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04050098 CITY OF CUPERTINO e'rc BUILDING DIVISION PERMIT 'fCOIVY,RACTOR INFORMATION BUILDING ADDRESS: MI ELECTRIC INC PERMITN004-050098 10742 CARVER DR OWNER'S NAME: PERMIT ISSUE DATE CHRIS CAMPO 5255 STEVENS ('REEK 13LV 430 nc; /17./2on4 ONE: SANITARY NO. CONTROL NO. (408) 366-0100 ARCHITEMENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH t� Q n00 LICENSED CONTRACTOR'S DECLARATION JobDescri tion Wu C I hereby afford that d am licenakd under provisions of Chapter 9(commencing p c, with�ato97,=,) fDiviv Sof NC Busin�ru Cc .and Immune, _tR„ ;nmllThyy'adery n UPGRADE SERVICE PANEL TO 200ANBNALE© pcaz Limns Lie.a ARCHITECTS R 10 fy� '�p-' IundcrstanJ my plans shellMusedas uhfe mentis MAY (,yV 2004 DyU ;�t; Licensed Pmfcssimaid i g OWNER-BUILDER DECLARATION 1 hereby Mforn Nal I em Carhop,firm the Contractors License Law for the a moon. BUILDING o following (Sotiom 7131.5,Business and Porasso iuCade:Any city or county I K$ff which mulches a permit to construct.cher,improi demolish,or m,M,any structure 'awe prior N its issuance.also requifea the applicant for such perllit to rite a signed statement that he is licensed potation to the provisions of the Convector's Limeac Law(Chapter 9 Sq.Ft. Floor Area Valuation (commencing with Semion 7000)of Division 3 of the Business and Professions CMC)or i that he is exempt therefrom and the btu for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 0 0 Occupancy Type not more than f hundred dollars($500). 0 I,m owner of the property,or my employees with wages in their sole compensation, will do the work and the swaum is not intended or offered for sale(So.9004,Business and Professors Code:The Chinn 'a Licerue Law does not apply to an owmm of Required Inspections property who builds or improves themon,and who dos such work himself or through his own employees,provided Nat such improvements am not intended orofre ed for aide.If. however.the building or improvement is sold within one year of completion,the owner. Milder will have the burden of proving Nat he did not build or improve for puryose of Calc.). I,as owner of the pmpcny,am exclusively convecting with limited contractors to COMCMCl the project(Sec.7814.Business and Professions Code:)The Contractor's Li moan law dors not apply to an owner of property who builds or improves themon,and who contacts for such projects with a contrxcmKs)limned Putman,to the Contractors License U- 0 1 sir exempt under Sec. .B&P C for this maser Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penally of perjury one of the following dedarafome 1 have and will maintain a Cenifcam of Consent to self-insum for WekersCompen- station,as provided for by Section 3700 of the labor Code.for Ne performance of the work for which this permit is issued. 0 1 have and will maintain Workers Compensation Insurance,m mquirod by Section 37 the labor Code,for NPermit e performance of the work for which this peit is issued. Mlt rmr '�Coms prsennmfioon lT su �cc carrier Pol lq- Carrier. 'nMf.YYVM� 7�1I�tWtyNo.: CERTIFICATE OF EXEMPTION FROM O..ERS' COMPENSATION INSURANCE phis meNmn need not he Completed tribe pcmiit Is forome hundred d ilhrs(5100) less. I mNfy Nm in the performance of the work for which this permit Is issued.d shall not employ any person in any manner an as in become subject to the Workers Compewuon Laws of California Box Applicant NOTICE TO APPLICANT:If,afar making this Cen ficale of Exemption,you should become subject to the Worker's Compensation provisions of the labor Code,you must �Z forthwith comply with such provisions or this Permit shall he deemed mvokcd. ZO^ CONSTRUCTION LENDINGAGENCY 44w l hereby affirm Nat Nem is a roittocunn lending agency for the performan¢of 1r 7 Ne work for which does permit is used(Sec.3097,Co,C.) D]A lenders Namc Dz Isnder's Address U O 1 comfy that I have mad this application and state that the above innervation is [a. f" cared 1 agree to comply with all city and county ordinances and mule laws mlating to 0 C.j building convection,and hereby auNoria mprmxntstives of this city to enter upon the Y' above mentioned property for iitpccu0n purpo.a (~6. (W c)agree to ave,indemnify and keep harmless the City of Cupertin0 against TA limilitma,is gmenu.eosis and expenses which may in any way accrue against aid City ' r q� C)z incanseque corthegrantingorthis Permit. (/ ^ APPLICA UNDERSTA DS AND WILL COMPLY WITH ALL NON OINT Issued by: Date SOURCE ULATION Re-roofs 91. m o 1 P ' HAZARDOUS MATERIALS DISCLOSURE Da Type of Roof Will the applicant or furore building Occupant store Or M1andlc havutlous mammal as defined by the Cupertino Municipal Code,Chapter 9.11.and the HeaIN and Safety adMode,Scc Yes �n 25532(a)? &No All roofs shall be inspected prior to any roofing material being installed. ❑Y Will the applicant or rote.building Occupant use equipment or dkvioos which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. DistritO ❑Yes dNu 1 have mad the hmallous martinis regWremems crack,Chapter 6.95 or the Califo. M.HeslN&SafetyCode.Secueu 25505.15533 and 15534.1"Clikevnd that if the Wilding docs not currently ave a UMM4 Nat it 4 my resptmihifity cry the ac ant n e acquircmcnuwhi mustbcmc 'ortuesounceofaCci-id,t cuy�r Signature of Applicant Date Owne,aaoloni cIa CM �J ate All roof coverings to be Class "B" or better a Community Development `4✓ 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408) 777-3333 #UPEkTINO Building Department JOB AD SS: PERMIT A C' (C5- n ry o� a 9 ?5 OWNER'S NPHONE GENERAL CO ACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followin ,information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical (C. 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 /Contrafor Signature ate CITY OF CUPERTINO CUP OF TYO PERMIT APPLICATION FORM N # �7S— 3 -21- U cr Date: 5 111-1 Da Building Address: Mailing Address (if different from building address): 0= aCA12- FX nkiv�- Owner's Name: Phone #: C"Il CAMM Contractor: License#: MI Ir- INC . c6o)0,912 Contact: Phone: Cupertino Business License#: o%g —0I00 Fax: g7 �6G-.2400 . Building Permit Info: Bldg ❑ Elect R� Plumb ❑ Mech ❑ Job Description: UPGRCtJgI; WIAll1 9evzVICQ Residential ®' panel 6qO6 A Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupan Group: Type of ConstructiPlease check this box if the pr6ject is a second-story addition: ❑ rgiect Size: Standard Lar e ❑ Ma'or ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER OtherAppliances MECHANICAL 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 I of 3 ��� v, 6z 7 ' ` CITY OF CUPERTINO �� CITY OF PERMIT APPLICATION FORM CUPEkTINO 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 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 HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMA.IRHAN 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 BREN MISC 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 2 of 3 CC CITY OF CUPERTINO CUP TY OF O PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 BSVTIM 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 • ZADDCHG Address Change BUILDING 3 of 3