08100003CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTOR
IN'ORMATION.-.,
BUILDING ADDRESS:
PERMIT NO.
19770 STEVENS CREEK BLVD
TBD — TO BE DETERMINED
08100003
R'S NAME:
PERMIT ISSUE DATE
EVERSHINE VI, LP/ BLDG B
10/01/2008
PHONE:
!
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
ADD 200 AMP 30 SERVICE
BILDO EO PLUMB
O 0
LICENSED CON RACIOWS DECLARATION
RxisTiHS METER
Job Description
hereby gaim that 1 am lkcmd under provisions of CWpW 9 mommencing
with Seeuor 7") ol'Divishm 3 of ft Business and Professions Code. and my license is
i T and at.
eIII
Lle. g
Da¢ Contractor
ARCHn ECIS DECLARATION
1 understand my plans shall rte used at public meet&
Licensed Professional
OWNER -BUILDER DECLARATION
1 Wmby aflame that 1 am esempt from the Contractors License Law for to
following mason. (Sauon 7131.5, Business and Poefcainm Code: Any city Or county
which .quires a permit to construct. alter. Improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit o file a signed sam mem
Ft. Floor Area
Valuation
Net he is [learned pursuant to the provisions of the Contocwrf License Law (chapter 9
Sq.
(commumd., with Section 7000) M Division 3 of site Business and Professions Code) sir
that W Is eumpt therefrom and the basis for the alleged aaemptiOn Any violation of
APN Number
Occupancy e
p y -+ l'y p
Seeuon 7031.5 by any applicant fora permit mbj.0 the applicant M a civil penalty Of
an, mom than fin boosted dollars (SSW).
I, ss owner of the property. or my employees with wages as tau sole crmpenatiou.
Required Inspections
will de the wort and the structure Is not intended or onetd for We (Sec. 7066. Busi.
and Professions Code: The Contractors Liana law does ant apply to an owner of
property woo builds a i.p.. thancom. mdwho doessuch woo himself¢Waugh his
own employees, prolded that such impmvemenu art ruminaeded moRerd (¢sale a,
brwever.Ihe Wilding or improm ant is mid within one year ofeaoplduon, the owner -
Wilder wE have the harden of pressing that Ite did an, Wild or Worm for purpose of
aleJ.
❑ 1, a pewter of the property. w ¢elusively contracting with liesmad cLnrrmsas to
construct the Project (Sec. 7W. Business and Profusiolu Code:) The Contranors U.
c ux Law does not apply to m owner of property who Wilds of import themon. and,
who contracts for such projects with a contractor(]) lianeed Pursuant to the Canum,amer
Lice. Law.
lamesempunderSee .B&PCfalhumamn
et Dau
WORKER'S COMPENSATION DECLARATION
I batch, affirm under penalty of perjury oro of the following decorations:
❑ Ihaw:md will main WnaCmiOcateofConsentwx](insumfawahersCompcn-
scion, an provided for by Section 3700 of the labor Code, for the Performance of the
wart for which this permit is issued.
❑ I love and will maintain WorYers Compensation In.ram a, at required by Section
3700 of thc labor Code, for the periOmona of the woo for which this permit is issued.
My Workers Com,(p�enamon torero carrier and Policy number M. ♦ __��``�.{�
Cartier. C u � -Policy No.: &ALULG1('24 ss` 1
CERT3F7CA OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ins section ted Our Ite completed lithe pemit is feature hundred dollars (5100)
or less)
1 wtih that in the performance of the wort for which this permit is banned. I "I nm
employ arypersoa In my manner w u to become subject to the Workers' Compereauon
Laws of CaliforNa. Due
AppBcant
NOTICE TO APPLICANT: If, after making this occlOcau M Eactnpon, you should
become subject to the Wooers Canpeaation provisions Of the lana Code, you min
' forthwith comply with such provisions or this permit shall he deemed tevok.d.
LENDING AGENCY
CONSTRUCTIONisacnstr
1 by armarmthis mW • olcdm lending agency for the peRormana of
here
IW I
' wort for which this permmitit ts lass (Sec. 3097, civ. C.)
Lenders Name
,
Landers Adsrras
I oenlfy Nu 1 have mad this application and site that the move information is
correct. 1 agree to comply with all city and county ordlnarces and stile laws Rhling to
Wilding caswction, and hereby wtharion representatives of Nis city to enter upon the
abow-mentienhad property for Inspection pufpmes
(We) agree t0 ave, indemnify and kap humoless the City of Cupertino against
liabilities, judgments. costs and eapcmes which may I. my way oma against sold City
I. consequence Of the granting of this permit.
s APPLICANT UNDANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: - Date
SDDR
Re -roofs
'^ ZQAr 0g
Sig OfApp' an ontracwr DT—
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof m
Will the applicant or for= Wilding Occupant store or handle hmallous material
Med by the Cupertinonicipal Code Chapter 9.13, and the Health and SiRry
dc. section 25532(a)7
All roofs shall be inspected prior to any roofing material being installed.
