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05050030 -I CITY OF CUPERTINO •*• .._,..w�,:.r • ''k•,' =- «n_., "'*'_ ' • BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: P1kRMfI NO CITYWIDE ELECTRIC 05050030 Q 1 7sL^AZAP AVE — OWNER'S AME: PERMITIBSUEDATE 'TTTTTD AF'f'TC F'TTTITTT n n corvc 6 lullBRC-uRy q-i--1fA ��C`tlNtROL NO. SANRARY- Rnn) -747_ae,7,7 ARCHITECUENGINEER. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u00 LICENSED CONTRACTOR'S DECLARATION F I ? )sir That I am licensed model al professions of Chapter 9(commcncing Job Description (�+�rypppgO� [��^ iW with llto Section)Bflcfl�caaDiviaion]of Bm BUanuaarb Profcsvuv Code.and mYhccnsc is ©dm Flr'�<q�J �N"'® L'q DacnmaClnud`r`�1D Le. -7. SERVICE UPGRADE 100AMP tltltl���k1�1 =� Dam ARCHITECTS Contractor DECLARAAaTIO _ U1 understand my plans shall he used as public records /��' 2005 ;Q� Licensed Professional OWNER BUILDER DECLARATION .�<I 1 bream .('firm that 11. exempt from the Contractor's.:Any Law for the p� pf (1ry1� 5 O o which re reason.(Section](131.5.Business and intrusive,de nv Cale:Any my or county �a m so which t Ingmry a e,ho a mini die plic impvw,h rOmash.m e past anY iltuaum conot _Zy pOnfmiI5133varleCa lSURgmrC Shcta pphean(rOrSnfhperrllntoRlUagn edElalemen( 3v ss2< that he is licensed pursuant to the provr siovo f the Common's Lncnsc Law(Chapter 9 Sq.FL Floor Area Valua on y F-O (commencing with Section 7")of Division 3 of the Business and Professions Code)or That he is exempt there(¢¢and the basis for die alleged exemption.Any violation of Section 701.5 by any applicant for a permit subjects me applicant to a civil penalty of not mom man B.a hundred dollars(S50D). 3 5VV4rft9qSr0 0 Occupancy Type I,as owner of she property,army employees with wages as theirmic compensation, will do the work and the Structure is is ntended or offered for sale(Sec.7044.Business --- and Pmfeusoru Code.The Commictors License law door set apply m an awmr of Required Inspections pperty who buds or improves thereon,and who does such work himself sir through his Own employ=.provided that such improaemenu an,not intended oranemd formic.IL however.We building or improvement is sold within sine year of completion,the Owner- builder will have Ox bunion of proving that he did not build or improve for purpose of .In) ❑1.as uwnef of tM propeny,am uclus,nly corrosion,wish licensed...I.u construct the project(Sec.7064.Business and Professions COdc:)The Conuacurs Li- cense law does not apply to an owner of propeny who builds Or impreva damn n,and who canines,for such protects with a conuacuf(s)licensed pursuant m the Commuters License law. ❑1 am exempt under Sec .B&P C for his reason Owner Data WORKER'S COMPENSATION DECLARATION 1 hemby affirm under penalty Of pe0ury Om of the following declarations: I haw and will maintain a Certificate of Consent to selbmsuu for Worker's Compen- sation,v provided for by Section 3700 of Me Labor Code,for the performance of she work for which this permit is issued. A]I have and will maintain Worker's Compensation Insurance.u required by Section 00 ofg labor Code,f ordeperf ormanceof theworkforwhichthispermitisissued. My Workers COm saoonl note Gamer and PObcy numMr//are: ` Carrier Policy NO d y V,1 0 It O NZ /,—P 1 CERTIFICATE OF EKEMP ION FROM WORKERS' COMPENSATION INSURANCE (this section need not W completed if the pe mil is foram hundred dolhrs($100) Ideas.) 1 certify that in quit performance of Nit work for which this permit is issued,l shall not employ any person in any number So as u become subtract in the Workers'Compcvmon Laws Of California.Day Applicant NOTICE TO APPLICANT.If,after making this Ccroficam of Exemption,you should become subject to the Worker's Compensation proviaov of dm Umor Code,you most .J z faMwM comply with Such provisions or this Mronit shall be deemed Invoked. Z '-' CONSTRUCTION LENDING AGENCY l hereby.!Posh that mere IS a consuuctinn lending agency for the performance of C' she work for which doss pcnn r u aimed Sec.309'/.Ch,C.) U3 0 Lenders Nation =z Lender's Addm• U O 1 Certify that 1 have read this application and state that the above infoonauun is [6. P correct.I agree to comply with all city and county animation and sum laws belaung in 0U budding construction,and hereby authors repscsenuinves of this city to inner upon She r W above-mentioned pvpeny for inspection purposes. (We)agree m Save,indemnify and keep harmless me City of Corinna.isminss F" y (iabiliues,judgments,costs and expenses which may in any way accme against Said City U in consequence of the granting of this permit. APPLICANT UNDERSTA S AND LL COMPLY WITH ALL N NPOINT Issued by: Date SOURCEREGSll.AT10 � / -93�C _ y o-� Re-roofs Q Signature ofApplicanV tractor Due H RDOUSMATERIAISDISCLOSURE Type of Roof Will the applicant or form building occupant gain or handle hvardous material as defined by the Cupemno Municipal Code,Chapter 9 12,and the Health and Safety Code,Sections 25532(.)