04070041 CITY OF CUPERTINO
BUILDING DIVISION PERMIT kWONTRACTOR INFORMATION
BUILDING ADDRESS: PERMIT NO.
FISHER POWER AND DATA INC 04070041
OWNER'S NAME: FERMn ISSUE DATE
'FNARILYNN
ONE: SANITARY O. OL NO.
I
CHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
4LICENSED CONTRACTOR'S DECLARATION lob Description
I hereby affirm Na,l em liceved under provisions of Chapter 9(commencing p
N")of Division Sof He Busimss aQQyrofesiom Code,and my licenxund eff=cIfa39� 100 AMP PANEL
ogas till Lic.p
�F� DaCSDn - ,� �rlC (
F ' 3�, ARCHITECTSD sublio ATION /
I�nayannd my Plans shall he used pe puMi�aeYnrJs
ile
'6u \
O Idccmcd Pndcsional
OWNER-BUILDER DECLARATION
Z6 f 1 mato affirm that 11. cxcmpt Imre Ne Contractor's Code:
License Law for my C .
O O following mason.Permit
](D mi Business and ere.dinabl Cak:Any cosy as county /
$�i which requites a pmmit fe cadmium,the
Man.lie improve,k Permit t or repair any statement
/
1Z6 prior LL1slicerake,alsum(1.Wepooisionaof th,for Ceh PermittoNeic LawJChapten,
(co me cing wit pursuant to Nc of Disiom Sof Business
Liccnx Law(C Cook)
Sq.F[.Floor Area Valva On
that
exempt Section]DOD)of bed for th NCBusineuandon.Anynvi Cade)of
y Net io u Bumps therefrom and the aper for be alleged exemption.to Any violation of
Seniors Tn.few hundred chars npermitsubjecu Ne applicant,oacivil penalty of 3 UPIPM0 Occupancy Type
not roam Nan five hundred dollen($5007. r ,
Ld owner,Bre tho!"C of myemplayw withwagess Heir sale 044,8 sins,
witted fa work end the he Contranotinkndesoraw do senate(Sec.]044,Buser of
mrd Professions Cade:The cantrxtort rd.h.Law dope,rot apply lf an owner of Required Inspections
ow nervy who wilds of improves Hereon,end who decision work himxl f or Nmubh his
awn ver,We Wilding
Beat arch improvements are not our o ed oroffeopted ea for Owner-
however,We building or Improvementanis mid within n,e yeti of completion.Ne owe of
Owner-
Wilder will Mw the burden of proving that he did trot build or improve for purpose of
sale.).
❑h as Owner of the property,am exclusively convecting with licensed contractors to
construct the pmject(Sec.7044,Business and Professions Code:)The Contextori Li-
come Law ams not apply to an owner of property who wilds or improves thencon,and
who contracts for such projects with a canvutor(s)licensed pursuant o the Convectors
Liccnx Law.
I an exempt under Ser. ,B&P C far this reason
Owner Dam
WORKERS COMPENSATION DECLARATION
1 hereby anion under penalty of perjury one of the following declarations:
❑11 have and will maintain a Cudfiare of Camcnt to self-imureforWorkersCompon-
sstion,pe pmviked far by Section 37W of der Labor Code,far the performmme of the
w/ork for which this permit is issued.
EQ 1 have and will Mansura Workers Compensation Insurance,s required by Section
]10 of the Labor Code.for He performance of the wart for which Nis permit is issued.
