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05040096 CITY OF CUPERTINO BUILDING DIVISION PERMIT 4�0NTRACTpOR INFORMATION ' •>Rz ni, a .u+x` g. .:,ihx' rEt„ '-Xg 'Rks? BUILDING ADDRESS: AA ELECTRIC INC PERMITNO OW NER'S NAME: PERMIT ISSUE DATE ONE: SANITARY P0 iftOL NO. ARCHTfECT/ENGINEETa: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH uoo LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licensed under pmvidmea of Chapter 9(commencing lob Description n$p with Section 7MO)of giv;sio f the Business and Professions r mylicenecis <n• in full fosse ntl efT c-TU ueen:ee4 Lie.g_�"�'fi( UPGRADE METER MAIN PANEL r o Dam Conmcmr 200 AMPS ry ARCHITECTS DECLARATION s ¢ I understand my plans shall be used az public mcorda aIn a G Licensed Pmfcseional S OWNER-BUILDER DECLARATION 1 humpy aMrm that 1 am exempt from 00 Convertors License Law far the a2 following mason.(Seeds m 70315.Business and Professions Calc:Any city nr county K m�+ which require a perm,to cnnmmcl alto,.improve,demolish.or repair any structure Fiy prior to itsieirmcc.alsomiluires the applicant forsuch permit to file a signed statement < that hculicenscJ purwant to the pmvisiormofthc Conuacmr's limns,law(Chapte19 Sq.Ft.Floor Area Valuat$oi1600 is a (commencing with Section 7000)of Division 3 ofthc Business and Profeaaions Code)or i 0 Out he is exempt thrmfrom and Ihd basis for the alleged...,do..Any violio nn of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not mom Nan foe hundred dollars(55(101. ❑Lazawner ambo pmlaeny,army employcu with waguasdcb sore mmpensadon, 35911048.. 00 will do the work,and the structure is not wooded proffered forsake(Sec.7014,Bumrw and urtywh W core:The mstheContractors Uanm taw dam oat apply lf an rough or Required Inspections own eny who builds provided Out sch impr and who dosssuch work himself edNmugh his awnemployers.provided Nm suchim is toiidarenot earfircurpoemd formic.inumeL builder willho ld;ngorimpmprovin asaldusdid of year of completion,theowe of builder will have Ik burden of proving Our M1c did not Wild or improve for purpose of ! sud 0 1,1,as t the p or the Sus.7property..B sines. nd contracting Cod :)Thud mnuactas m / cense a the project(Sec.lou,Business and Pmfuoioaz Gaon)Them thereon, nd Li- cense raw does not apply m an owner of pmpeny who Wildspor;mprnvu thereon,and who counters for such projects with a eonuacmr(s)licensed pursuant to the Conmetoea V Liccme law. ❑I am exempt under Scc. .B&P C fa Nis mason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury,ore of the following declarations: - 1 have and will maintain a Certificate of Consent to self-insum for Worker'sCompeu- Orion,as provided for by Section 3700 of the Labor Code,for On performance of the work for which this permit is issued. ❑1 bare and will maintain Workers Compensation Insuvna,u required by Section 3700 of the Labor Code,for the performance of the work for which Nis permit is issued. My WoC4.��a ropepeenssatio nsum,.sarin and Policy num Carrier Jllr"'/G tl Poll,No.: ©� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section reed ret W completed if the Permit is for one hundreddollars(Slip) or less.) I sanity Out in the performance of the work for which this permit is issued.1 shall not employ any person in any manner m as in become subject to the Workers'Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If.after making Nu Certificate of Exemption.you should become suvocet to the Worker's Compensation provisions of the Labor CWC,you most z forthwith comply with such provisions or this permit shall be deemed revoked. z O CONSTRUCTION LENDING AGENCY [-.��+ I hereby affirm that there is a constreconn lending agency for the performance of W> the work for whish this permit is issued(Sol.3097.Civ.C.) L90 Lenore.Namc ,'z lender's Address U O 1 certify that 1 haw sad this application and mate Our the show informauun is cored l agree to comply with all city and county ordinances and sum laws mlating to OU builslingeonswck authorim representative of this city to enter upon the ,rte above-mentionedpection pupwses. (We)agreenify and Fecp hernlcss the City of Cupertino against H N Babilidesjudgrepessw which may in my way seems agemst saio City ❑z incrosuqucn othis permit. APPLIC AND WILL COMPLY WI A NO DINT Issued by: Date SOUR Re-roofs Sig sore of ApplicaRr Da HAZARDOUS re O S MATERIALS DISCLOSURE Type of Roof Will the applicant or future building e.Chapter stmt orimidhandle husrdoanmaterial az defined by the Cupertino Municipal Code.Chapter 9.13,aM the Health and Safety Cods,So,bon ❑Nu ion 3553I(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ Will the applicant or future building atiupant use equipment or dcviecs which If a roof is installed without first obtaining an inspection,I agree to remove it havudous air contaminants as Jafncd by the Bay Area Air Quality Management all new materials for inspection. isaict? ❑Yes ❑ I have to d0 has quirementsunder ChaW ofNcCalifm- niaFio7tth&Sarcty ,Sc ) 5533 cert]255]4.1 unJcit ImilJindoes note entl o tism sponsibility m nouponreyuiremcntsw a a rt mare cemfem Signature of Applicant Date Owner or authariaxd aFcnt Dam All roof coverings to be Class "B"or better n Community Development r 10300 TorreAvenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building Department JOB ADDRESS:/ 0 �� ����� ,fir, PERMIT # C)S—oLI C 0O-LI OWNER'S NAME: 2- /S PHONE # L 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 Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Thnk Sheet.lMet Sheet R l T. / 4-11 i Owner/Contractor Signature Date - CITY OF CUPERTINO � /0q 1TM0F PERMIT APPLICATION FORM ' v" CUPEkTINO APN # ��—q 0 )l r Date: Building Address: / 70 MPylin Address if efferent from building address): 8�ti YJ�� Owner's Name: - Phone#: 1 Contractor: License#: �/ / '] Contact: Phone//%p r/� pertino Business Licensee#: Fax: Building Permit Info: Bldg ❑ Elect l Plumb ❑ Mech ❑ Job Descdentiapti�on/� . C/� 0g<��� 2otp �� Residential�Ll �1CCrf/� Commercial Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: 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 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 g{J�w CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEI�TINO 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 BPRE PIPE 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 cfrn 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 Appliance ELECTRICAL 2 of 3 r_ CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM QuantityFee 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 BSEISMICRF, 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 MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING } 3 of 3