licenced Professional OWNER -BUILDER DECLARATION I botany afrr that I am exempt from the Contractors License Law for the fallowing mason. (Section 7031.3, Business and Professions Cat: My city of county which requires a permit in consttucL slmr, improve, demolish, lir repair any structure prior m its issuance, also requires the applicant for such peril m rile a signed statement that he is licensed purmant in the provisions of Ne Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7OD0) of Division J of the Business and Professions Code) or $13000 that he Isexempt thertfmm and the basis fa the alleged exemption. My vichuon of APN Number Occupancy Type Section 7031.3 by any applicant for a permit subjects the appikam to a civil penslty of act mom than five hundred dollars (53007. O I, u owner of the pmpmy. m my employee with wages u 0mtr caro compeoudon. 88 will do Newark, and the structure is notintanded aaffered forsak(See. ION,Bus teas Required Inspections and Professions Code: The Connotes License law does set apply M an awmr of property who builds or Improves thereon, and who does such work himself or through his own employees, proNded that such Improvements art not intended or offered for Gala. IL builder, the building orden of pmennhmid withinowyou of completion, the owner. builder nth have tiro burden of proving I Wl within not build o improve for tpurposehe of ole.). O i, As owner of the property am exclusively mrareaing with licensed contractors to construct the project (See. 7044. Business cad Profession Code:) The Contractor's U. cense Intra does not apply m to of property who builds rs imptovu Norton, and whoseLacontracts for such projects with a convacmrp) licensed Dunwm m the Contractor's with a License / ❑ 1 am uemp, under sec. . B k P C for Otis recon 0 acr / owner Dam e� / WORKER'S COMPENSATION DECLARATION 1 hereby affbm under proudly of perjury arc of the following declwiorw �x i ham and will maintain a Cenirleemof Conun, to elf-inYrt far Wafkmi Compen- `V\\ ration. u provided fm by Section 3700 of the Labor Code, for the performance of the work for which this peril is issued. O I have and will maintain Worker's Compensation Insunnce, As required by Section 7700 of the labor Code,for the performance of the work forwhich this peril is Waned. My Worker's Compensstien Inuranm now and Policy number am: Cartier. Policy No.: CERTIFICATE OF FEXEM MON FROM WORKERS' COMPENSATION INSURANCE (Thtssectimt two nolhc completed iftbe peril is forme hundred dollars (5100) or Wa) I cenify that in the performance of tie wart for which this permit is issued, I dull as employ any person in any meaner an As to become subject to the W erkon'Compereatien Laws of California, Dam Applicant NOTICE TO APPLICANT: If, after making this Ccnlfresm of Eacreption, you should become subject in the Worker's Compensation provisoes of the Labs Code. you muss forthwith comply with such provisions or this Permit mail W dcemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby mT,. that Vert is a..do. lending agency rte the erfarance of the work for which this permit Is Wed (Sec. 3097, Civ. C.) ' Lender's Name , IarMtn Address I certify that 1 neve read sus Application and sum d u the move Information ts comero. l agree to comply with all city and county or inaaxs and sum law senting to Wilding consuaction. and hereby authorize representatives of this city to tate upon the ahmn,mendoned Property for inslmction Pmpous (We) agree he aro. indemnify and keep harks, the City of Cupertino against liabilities, judgments, cuss and expenses which may In any ray same against said City S in convgwrce of the Sterling of this Perl1. ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH All. NON -POINT Issued by:Date � ONS. SOURCE REGULATIONS, Type of Roof , Signature cdApplinumfContractor HAZARDOUS MATERIALS DISCLOSURE Data Will the applicant or future building occupant stare or handle huardaw material darned by Ne Cupenian Municipal Code. Chapter 9.12, and the Health and Safety e. Smile.23532(a)7 All roofs shall be inspected to any roofing material being installed. 