Workers ComMisation In matt carrier and Policy number am:
t�'IGEMICfTF1E)(E=Polity ROkIWO KERS P'�I ■
CE Fl— TI CA�Pf1 NSUR WORKERS'
COMPENSATION INSURAI� '
(Th r xctim need not he complemd i f the Fermis r far orae hunanA dollars(5I W)
or less)
I certify tat in the perfoormace of the work far which Nis Permit is issued.l shall not
Monday any person in any manner an as to become subject to the Worked Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Condit=of Esemption,you should
aecome subject to Ne Worker's Compensation provisions of He Labor Code.you most
.Jz forthwith comply with such provisions or this Permit shall he deemed revoked.
z CONSTRUCTION LENDING AGENCY
[-. I hereby We.than Nem is a comwcsian lending agcr,cy for NC Performance.f
FL
the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Landie's Name
Under,Address
V Q I modify that 1 have read this application and sum Nat the above information is
D,t" conecL 1 agree to comply with all city and county ordinances and sou laws missing to
Wilding consvuovan,and hereby authorise mpresemaliws of this city to onus upon we
purpo
U awve-mamidgm pmpc ret for Impeding which may
(We)agree to save,indemnify and keep hama ess Oto City of Cupenino against
fay in contiesunce of
costs and of this
mryinany sway name ageimtsaid City
C)z A APPLICANT
of DERST N of this Pcrmil. Issued by: Date
APPLICANT UNDERSTANDS ANgsWILL COMPLY WITH ALL NONPOIaN�TI1
SOURCE REGULATI S. I I-
—.IJ' Re-roofs CT
Si t of ApplicaHAZARDO aW
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
II in applicant or fumes wilding occupant stem or hurdleHeaMotorial
as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health
anand Safety
Cole,Sayan 23532(x)?
❑Yes MN. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future wilding Occupant ax equipment Or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
emit hrardom air commovents pe defined by Nc Bay Ara Air Quality Management all new materials for inspection.
District?
E3 Yes No
I have read He ha side,mamrials requimmena under Chapter 6.95 of Ne Califer- ^�
nix Health&Safe,yCods.Stearns 25515.25533 and 25534.1 understand We if the wilding
docs not c nently haw a mnam.Nat it r my ms nsibilily W notify the occupant of Nc ate/
rcq acs whichmuvbeMCI pbis ' ugr Ccrvfrcamoroccupanry.! ,I gnat r of Applicant Date
ser or w rima sent ��--''llff D,W I—Yll All roof cverings to be Class "B"or better
Community Development
10300 Torre Avenue
to
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Dep4ytment
JOB ADDR S P IT #
�/ 33 �eLKrla ��'• O
OWNEWS N fY14 ri ( n n er e PHO &2 -qqq 3SGo
GENERAL CONTRACTOR FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical 1 skier oWPx �t mak.
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
V"�;) 74k rhv �a ,,6a XVC . q-oy
/Contractor Signature Date
SVim- CITY OF CUPERTINO
cuCITY OF o PERMIT APPLICATION FORM � `� c'
APN # Z , 6 q G Date:
v 7 " f
Building Address: Mailing Address (if different from building address):
-:L 33 6eLK/7a C fTlna
Own e ' Name* Phone #:
IRn
CLri 1 n �er ev1 650-
Cont tor: License #:
I s he r EDLOer 4 ba:/A--�n c . (o G 6 3 y J
Contact: Phone: 056-494 15-6C Cupertino Business License#:
TO(I 0/2- P— LLl o T7— Fax: &5o. L/9 !• 3G6a
Building Permit Info: . '
Bldg ❑ Elect Plumb ❑ Mech ❑
Job Description:
Residential R 100AM10 Pa✓lel Vk (aCeM60t Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Peoff
ct: ayS O o-z� Occupancy oup:
truction: Please check is dox if the r ' t is a
second-story ad
Pro'ectSize: StandardLar 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 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 Energy Add Multi BUILDING
BINVESTIGA Investigation fee 'gBUILDING
* Z6 Z I
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n CITY OF CUPERTINO
C g PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
IMP 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
BOVERM E Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pb1g 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
mr 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 chn MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm 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
BREMRECEPT Rc tl Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res A liance ELECTRICAL
2 of 3
IRS, � CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM i`
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmd] 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
PPERNHTFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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