04080225 CITY OF CUPERTINO - e
BUILDING DIVISION PER . Ct0NTRACT0R INk'QRM ON
BUILDING ADDRESS: RYON COMMERCIAL INC PERMIT ND.04080225
0181 RITRR Rn
'NER'S NAME: PERMITLSSUEDATE
DEVCON BU
PHONE: SANITARY NO. CONTROL NO.
(408) 590-8894
AICHMECTIENGINCER
08 590-
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Zen,
LICENSED CONTRACTOR'S DECLARATION Job Description
y U F I hereby affirm that I am llccv (IOncd under provisions of Chapter 9(Commencing P
ezUw with Sectio"n?pus)of Division 3 of th.Business and Professions Code,and my license ex
in Tint mrde�Bd erfem _ _���� GAS METER
o n i Lienee crass tie.a
��w Dam Comracmr
ARCHITECTS DECLA ATION
5y 1 u�lraand m lans shall he d as Pub' records
ea )m
U yn) E4^dys/j�! s�'n
;O G Licensed� / T
3 OWNER-BUILDER DECLARATION
af 1 hereby affirm that I am cxcmpl fru.the C.Ouncmrs U,cnsc Law for Nc
ra o following reason.(Section 7031.5.Business and Profeesiuns Code:Any city or county
ie m tai which inquires a Permit to consrucL eller,improve,demolish.or repair any stranum
prior In its issuance.also rcquims the applicant for such Permit to rile a signed statement
that he is licensed pursuant m the provisions of the Contractor's License law(Charter 9 Sq. Ft. Floor Area Valuation
�1--N (Co.dancing with Section 7")of Division 3 of d¢Business and Prof...Cole)Or
that he is exempt Ncmfrom and the bods for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of 3 WPN0'Ii1fffficr00 Occupancy Type
oat mom than five hundred dollars($5D3).
I,as owner of the property,or my employers with wages as their solc compensation,
will do Ne work,end the sw.ure is not intended Or mfemd(.!sale(Sec.1044,Basin...
and Professions Code:The Con racuses License Law does not apply m an Owner of Required Inspections
ownproperty who builds orimproves t such impr omentand who som not chwded oroelror edthrough his
ownemploye¢,ping or i pr suchimprovementsartnot ear of Cm.Beree the xleown If.
however.Nc building or improvement is salt within one year or completion,mrawned
builder will have Ne burden of proving Nat he did not Wild or improve for purpose of
calm).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
comm La d paned(Sec.]Bed,Business and rty who nx Code:)The Contractors nd
ccoe Law docs rnot suapply w an owner of property who sed p ar improv Neuron,and
who contracts for such projects with a contranor(s)liccnud pursuam 1.the Contractors
License Law.
❑1 em exempt under Scc. .B A P C for this..on
Data
WORKER'S COMPENSATION OECIARATIta
1 hereby a ilm under Penalty of perjury ane Of Ne fallowing declarations:
' ❑Ihave and will maintain aCcrdfieamof Canmm wself-inure ror Workers Comped
cation,as provided for by Section 3300 of Ne Labor Code,for the perfosmonce of the
work for which Nis permit is issued.
❑1 have and will maintain Worker',Compcnmtion Insurance,as required by Scion
377 of the Labor Code.for the Ndorma ce of the work for which this permit is issued. -
VM orker:ComPensadotn lrtsumnce carrier and Policy number art:
_r: / ✓N� Polity No.: 7 7d.�ay
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
On.seed.need not he completed if the parol,is for one hundred dollars IS IpB
or less.)
I certify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner at u to became subject to NC W.kerx Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
become subject 10 the Worker's Compensation provisions of the Labor Cndc,you must
.,,z fOdhwl Or comply with such provisions or Nis Permit shall he deemed revoked.
zCONSTRUCTION LENDING AGENCY
[r I hereby affirm Out the.is a c.olmainn lending agency for the performance of
(Y
the work for which this permit Is issued(Sec.309'!,Civ.C.)
Wa A Lenders Name
z Lender's Address
U Q 1 certify Nal l have read this application and Stam Nat the above information is
It, F' correct l agree to comply with all city and county Ordinances and sum laws relating to
.0U building Construction.and hereby auNome represamcadYeS Or this city m enter upon the
W above-.rationed property for imPenI..purposeca.