+ All roofs shall be inspected prior to any roofing material being installed.r-1 Yes Ewa, Will the applicant or future budding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree ro remove ;nu haianious air conmmmams u defined by the Bay Area Air Quality Management all new materials for Inspection. D'sncR 11 ❑Yes Lull I have read she haaanimtsmateralsmquirchous under C1haper6.95 of she Califor- nia Hn(th&SafctyCodc,Sccuov 255(15,25533 and 25534 I undersmad mu if de luddmg does not currently haw a mart,that it ts my responsibility u nou(y iM occup.nt true tequiremer; h almat prior sumet of a Certificate of Occti7 Signature of Applicant Date — Gamernramb.nred e9V Date c)5 All roof coverings to be Class'B"•or better Community Development -3$ '3 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEI�TINO Building Department I JOB ADDRESS: PERMIT # 02 �t v_ Q�c CUL, d,(, via OWNER'S NAME:gi l#„ / L �( �i,r0 2 dL PHONE # 7 2 8 S —y 3 GENERAL CONTRA OR: Qom / FAX # I am not using any subcontractors: at""Ci > - _ S /y4vS Signature Date Please check applicable subcontractors and complete the following information: ® SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation j Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing I Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock I Tile I I Owner/Contrac'ior Signature Date (1 p- CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO APN # S 1 _ 4 _ o Date: s-/,//67 Building Address: ,^ Mailing Address (if different from building address): -2-1710 — Owner's Name- Phone#: Contractor License#: 75/37 / Contact: � � Phone: EW--1j7-60 Cupertino Business License#: Fax: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Descriptio Residential 7: -/W Commercial ❑ Sq.Ft. Floor Area: / $/Sq.Ft.: Cost of Project: o2000 1!� Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ 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 Elee 600V> 1000A ELECTRICAL 1 BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING I of 3 ' 4r I�T CITY OF CUPERTINO CUPE °TM T INO PERMIT APPLICATION FORM Quantity I Fee ID I Fee Description Fee Group BMISCELL Miscellaneous Fee I BUILDING BMITIGATC I Comm. Housing Mit. Fee I BUILDING BNUCOMME_ I New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME I Inspection Overtime I BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL I Cesspool I PLUMBING BPERMFEE I Bldg Permit Fees I BUILDING BPFIXTURE I Pblg Fixture_ I PLUMBING BPGAS I Gas Piping System Fee I PLUMBING BPINTERCEP I Ind Waste Interceptor PLUMBING BPLANCHK I Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP I Plan Check Repeat Fee I BUILDING BPREPIPE I Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER I Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo I PLUMBING BPSTORM I Storm/Rain Water PLUMBING BPTRAP I Kitchen Trap I PLUMBING BPVENT I Alt of Drain & Vent I PLUMBING BPWATER I Install/Alter Water Pipe I PLUMBING BPWHEATER Water Heater/Vent I PLUMBING BPWSVCS I Main Water Service I PLUMBING BREINSPECT I Reinspection Fee I BUILDING BREMACOVER I A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI I ; Appliance Install I MECHANICAL BREMBUSWAY Remodel Busways I ELECTRICAL BREMFIXT I Lighting Fixtures I ELECTRICAL BREMFURN I Relocation of Furnace + MECHANICAL BREMFURNOV I Relo Furnace > I OK btu MECHANICAL BREMHEAT I Heater Installation I MECHANICAL BREMINHOOD Installation of Hood I MECHANICAL BREMMISC I Misc Apparatus I ELECTRIGAL BREMNRAPP I Rem Non-Res Appliance I ELECTRICAL BREMPOLE I Pole/Platform Fixture I ELECTRICAL BREMPOWER I Power Device/Apparatus I ELECTRICAL BREMRECEPT I Rcptl, Switch & Outlets ELECTRICAL BREMRELOCA I Relocation of Hood I MECHANICAL BREMREPALT I Repair/Alter Heating MECHANICAL BREMRESAPP I Remodel Res Appliance I ELECTRICAL 2of3 1 - CITY OF CUPERTINO Effyo PERMIT APPLICATION FORM CUPERTINO 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 IJ BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL f 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 PLLONGRNGC Planning LIZ Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3of3