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04060080 CITY OF CUPER'rINO " ' BUILDING DIVISION PERMIT akCONTRACTOR'INFORMATIO M' BUILDINGADDRESS: MI ELECTRIC INC PE""904060080 10742 CARTER DR OWNER'S NAME: PERMRL9SUEDATE CHRIS CAMPO 525S STEVENS IEo SANITARY NO. CONTROL NO. . (408) 366-0100 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH +,+O i] LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that 1 am Iicemed under provisions of Chapter 9(commencing with Section 7")of Division 3 oftie Dusirrc. rofessions Cade.and my license is Motif ao �d eIf � dip's UPGRADE ELECT. SERVICE U=IPJALEln m 2 Liccnu I X L�lJ Contra r e ARCHITECTSDEC ATION ' J01- 1, - 2004 'y5 z I understand i urecants my plans shell used ahlicrecants ZiV C, LittnscJ Pmlcssinnel '—' < OWNER BUILDER DECLARATION CmdraON .@ �I.� L<F I hcrchy affirm Thal 1 dm exempt from the Comonors License Law for the MILII LING s p o following reason.(Section 903 I.S.Rusin¢s add Prefra Imes Code:Any city r county ss� �tl�J K m ff which hegoios a permit to construct,.Iter.impose,demolish.Or repair any ewcmm ROO 'y—to prior to its issuance.also requires the applicantfor such permit to file a signed statement Nal W is licensed pursuant o the prevision of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valua[Ion z:a (cnnmencing with See ..1")of Division 3 of the Busirnsand Professians Cale)or y 3 that he is exempt therefrom and Ne basis for the alleged exemption.Any violation of Section 7031.5 by arty applicant for a Penna subjects Ne applicant to a civil penalty of 3 AP32faii)rffier0 0 Occupancy'Type not mom Nan five hundred dollars(a5W). 0I,mowneroftiroprogeny,ormyemploycuwithwageuNoirnlcmmpcn on, will do Mc work and Ne swcturt is nollmcMcd or offered forage(Sec.7014,Business and Profusions Cade:The Contractor's License Law does not apply to an owner of Required Inspections progeny who builds or improves Nemon,and who does such work himself or through his own employees,pmvided that such improvements are not inmnded oraffemA forsala If. however.Ne building or improvement is sold within one year of completion.Ne owner- builder will have Ne burden of roving Nat he did not build or improve for purpose of .I.I. 0 1,as Owner of Ne property,am exclusively contracting with licensed contractors to construct Ne project(sec.704a,Business and Professions Code:)The Contra n's Li- ane law dors not apply to in owner of property who Wilds or improves themon,and, who contracts for such projects with a contractor(s)licensed pursuant on Me Contractor' 0 I am exempt under Sec. .B k P C for this rtssan Owner Dam WORKER'S COMPENSATION DECLARATION I hereby affirm under penally of perjury one of the following declarations: have and will maintain a Ccnifieam of Continuo self-insure for Workers Compcn- .tion,as provided for by Section 37W of Ne Labor Code,for the performance Or tW work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Insurance,as mquimd by Section 37W of the labor Code,for Ne performance of Ne 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 mus section need not W completed if the permit is for..hundred dollars($100) or less-) 1 certify that in Ne performance of Ne work for which this permit is issued,l shall not LM., to an rs�inn any manna tyre ry[ c.the Workeri Com .tion laws of Cal ragnman 2� 9comeau�jef pen Applian // 4 NOTIC APPLICANT:if,after..king Certificate of Exemption,you should bccom a jcn to the Worker's Compensation provisions of the Labor Cotle,you must .,Z, forthwith comply with such provisions or this permit shall be deemed rooked. Z2 CONSTRUCTION LENDING AGENCY [-. 