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05050073 g CITY OF CUPERTINO BUILDING DIVISIONPER MIT ACONTRACTORINFORMATION BUILDING ADDRESS: PERMIT NO. ALTERNATIVE POWER & ELECTRIC 05050073- 09 9R aOW NER'S NAME: FERNOT ISSUE DATE VICTOR d. 17TRGINIA TTT3AQQZ HE 'c SANITARY G01-01-N0. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG EIFLT PWMB MECH _Cop LICENSED CONTRACTOR'S DECLARATION U1 bemby airman Our I am Bttnsed under provisions or chapter 9(ammeocing Job Description with Smoon 7")of Divisi n 3ofthc Busim_v and Pwfudiom Code.a dmylicenuif o. in full forte and cffm ; = -a full a N Lk.N a-a1�-q UPGRADE MAST/GROUND ELECT. BOX �r� Dale Contractor c1112 t CHK WIRING ARCHITGCPSDECLkRATION vs,�ti 1 understand my plans shat I be used as public records C e S. H Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the 00 following mason.(Section 7031.5,Business and Professions Code:Any city or county K m� which requires a permit to construct,alter.imprnvc,demolish,or repair any structure ,e¢i prior to its issuance.also requires the applicant for such pcmmino file a signed statement a that be is licensed pursuant to the provisions of the Contracture License Law(Chapter9 Sq.Ft.Floor Area Valua�f.3D..00 S L Y F C that ha exempt Sedioom and of Divisionfr of the Busaged cxa pt Professions Code)m i�$ that he is exempt Ihcrefrom and Nc bud for the alleged exemption.Any violation of Section 9031.5 by any appBcmt for a Permit subjecm Ne applicant to a civil penalty of APN Number Occupancy Type not mom than five hundred dollars(5500). ❑i,as owner of the properly.or my employers with wage ss their sole compensation, 31631013 . 00 will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Cede:The Contractor,License Law doe car appy an an owner of Required Inspections pmpeny who builds or improve theman,end who docs such work hi..IrC,H mugh his own empioy�•provided that such improsaananm am not intended oroffemd forsala.If. ppp�� non however,one Wilding or improvementissold within oro year of completion,the �� builder will harc the burden of ement ivir,Nvl he did nm build a comple for thP.e own of r. sal,.). ED ❑I.as Owner of Be portion,am exclusively contracting with licensed conuacrom to construct the pmject(Sac.7004,Business and Professions Chad;)The Contnctars re raans Li- 1491' 20 05 Li- Came dnot apply to an owner of progeny who builds or impmKs themon,and 19 who contracts for such pmjecu with a contractor(s)liamed pursuant or the Conuacmrs License Law. O T am cacmpr tandem See. a azn j for this mon Data Owner Date f11r�J,/\1/5' 'JI'I fl WORKER'S COMPENSATION DECLARATION I hereby arum under penalty or perjury,ate of the following declamations: - 1 have and will maintain a Cenifcam of Consent to self-insum for WorkersCommit- snion,u provided for by Section 37W of Ne labor Code,for the performance of Ne work for which Nis permit is issued. ❑1 ban and will maintain Workers Compensation Insurance,as required by Section 37W of the tabor Code,for the performance or the work for which Nis permit is issued. My Worker's CUM pemeubm Insurance carrier and Policy number art: t\ Cameo. Policy No.: � n l �`"v ' ^CERTIFICATE OF EKE P ION FROM WORKERS' COMPENSA IONINSURANCE (Tbd Section need not he completed if the permit is faronc hundred dollars(3100) or less.) 1 certify Nal in Ne performance Of the work for which this permit is issued,1 shall not employ,any'pcdon y manner at u w become subject in the Workcn'Compensation Laws of California Applicant NOrICE TO APPLICANT:If,afterTibming this CcmBcam of Exemption,you should xcome subject m Use Worker's Cmerensnion provisions Of Ne Labor Code,you muse J z foMwimh Comply with men provisions or this permit shall be domed ranked. z CONSTRUCTION LENDING AGENCY E+� Ihemhy Coffman Ban dem it emmtrvctinn idndingagcm,for the performance of C the work fur which Nu permit Is issued(Sec.3M,Civ.C.) IT] Lender's Name z Lender's Address U 0 1 certify that I have read this application and sum that the about infnmaown i, L.P correct 1 agree to comply with all city and county oNimnas and two laws mlating to 0 building construction,and hereby vuthe0m reperenutics Of this city an enter upon do Y'C above-mentioned property for inspection purposes. (WO)agree In save,indemni ry and keep detailed the City of Cupertino against Fpr' liabilities,judgments.costs and expenses which may in any way accrue against said City of the grand ag of U Z APPs Permit. LICANTeUNDERSTANDS AmND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGUL 1 S. Re-roofs Signature of ApplilmVCuntncmrDam , HAZARDOUS MATE 04ISCLOSURE Type of Roof Will too applicant Or future building Occupant store or handle hatwoo us material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code.Section25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑secs Will thea applicant or future building=upon(ort e t Or devices which If a roof is installed without first obtaining an inspection,I agree to remove rap g p a Air n it hazardous air contaminants ss defined by the Bay Area Air Quality Management all new materials for inspection. Weft? Yes t11a`v^'�/ 1 have real Ne RvaNmws materials mquimmcnts under Chapter6.95 arthe Califon elect not a Scions 25X)5, My nlWOfy Naz err Wilding Jars mrot currently haw•¢neem Nor it is my rmpomibilitY b matifY tin laupanl of Nc mgcimancmm wnicn mustia:mepri r womanaofaccrufcam ora pauy. Signature of Applicant Date �� st Owner or samoriaca.gCod Dam All roof coverings to be Class"B"or better Community Development 0 Torre Avenue CupOertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building De artment JOB ADDRESS: PERMIT# \`145-54 v-�'b 3)r, -7 OWNER'S NAME: PHONE # -.7�0 3 . 41 GENERAL CONTRACTO FAX# I am not using any subcontractors: c7LC.s�L9OcL° s� `G S ( O Signature V J Date Please check applicable subcontractors and complete the following information 66 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 ner/Contractor Signafti4j Date � \ x( - CITY OF CUPERTINO • CITYor PERMIT APPLICATION FORM D S-z S' CUPEkTINO APN # t 31 Q l 3 Date: I t 5113 \0 -' Building Address: Mailing Address (if different from building address): t99SA hoc �a-,,A Ln1 \ ll 1 V t� Owner's Name: Phone#: Contractor: License#: Contact: Phone: Cupertino Business License#: 6 V-5er✓vt- , Fax: Building Permit Info: .Bldg ❑ Elect .E Plumb ❑ Mech ❑ Job Description: Residential tNnA- elee.•`w�--k- c very wU Commercial ❑ Sq.Ft. Floor Area: S/Sq.Ft.: Cost of Project: t,_ Occupancy Group: Z. ooCD Type of Construction: ` Please check this box if the project is a k-'(—k L42111 - second-story addition: ❑ Pro'ect Size: Standazd ❑ Lar e ❑ _Ma or ❑ 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 IM 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 I of 3 tv 73. �� { G CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO 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 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 BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFLYT 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 BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO CUP TYOF O 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 MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG- Plumbing Fee sq foot _ PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR P1 ning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3