(We)agree to save,indemnify and keep h ccs Nc City of Cupertino against
ran liabilidcs.judgments.costs ane capcnus whin n anyway accrue againstmid City
U Z inr.mC,tenee Or the granting of this Perml
APPLICANT UNDERSTANDS A KILL COMPLY WITH ALL NON-POINT Issued by: Date e
SOURCE REGULATIONS.
1G`�y Re-roofs
ignature of lic nUContraetor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store dr handle hanrdmo material
as dcancd by the Cupertino Municipal Colic,Chapter 9,11,add the Health and Safety
-ode.EDY ;25532(a)7 6vas All roofs shall be inspected prior to any roofing material being installed.
V
Will the applicant or future building ottupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as def.d by the Bay Area Air Quality Managcmcm all new materials for inspection.
District]
❑Yes /�Nu
I have mad the hmardnus materials osp imams under Ch.,w,6.95of One Cable,
nia s not cu have
a Sections 155 .33533 and 15510.1 understand thmdNe n Of the
does n.cumcmly Lams a tenant N tis my respominility w nodlj the«'cupant of Nc
re�ents�stbame -,toisaaane.Ofacemfeateofaapancy. Signature of Applicant Date
� at(
r` owner.raaltlarf/Gllageol ^Date-r All roof coverings to be Class "B" or better
mu
- CITY OF CUPERTINO* Z
CITY OF PERMIT APPLICATION FORM
9CUPERTINO
APN # 7Date:
PN S2 0
Building Address: Mailing Address (if different from building address,.
U,Q M S'Or/2 za/
Owner's Name: Phone #:
Contractor: License #:
Contact: Phone: rJ1 9' Old Cupertino Business License#:
C L C/N ' Fax:
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Job Descri tion: L,� o
Residential El /" �� Comm
Sq.Ft. Floor Area: $/S t.:
Ub A
Cost of Project: ccupancy p:
DDO
Type of Construction: Please check thi box if th W oject is a
,/V =4l /yL'L->Z-Yt second-story addit on:
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
1of3 � , QQ
SCITY OF CUPERTINC
CUP TYOF O PERMIT APPLICATION FORM
QuantityFee 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 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 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 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
Q1WITY OF CUPERTINO*
CITY OF PERMIT APPLICATION FORM
CUPEINO
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL
BREMSIGNS Remodel Sips, Marquee ELECTRICAL
BREMTHEATR Theatrical Li ting 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 Insaction BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL -
BUSLIC Business License BUILDING
ELECTRIC Elfctrical 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
ZADDCHG Address Change BUILDING
•
3of3
CITY OF CUPERTINO
BUILDING DIVISION PERMIT '0
BUILDINGADDRESS: RYON COMMERCIAL INC PERMITNO.04080225
OWNER'S NAME: PERMIT 15611E DATE
DEVCON BU
IE: SANITARY NO. Cath OL NO.
(408) 590-8894
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELEC PLUMB MECH
0 0 LICENSED CONTRACTOR'S DECLARATION O (j D O O
<�C I hereby affirm Nal 1 am licensedONTRA under provisions of Chapter Y(commencing Job DesC t (////Rlq.\9IILfIS IIIILLLIrrr55S^___
i with Sado 7 )of Division 3af the BusiPrafexsium Code.and mylieemeu
'Eq? in mum derrat �7Z t�!/ GAS METER
Litems ass Lic.N
H °'W `anDECII SEP 4l 2004
\ ARCHITECTS SDECUgAT10N
—t I uMctwnJ m lana shall te J es p recnrds
H
Ld u VnpL 6ifYl 4^63O-d'�hl s4c
w I L¢cnuU Pm OW / D I� �I 11 tF� Icy n /a
.�05 OWNER-BUILDER DECLARATION 'I�Jw hI�U I�I\((\`�—i/
<I I Wmhy affirm Nal 1 am eempt from the COFora lags License Law for the u V
n 0 following mason.(Sadun 7(01.5,Business and Pro saw.Coca:Any city or..my
m which requires a permit to construct.allen improve,demolish,or repair any mromure
Fa prior to is issuance.also requires the applicant for such permit to File a signed surcmcm
<
that be is licensed pursuant to the provisions of the Contrazmfs Limon law(chaptm 9 Sq. Ft. Floor Area Valuation
¢�0 (commenang with Section 7")of Division 3 of NC Business and PmfessinnsCMe)ur
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjccu the applicanuo a civil penally of 3'WPXQ'IitMcr 00 Occupancy Type
th
nut mom an five hundred dollars($5002 P Y YP
0 I,as owner of the property,or my employees wish wage u their sale compensation.
will do the work,and the suucwx is nm intended or offcxd tarsale(Sec.7344,Bum..