0y. No
I If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding occupant ane equipment Or dcvi.es when
.mit harardnus air...=inass dcfin ed by the Bay Amo Air Quality Mmugcmcm
all new materials for inspection.
DiWictt
0y.Nu
1 Woo read One hauNous materiaWmquimrrrms underChapter6.95 of the Califs.
`
ria Health&Sa@ty CO@,Secuau2550S25533ad2553d.Lundcrmd NatifNe building
does not eumenuy w.LinatLthatit4myresp bility w mufy the =upant Of site
mga[rome h t piorwiaaanaofaCmf"awofampm ..
Signature of Applicant Date
All roof coverings to be Class'W or better
Owner u Osumi gen Dau
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36906088.00
DATE ISSUED.......: 10/01/2008
RECEIPT #.........: BS000006254
REFERENCE ID # ...: 08100003
SITE ADDRESS .....: 19770 STEVENS CREEK BLVD
SUBDIVISION ......
CITY .............: CUPERTINO
IMPACT AREA .......
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT
0
AMOUNT
---------------
113.53
---------------
113.53
REFERENCE NUMBER
--------------------
1563
OWNER .............:
EVERSHINE VI, LP/ BLDG B
ADDRESS ..........:
19770 STEVENS CREEK BLVD
CITY/STATE/ZIP ...:
CUPERTINO, CA 95014
RECEIVED FROM ....:
BULLDOG ELECTRIC
CONTRACTOR .......:
TBD - TO BE DETERMINED
LIC # 00096
COMPANY ..........:
TBD - TO BE DETERMINED
ADDRESS ..........:
CITY/STATE/ZIP ....
,
TELEPHONE ........:
FEE ID
---------
UNIT QUANTITY
AMOUNT PD -TO -DT
THIS REC NEW
BAL
1BELEC200
----------------
METERS 1.00
------------------------------
29.43 0.00
----------
29.43
0.00
1BSEISMICO
VALUATION 12,000.00
2.52 0.00
2.52
0.00
1EPERMITFE
FLAT RATE 1.00
40.79 0.00
40.79
0.00
1TRAVDOC
FLAT RATE 1.00
40.79 0.00
40.79
0.00
TOTAL PERMIT
--- ---------- ----------
113.53 0.00
----------
113.53
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT
0
AMOUNT
---------------
113.53
---------------
113.53
REFERENCE NUMBER
--------------------
1563
4 �✓
CITY OF
INUPEkTINO
E
171
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
O STt✓c s cz_ SVD
PERMIT #
d'/00cx,)-3
OWNER'S NAME: KC !X-IICLopMo
PHONE # -j085 X II
GENERAL CONTRACTOR: LE C
FAX #
7
I am not using any subcontractors:
ignature D to
Please check applicable subcontractors and complete the following information:
er/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
1-7
Tile
er/Contractor Signature Date
•
•
k�ce.-
cl OF
CUPERTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
raTURNAM
APN # O va-.Op
Date: to
Building Address:
191'10 STCOEtt� C1jjeeK �3Lafa C1n�E�2� 1fSo Cdr `j�ol�
Mailing Address (if different from building address):
Owner's Name:
14 Z DCWE4-0 Pmajr
Phone #:
�67 343 1c�06 ) 8 IB
Contractor:
Phone: iibg (-1�2 91 oE)
I3Ui.L>C- ELF- m�C
Fax: 4615 "Z 1101
Contractor License #:
Cupertino Business License #: 01 oo0 oLI IS -1 3
Contact: S,rlv1'Ei t
1 t
Phone: -11$ -7 aj
Fax: qcb LA9,Z 01101
ResidentialH Commercial
Job Description: I> -&)D- � � 3�
St=��a1tLE i
f
Sam CITY OF CUPERTINO
CITY OF
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf
Fee ID
Fee Description
Fee
Permit Type
Group
1GENRES or
1GENCOM
1 BBOILERI
For the installation or relocation of ea
M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw
1 BBOILER2
Installation /relocation of ea
M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1 BBOILER3
Install ation/relocation of ea
M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1 BBOILER4
Install ation/relocation of ea
M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1•,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILER5
Installation/relocation of ea boiler or
M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750;000 Btu/h
1 BAPPLOTH
For ea appliance or piece of equip
M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
1 ELECINSP
Other Electrical Inspections (per hour)
E
I MECHINSP
Other Mechanical Inspections (per
M
hour)
1PLMBINSP
Other Plumbing & Gas Inspections
P
(per hour)
1MEETINGIHR
Application Meeting
B
•
•