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03120115 CITY OF CUPER'fINO &W BUILDING DIVISION PERMIT ,„CONTRACTOR INFORMATIO Bu u.DING ADDRESS: RYON COMMERCIAL INC PERMIT NO 03120115 OWNER'S NAME: PERMIT ISSUEDATE RON LYON 1110 ORC ART) T)P 1919912003 ONE: SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MF.CH �Op LICENSED CONTRACTOR'S DECLARATION O O O O so❑ 1 hcrchy affirm that I am licensed trod proviemm.,ter chaPmr v unmmen Job Description is with Sccti l j of Division 3 of the Bus' dAW Profession.,Code.and my' is n irmnrrm dery 7 UPGRADE METER/SPLIT PANEL Dtl�iLiccnx s C Lic.a Z r p Dam Coal. L4 A 1 CI'S D ATI he< I undcrsund my plans shall he used u public rtcads ,yu Q� Licensed Pmfcssional o 5 OWNER-BUILDER DECLARATION �s- i hcrehy.arfrm mpt at I am exemfrom the Contractor's Liccnx Law for the it,o following moon.(Section efO 1.5,Business and Pmfcasiona Code:Any city lir county K$ which requires a permit to construct,alter,improve,demolish,or repair any structure ?_y prior in its issuance.also mquims the applicant for such permit to file a signed suxmem X=, thatut is licensed pursuanuo the provisions of the Contrazmr's Liccnx Law(Chapter 9 Sq.Ft. Floor Area Valuation yl-$ (commencing with Section 7")of Division or the Business and Professions Code)or - y mat he is to mpt memftom and tit basis for the alleged exemption.Any violation of Section]051.5 by Ary applicant for a permit subjecm the applicant o a civil penalty of 37+tBDl3`(UHt$er00 Occupancy not more man fin hundred dollars PDfal). P Y Type ❑1,u owner of the progeny,or my employs.with.,as as their sole compensation, will do the work,and to structure is not intended car offered for sale(Sec.TDW,Business and Professions Code:The Conuactora License Law docs not apply m an owner of Required Inspections property who holds;orimproves thereon,and who doessuch work himself lir through his Own employees,provided that such improvements art not intended or offered for ale.1(. however.the building or improvement la sold within one year of completion.the owned builder will have the burden of proving that he did nos Wild of improve for purpose of Nei W ��® sale.), em ❑1,as owner of Jre propeny,am exclusively contracting with licensed conractprs to Construct the pmject(Sec.YBLd,Business and Professions Code:)The Contractors Li. FEB 2eat ohms Law dors nos apply to an owproen ner of gy who builds lir improves thereon.and P C O 2004 Who counters for such projects with a eontracmr(s)licensed pursuant to the Contractor's 9 License Law. BUILDING }p{y'e B �1 ❑1 An eaempt order Sec. .B h P C for this reason 'ten{OI/,®11{�G Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: . 1 have and will mainuim a Certificate of Cooent to self-insum for Waters Compen- sation,as provided for by Section 37M of the Labor Code,for the performance of the work for which this Permit is issued. ❑1 have and will maintain Workers Compensation Insurance,as required by Section 37M of me r Code.for the performance of tit oro k for which this permit is issued. My Works < pens inion Io rance caricr and 1. �mp7�r Cartier. 5��frgy� P scy No.:mJ_LL/Jy—'Zw� CERTIFICATE OF EXEMP ION FROM WORKERS' COMPENSATION INSURANCE rrhu sectionaced nor be eomPleed if dr .it is fomite hombrud dNlars(Stip . or less) 1 minify that in the performance of the work for which this permit is issued,I shall not employ any Person in any manner as as A become subject o the Workers Compcnation Laws of California.Date Applicant NOTICE TO APPLICANT:IL after making Nis Certificate of Exemption,you should . . become subject to the Workers Compensation provisions of the Labor title.you mus .J z forthwith comply with such provisions a this permit shall ba deemed revoked. Z'O CONSTRUCTION LENDINGAGENCY ,e+ Ihamhy affirm that there is a construction lending agency for the performance or the work for which this permit is issued(Sec.3W7,Ci,C.) W PLender's Name M. Leaders Leaders Address U O 1 certify mat 1 have mad this application and sure that the eburs information u C)U cuildin lagree mcomply and withal city and county ordinancesandsum hws,.,Amgto �U .1how.ngepnamucti.,tryhereby amM1ome reprc tivta of Nis city tp cnmrupnn the HFq .,lave-memiunee Pmlmny tedcils'tion pas t3. (We)agree to save,indemnify an c Icu the City of Cupertino against h liebilities.judgmcnu,costs end cxpc w may In any way.,scree against said City U'z in consequence of the granting of pc It. '^ APPLICANT UNDERSTAN A WILL COMPLY W L NON-POINT Issued by: Date SOU REGULATIONS _j7 4zl<z Re-roofs sly....Oppl nVCommi Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applieam Or rutum Wilding oeeupant nom or handle ha oreous material u defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety cure. pn 25532(.)' . All roofs shall be inspected prior to any roofing material being installed. V �Np Will the applicant or Idiom building occupant use equipment or devices which If a roof is.installed without firs[obtaining an inspection,I agree to remove isohazardous ardous air conmmina��npppu as defiined by the Bay Arca Air Quality Management all new materials for inspection. ❑Yes /L�nu I have read the hvaNlws materials se momsunderChapter6.95oftheCalifnr- niaHeshr X Safety Code,Sections 255)5. 3 and 25534.1 understand that ifthc Wilding Jou trot currently holt a tenant that i ' y mspauihiln, notiry the occupant of the requirements which most he met p' ssuarm.nfa Ccruf'a Oceopaaey Signature of Applicant Dale -uv3 net or amhorircJ t All roof coverings to be Class "B" or better pare ((C �- CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO 40 1 JPAPN #32,6 3 3 7 Date: Building Address: D 7 /i Mailing Address (if different from building address): Owner's Name: J� J Phone#: O^ G SOON 4119- ,74W-0 330 Contractor: License#: Contact: Phone: Cupertino Business License#: 6IUlv - Fax: Building Permit Info: � BId 6 Elect � (Plumb e Mech ❑ Job Description: Residential ❑ Sq.Ft. Floor Area: fiwt Cost of Project: / Oc upancy Group: Type of Construction: C� lease check this box if th pr 'ect s a second-storyaddition: vv Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1 M 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 i BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING Iof3 3 / /. 0 CITY OF CUPERTINO s CITY OF PERMIT APPLICATION FORM CUPEkTINO uanti Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res 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 Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinMer/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 BREMAIRHAN A/C Units<= 10,000 chn MECHANICAL BREMAPPLI 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 BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL 2 of 3 CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 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 Mechanicals . foot MECHANICAL IW MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3