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03090154 CITY OF CUPERTINO w � �xraC' mm '.x BUILDING DIVISION PERMIT .�,CTRACTQR ONINFORMATION"': BUILDING ADDRESS: PERMIT NO03090154 OWNER'S NAME: PERMIT ISSUE DATE NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH t� E 0 i00 LICENSED CONTRACTOR'S DECLARATION bF I hereby affirm that 1 am licensed noun, rawiti.m id Chapter 9(commend., Job Description £]21Tr wtth See t on�7")of Division 3o ideaQs7rmuand Profess ions Code,sud my limnseis v>� in full fo�D'�n f I. j License Corsi�t"I.Ic.« C('� ELECT SERVICE UPGRADE �'o Dam cool CONTRACTOR: E.G. ELECTRICAL PINALED puuuyiii ARCHITECTS D�• "RATION W6 r J 1 s shell M u puhlic records "5 I SEP 3 .0 Lieenu m(„Stn 2003 7 g OWNER-BUILDER DECLARATION Z o q 1 maxo IRrm on 1 em exempt from NO Contractor's :Any c Lew for the O go following reman.(Semon IInstr Business and improve, de oli Calc:Any city as county - BUILDING 3$LL which its im a permit l0 Cnaas the plim.plic applicant for orrsu demolish,t a repair any tatement _Z> ththenslicened o,also puruarequimuheisio of,hevuchperm's Lica esigrwdaumment a (cohe mmencing with Swoon 7000) provision Division ar of the 0 renmsandPrselaw(Chapur9 Sq. FL Floor Area VaIUBC 65O �FreS (commencing Scction7000)she Division?of the pion Any vi Code)or Net M Iv,Strep,tMm(mm and Ne basis for the alleged exemption Any violation of -f,mw�n.A�w,p Section 7031.3 by any applicants fon Permit Subjects die applicant m a civil penalty of 3 �CLOMi Weir00 - .Occupancy Type not mart than five hundred dollars($300). -- ❑I.uownu of die pmpeny,Or my employcu with wagesu Nei,vole compcnaelon, will do the work,and the swcone is not intended oroRered(anal,(Sec.7044,Business and Professions Code:The Contractor's License Law docs not apply to.n owner of Required Inspections property who builds or improves thereon,and who Eoessuch work himselforthmigh his 304 - ROUGH ELECTRICAL .aemploy.,,p...Wind that such improvements,,,.,Otandedoroffered for sale.If. 501. — FINAL ELECTRICAL ENERGY however.the building or improvement 1,old within one year of completion,the owmr- builder will haw Ne burden of proving Nae he did not Wild or improve for papose of 505 - F I NAL ELECTRICAL ole.). 1,as man,of die prepeny,em exclusively convecting with licensed convectors to construct the project(Sec.7044,Business and Professions Cadet'The Contractor's Li- came Law does not apply at an Owner or Property who Wilds or improma themon,and who comment for such pmjeeu with a eonuueor(s)licensed pursuant to the Conuutofa License La- o I son exempt on&,San. aw.❑Isonexempton&,San. ,BAtPCfor this rtuon Owner Data WORKER'S COMPENSATION DECLARATION . I hereby affirm under Nasty,of perjury one of the following dedara0ons: -J I hoe and will maintain a Certificate of Consent o self-Ioaum for Worker's Compcm v scion,as provided for by Section 3700 of the Labor Code,for me performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the labor Cade,for the performance of die work for which this permit is issued. My Wohkefv Compeeseli almunnce nrtinr and Polity nu on Cemgr.s I tiny No.: Jv CERTIFICATE OFEKEM ON ORKERS' COMPENSAT NINSURANRANCE ,tris action need not W completed if tic Mood is for one hundred dollars(HM) or lest) 1 Certify that in the performance of the work for which this permit H issued,l shall not employ any person in any manner su as to become subject to the Workeri COmpcamflon - Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this CCntOcate of Exemption,you should become subject to the Worker's Compensation previsions of the LAWf Code,you must �0 forthwith comply with such provisions or this perm i i shell W deemed ranked. Z0 CONSTRUCTION LENDING AGENCY I hereby olfvm that there is a construction lending agency for the perform Tom of x> the work for which this permit iv issued(Sce.3097.Co.C.) 4 QLender's Name 3 Lender's Address Q I canify that 1 ham read this application and sate Lou the above information is y (✓ Correct.I agree to comply with all City and county ordinances and sum laws relating to (J building construction,and hereby auth rim representatives of Nie city to enter upon the a .hovcmcntioned pmpcny tori npurpoua. (We)agree to vm,' c and keep harmless the City Of Cupertino against ti to liebiliuu,judgro ,c cod which may in any way acme against saidCity J]�, in conxque oft c tin of is permit. APPLICA T D AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU E R 0 Re-roofs Si mcofAreact o rscmr Data A ARDOUS MATERIALS DISCLOSURE Type of Roof Will thePPI t or future Wilding OCcupent nom or handle hsrudous mamdal as defined by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safely ode,Sccdon 13533(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes No Will the applicanto forum building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it haurdous air conuminsnu as defined by the Bay Area Ail Quality Management all new materials for inspection. oleo? p Yet u l ham read Ne r materials reyuircmcnu under Chepmr6.93 of Ne Glifar cat.Health ons23503,13337 and23534.1, dcrsurb Ncirthc Wilding does note a art.Nal It it my maponsihiltry b )dry do oecupene of the myviremenu mus ren prior w iunancc oil Ccnifceie Occupancy Signature Of Applicant Date 2 d3 Owneru t e egcm All roof coverings to be Class"B” or better Oom CITY OF CUPERTINO p Y I S CUPEI�TINO PERMIT APPLICATION FORM APN# b �^ Date: _ 22 Building ATM 2- 1 2� �'V Owner's NamlleJJ: Phone #: c�C H Contractor: License#: E - _ L GJ iJ Contact:_ Cupertino Business License #: Ef N-Al ALD I x z Pe it Info: Elect Plumb ❑ Mech El 11 Job ription: ldential g- � i 6f� Sq.Ft. Floor . ea: $/Sq.F .: i Cost of P oje Occupancy rou Type of stnaction --------- Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other AppliancesMECHANICAL BBLDGFEE Bldg Permits . foot BUILDING 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<= IOOOA ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC I Comm. Housing Mit. Fee I BUILDING z3 zr� Iof3 f�-t67 CITY OF CUPERTINO aCITY0 PERMIT APPLICATION FORM CUPEkTINO uantity 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 BNUSFD New Single Family Res BUILDING BOVERTRYIE 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 rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent 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 BREM 3US WAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace 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 2 of 3 S,m,,eCITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group 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 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 Issuance PLUMBING PPLBG Plumbing Fee s foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3