0Yu ONu prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant um equipment tar devices which it hawrdnas air conuminsnts u darned by due ByArca Air Quality Management all new materials for inspection. Iadnotcumently isuicR[:3y. ONo I have taW Ne huudnwmamnats nmpAwnmUundmChpwA93 ofde Ci ifor- .H.I d: SalmyCode, Sad. 25305,23333 and 2533/. IundrotaMthstiflhc Wilding ta haw a went, thel it 4 my rospowihiliry m notify the occupant of dm mquimmenu which most le me, Doan Wumm ora Certifmam of Occupancy. Signature of Applicant Date All roof coverings to be Class "B" or better Owner or authorized agent Dem or CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM APN # 7 / 3 � 3 Fee Group Date: 0S- Building Address: I – Mailing Address (if different from building address): goo Tove Owner's Name: cl of c� T MECHANICAL Phone #: 777- 32.7L Contractorw K W �". BBOILER3 License #: b2 -'g l I Contact: Phone:. Fax: Boiler> 1M to 1.75 M Btu Cupertino Business, License#: Building Permit Info: Bldg❑ Elect Plumb —/ E]Mech z Job Description -_ Residential ❑ /–/ V SAI $ T,e w? Residential Commercial Sq.Ft. Floor Area: BCONSTAX —.Ind/Off/Comm/Quasi $/Sq.Ft.: Cost of Project: / 3 ©p d BUILDING Occupancy Group: Type of Construction: BUILDING BCONSTAXR Please check this box if the project is a second -story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ BELEC1000 Elec 600V <= 1000A 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 Ener Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CUPEkTINO . IWO CITY OF CUPERTINO 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 BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb 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 rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER InstaWAlter 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 BREMAIRHAN A/C Units <= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace > 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 BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Ap liance ELECTRICAL RW 2of3 Ll CITY OF CUPERTINO PERMIT 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 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 MPERWEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL — — PPERMITFEE---- —Plumbin -PermifIssue-- PLUMBING' PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3 of 3 1 y Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 C OF Fax(408)777-3333 UPEkTINO OF, Building Department I am not using any subcontractors: Signature Please check applicable subcontractors and complete the followine information Date JOB ADDRESS: PERMIT # BUSINESS NAME OWNER'S NAME: IPHONE# Cabinets & Millwork GENERAL CONTRACTOR FAX # . I am not using any subcontractors: Signature Please check applicable subcontractors and complete the followine information Date Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS 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 Owner/ Contractor Signature Date • Community Development 10300 Torre Avenue " Cupertino CA 95014 Telephone (408) 777-3228 aCOF Fax (408) 777-3333 . Ek /o goo Totr$uiliding. Department • I am not using any subcontractors:. � Signature Date Please check applicable subcoptYactors and complete the following informatio JOB ADDRES ul �t Yt rlr.D PERMFE / l 32?� BUSINESS NAME BUSINESS LICENSE # OWNE ' PHONE %S GENERAL CO CTOR: FAX # • I am not using any subcontractors:. � Signature Date Please check applicable subcoptYactors and complete the following informatio Owner/ Contractor Signature Date SUBCqNTRACT0P ^ BUSINESS NAME BUSINESS LICENSE # Cabin k • work r ' %S Cement Finishing Electrical .r 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 Owner/ Contractor Signature Date • IHD.r• ii, zuu) VI JAM WNW Mechanical Gontractors, Inc. �6111Ckn Pwu r w- k9 p11 P lata 10: Vdm rJbs*CL CERTIFICATE OF LIABILITY INSURANCE o Sad Services, iaC HI TIFF TE 27712 ONLYARDCONFERd N01 HOLDER THAI ClRTOACA liaa 8t „ Suite 409 .ALTER ?HE COVERAGE A 8511077-1213 Pax:408-977-1279 INGVRERSAFFORDOAC0% aith Sal cal COOtractor Bs�&8L. 9441/1L p� P"Me -an 1 F 95037 wmmo� "Jame COVERAOEB BHPOLI MOFN%PA=LSTFDBBLOW1NV£®lMR= TOt1e WJMMMAOM$011 TE P%V POW PCM&a w* mvc Of$+R�{l®BY PAD aAs*. PDuorxuWm w aeaeeu,waury 5 X eaeaz•'PL BOFaAL LuaLm 02SC07855A043T=03 09/11/04 09/11/03 GAILBALOE ®oma,; Do* 41 No, 8ue70 A P. rage:2 d2 NAICO 6BepLAOGff"T6 10200000C WA° L{WTAPPL®PM Pt+aoe�a•ro�+�e Am tY000000 POicv .PCI LOC up 3m. 2m/1m AVrOMMUIJU LM 5 X Artam D"107855A043=03 09/11/04 09/11/05 �C*MHZar:r�Plner $1000000 AAOYA®i: SMIML BOAVreB AmityT WAY P Wkov wm BODILY KLM (JW4m Q $ 5 I *WA Q OAS D1-' jVTft=P3S5KS793T=t 09/11/04I 08/11/05 Aar+Oa w=w aosssoosoa to/oi/oe 10/01/05 aL u0 AcareNr :lDDooa , - EL p6EA68-PAEYiotB $10 11 0000 Bl OIBPwm-Pa Lwr $100000 BLL D7EC07BSSUOT=4 09/11/04 09/11/05 ger St4m 50,000 1 Ded 500 C*rtili0at4 ie issued as &videaes of Zasurawe only. ZV=.:1OPEIPEOMTO DATBTMRBW-TPa*R*I =Lwmw6LIOUVORTOAW. 30 aLYswwm Evid4a04 of SOdOraac* NOM ToTMQMT CAT0 HX= NorDTOTIC M• OMPALMTO OO 00 WALL NOON NOOOLMT10NOR A1a61P/OFANYIGN VPON7m NKmK ns Adwm ON , I I I I I IQ I V V 11 L 1 0 � L U I sj 111 C. No. 1081 I State Of California CONTRACTORS STATE LICENSE BOARD ACTIVE LICENSE Consumer Affairs Lioense NjmbeJ 105 �, 2,",811 Entity CORP lautineft NanwWKW MECHANICAL CONTRACTORS INC C20 C43 C36 Expiration Dal* 05/31/2005 0:imp