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04020005Opp _O= D L-0 nFyJ <J< 7�U '0 no Kmta V'N YFC 0 2 Z C CITY OF CUPERTINO""°°�" BUILDING DIVISIONPERMIT CONTRACTOR(I,NFORMATION A: BUILDING ADDRESS: !I 1i rAmnT,R.T,TnT4T wy CLAUSEN ELECTRIC INC PERMITN004020005 OWNER'S NAME: PERMIT ISSUE DATE LIONEL D ONE: SANITARY NO. CONTROL NO. (408)927-7322 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION lb Description vixions nr Chapter 9 (commencing, 1 hereby affirm door 1 am licensed under provisions with Sectio(n �7�N�Xo of Division 3 of Ne Business an Pmfcaands Code. and my license is in full fenicti 2 (�� lti effect. Lic. x UPGRADE ELECT SERVICE LE MO a4 0�ARCHICOnlIII hV0/ TECTS E ATION I understand my plans shall he used uhhc records FEB 2 62004 Licensed Professional OWNER -BUILDER DECLARATION I hereby offi,m Nal 1 am exempt from the Contraao's License law for the nnnn BUILDING I�BI� Ii��I1�rr U n • n NG following mason. (Section 7111.5. Business and Professions Calc: Any city or county kts� which mquira a permit to consumer. eller, improve. demolish, or repair any swcture Prior m its issuance, also reqs nes the applicant for such permit to rile a.signed statement Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions nr the Contractors Liccnsc Law (&dcr9 (commencing with Section 81x) of Division 3 of the Business and Professions Code) or Nal he is exempt therefrom and he basis for the alleged exemption. Any vinlauon of 3 5191240"M 0 Occupancy Type Section 7031.5 by any applicant for a permit subjects be applicant to a civil penalty of not more than fivc hundred dollars (S5x). ❑ 1, as owner of the property, or my employees with wages as Nei, sole compensation, Required Inspections will do Nc work, and the swctim is not intended oro@red for sale (Sec. 7064. Business and Pmfcaslom Code: The Contractors License Law docs not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If. however, dic building or improvement is sold within one year of completion. our owne, builder will have the burden of proving Nat he did not build or improve for putpo.¢ of sale.). ❑ 1. as or, of die progeny, am exclusively conuulin, with licensed contractors to construct the project (Sec. 7oaa, Business and Professions Codd) The Contractor's Lb scone law docs not apply to an owner of property who Wilda or improves thereon, and who contacts (ontmhp 'ccts with a contractor(s) licensed pursuant in the Contractor's Li�eoae Law. ' 1 am excm t . B h P C for this moon c. r_ D;/1 WOR R'S COMPENSATION DEC I,�,�R%��1yON I hereby affirm under penalty of perjury one of the Tltllowing dcdvationx: 1 have and will mainuin a Certificate of Consent to ulr-insum for Workers Compere Wine. as provided for by Section 37x of the labor Code, for Ne performance of the work for which Nis permit is issued. 1 have and will maintain Worker's Compensation Insurance, an required by Section 37x of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Missection need not be completed if the permit is Intone hundred dollars ($ix) tr less.) 1 certify Not in the pa formasp f Ne work for which this permit is issued. I shall not employ any, .n an adtepytaslub�ome subject ro tbe Worker's Compensation '171 Laws of Calif i /'i/ (•, f� Applic m NOTE PPLI : 1 ,after making this Cenifica¢ of Excmpion, you shoulJ hcrome hlca m the Worker's Compensation provisions of the tabor Code, you moa forthwith comply with such provisions or this permit shall her deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that dere is a covtnnainn lending agency for the performance of the work for which Ron permit is issued ISw. 3097. Civ. C.) Lenders Name Lender's Address I 1 certify Nat I have read this application and cum Nu the above information is conch. I agree to Comply with all city and county ordinances and sate laws relating to building construction. and hereby authome representatives of this city to enter upon Ne above mentioned prepeny for impaction purposes (Wc) agree to save, indcmni fy and keep harmless one City of Cupertino against j IiabilitoWedgmeno. costs and expenses which may in any way accrue against said City in consequence of a granting Of this permit. / APP LICA s�d'n ERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SO E T N5. Re -roofs Type of Roof 0 2 L0 `/ sere WXprilicamulCondractior'Date, HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building Occupant store or handle Kerardous material as defined by the Cupenino Municipal, Code, Chapter 9. 12, and the Health and Safety Code. Section 25532(x, �Nu All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Ii❑Yes Will the applicant or forum Wilding Occupant use equipment or devices which it hasardous air conammanu u defined by the Bay Area Air Quality Management all new materials for inspection. aria? ❑Ycs Po to ave nod Ne hasardnms materials myviromena under Chapter6.95 of Ne Califory ' riaHarald&Safety Coke. Sections 25N)5. 25533 and 25534.1 understand door if the Wilding docs not cunenrly have afenadl to{Wot E1 u my importainility to notify IM oc upant or the requirements whichtp' ,mkssoaneeoracenlfi ..or actrppt_ - ¢ Signature of Applicant - Date 0_ Z�/Ia--�— All roof coverings to be Class "B" or better OwnKnao1hnrdVp of 'MF CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID APN # 36 Z 2y 0Y(o I Date: 2-1-2-101 BAPPLOTHER Building Address: MECHANICAL 1/6 tLe-ic G>' Bldg Permits . foot Owner's Name: Phone #: Boiler <= 100,000 Btu G/oNCL AUer 773-/67/ Boiler > 100K to 500K Btu Contractor: License #: Boiler > 500K to IM Btu Cc4e-�W ELEC j12/L BBOILER4 Boiler> 1M to 1.75 M Btu Contact: Cupertino Business License#: Boiler > 1.75M Btu - ?- Dvag- BCONSTAX Construction Tax Buil'ng Permit Info: CEle BCONSTAX ❑ Plumb ❑ Mech ❑ BUILDING ob Description: S02v1C-c.C11ANfy 100 7zoo AMO- �J✓Pt,20 �MFz�n� Con. Tax for BQ Zone Residential Commercial ❑ 5-13 AtX, 3p - BCONSTAXH Sq.Ft. Floor Area: $/Sq.Ft.: ` BCONSTAXR ,2/200 BUILDING BELEC1000 Cost of Project: 0 try Occupancy Group: 7 BELE 1001 Type of Construction: ELECTRICAL % BELEC200 Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING 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 BELE 1001 Elec 600V > 1000A ELECTRICAL % BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housin Mit. Fee BUILDING 1 of 3 CC- CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO idi Quantity 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 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 AOL BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Tmp 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 BREMAEUiAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY 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 Ap liance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL 2of3 a CIN OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMRECEPT Rc tI 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 BSWINI 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 sq foot PLUMBING ZADDCHG Address Change BUILDING BMISCELL Building Misc Fees BUILDING 3 of 3 1