and Pmfeainm Code:The Contmcmrs Limsue law dues Out apply In an owner of Required Inspections
property who buildsar improve dexon,and who dommich work himselfor through his
own employees.provided that such improvements art not intended or offered for mm.If.
bovv ver,the building or improvement is sob within one year of completion.the owner.
builder will have the hunden of proving that W did not Wild or improve for Purpose of
aaie.).
❑I,as owner of the propeny,am exclusively contracting with licensed conmcmrs to
construct the pmjen(Sec.7(144,Business and Professions Cade:)The Contrmmre U.
tens,law docs not apply in an owner of pmpeny who Wilds or improves demon,and
who contmcu for such pmjccu with acontractor(s)liaved pursuant in the,ConuanoYs
Lm.Law.
❑1 sm exempt under Sec. B k P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury one of Oc following doelumions:
base and will maintain a Ccnihmue of Consentto self-insure for WmlxxlsCompen-
an,as provided fm by Session 37W of the Uttar Code,for Ne performance of the
work for which this permit is issued.
0 1 hats,and will maintain Worker's Compensation Insurance,u required by Sauon
3700 of the later Cade for the performance of tie work forwhich this permit is iamt,d.
M ik�eer'+s Compensation Insurance artier and Polity number art:
er..] ��Policcyy Nu.:"'4':zeal
CECATEOF EXEMPnONrM WORKERS'
COMPENSATION INS ANCE
(This section need out W mmplcicd iflhc permit is farina hundred dolhrs SIM)
or less.
1 ecoury that in thc performance of tam work for which this pamn it is isma d,1 shall not
employ any person in any manner at u In become subjmuo Nc Wurkx,d Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cmifcae of Excmplion.you should
become sabjal to the Worker's Competsstion provisions of the Lathan Cade,you mum
.JO forthwith comply with such provisions or this permit shall W deemed revoked.
ZCONSTRUCTION LENDING AGENCY
'C+ � I Wreby allimt that them is a construction lending agency for the pefromonve of
xIW work for which this permit is issued(See.3097.Civ.C.)
U]R Lender's Name
= Z Lcndcr's Address
U p 1 certify that 1 have read this application and stat,that the above inrormatlan is
U. H come%,I agree 10 comply with all city and county ordinances and state laws relating to
.QV building construction,and hereby autonx mpommunives of this city to enter upon the
r D.1 athow-rn oissail propeny for iropeeuon purposes.
F S (We)agree tp save,indemnify mrd keep ass Ne City of Caganino against
h liabilities,judgments,costs and expcnus wbi many wayaemue against mid City
V Z in consequence of the gran'in6 of this pe /
" APPLICANT UNDEMANDS A ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATION$.
26' Re-roofs
ignalurc ofHtrAZARDOUS MATERIALS DISC�SIRE Dat, Type of Roof
Will the applicant or future building Occupant more or handle hmardous maerial
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
code, CCdon 25532(a)±
res All roofs shall be inspected prior to any roofing material being installed.
pap
Will thea applicant or building Occupant use equipment or device whim If a roof is installed without first obtaining an inspection,I agree to remove
pp s 0AirQu
t hvardnus air contaminants as JcfncU by the Bay Area Air Quality Management all new materials for inspection.
uim7
@s 0
I have real the hvallous materials rcyvircmcnu under Chapt,r6.95 of the Glifao-
.is Health SafctyCodc,Sections 25yfi.25533 and 25534.1 undenal aim ifUe Wilding
docs not currently hart a wnanL ' my nmNoxibiliry to notify de occupant or the
requirementsrequirementswhich mustbeme r missuanccofe Cenifca¢of '.Pznry. Signature of Applicant Date
26'vL
r_ ownmorauN xdagent ; Dat, All roof coverings to be Class"B" or better