1 hereby affirm Nal Neo is a constmedon lending agency for the performance of (y' 7 Ns-work fur which this permit is issued(Sec.3091,Civ.C.) Isntlers Name Z Lender's Address - V C) I certify that 1 have reed this application and sum Nat the above information is ly F cormcL 1 agree to comply with all city and county ordinances and sum laws relating to �W asnve-gentiond pro and hereby actionprprtsenuNes of 0.city to cnmrupnn the C. aWvcmcntionctl to ertysave for demnify an keep es ha (WC3 agree to save,indemnify and which harmless w y City of rumagenta against Uh incoitio,jutlgments,Sassing expenuswhich may in any way eccoe against and City V? APPLICANT eUNDERSTAof the NDS Aof IN WILL COMPLY WITH ALL NON-POINT Issued by:s Permit. Dat SOURCE EGULATIONS. / L_ �""l. 6�'' r(f- Re-roofs Sit�pdmof AFplusam/Camracmr /Dam HAZARDOUS MATERIALS DISCLOSU Type of Roof Will Ne applicant or fumrt Wilding Occupant sreo or handle haxami us material as lrcd by Nc Cupenim Municipal Code,Chapter 9.12.and the Health and Safety nuc. 0yn lss32(an eesra{It All roofs shall be inspected prior to any roofing material being installed. �wal the applicant ldm buildin Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove pp g pan quip. wards air contvninants as defined by Ns-Bay Arca Air Quality Management all new materials for inspection. sunt? ❑Ycx '&No 1 have head Ne haxodous amandalsseyvirtmenu under Chapter 6,95of the Calif.,. nice Health&Safcsy Code,Smuons 25505.35533 and 25534.1 understand thatif thc Wilding dOCi n01 Nrnendy have 8 ICnrdnl Ndl it is my(CSpanibililY m n'ry NC OCcupNt of dm rtquihemenm Mehmug bemetpdnrtoi.uaneeonceNBca ro[[p [y. o Signature of Applicant Date own[ rauth�n cdafc. pato a All roof coverings to be Class "B"or better CITY OF CUPERTINO BUILDING DIVISIONPER CONTI2ACTORINFORMA ° N + a.:,n.:l . _ .,.�, a .r;L°�;•.a -.-.;?:; 'cam: BUILDING ADDRESS: MI ELECTRIC INC PERMITNO0406 O O 80 10742 PERMIT ISSUE DATE ER'S NAME: CHRIS CAMPO 2 STq,l SANITARY NO. CONTROL NO. PHONE: (408) 366-0100 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH +�iOO LICENSED CONTRACTOR'S DECLARATION Job Description C I hereby affirm that I am licensed under provisions or Chapter 9(commencing b with Section 7000)of Division 3 of NC Rugines rofcssians Code,and my license is - aa _�„ 'Lich erm �- t; < (� UPGRADE ELECT. SERVICE p v�2 'Lich Ch Cl / Ch t2Camra r £u, ARCHITECTS DEC ATION c. IundcrstanJ my plans stall the used u u1dic rccards '+off LianscJ Pmfcsxinnol S OWNER-BUILDER DECLARATION o C <g I hcrchy affirm that 1 am exempt from the Contractor's License Law for the V as p O following reason.(Section 7031 S.Business and Pmfessimts Cade:Any city or County K$ which"rim,a North to conswa,alter impmva,demnlixh,or repairby.1.0the thrid in its issuance.also,requires the applicant for such permit to file a signedsutcmcnt S F[. Floor Area Valuation at he is licensed pursuant to the pmvisioa.of the Contractor's License law(Chapter 9 fl. y�$ (Commencing with Section 700)of Division 3 of the Business and Pmre'sinns CnJc)or ��,m� au�— Nat he u exempt therefrom and the basis for Ne alleged cs-mpf...Any=Of 3 7 .ywiwsLf sk�CiO 0 p y Type Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of OCCU anC T e not most than fisc hundred dolls.(55001. ❑1.as owner of Ne property,m my employees with wages as their role compensation, swill do the work,and the swaure is not intended or offered for A.).(Sec.7044.Business Required Inspections and Professions Code:The Contractors License Law docs not apply to an owner of q property who builds or improves Nchad.and who does such work himself or through his awn employees,provided that such improvements are not intended or offered for sale.If. however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not Wild or improve for puRose of gala.). 1,as owner of the property,em exclusively contracting with licensed eonwao.to chronic,the pmject(Sec.7044,Business end Profusions Code:)The Cmitac or's Li cents law dues not apply to an owner of propcny who builds or improves Neuron,and, who contracts for such projects with o coon nor(s)licensed pursuant to the Contraaots 01nY law. slam exempt undo Sec. .B&PC for this maze. wOcrDate WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Penalty of perjury one of the following declarations: ❑I have and will maintain a Ccrifacate of Consent o sel6ingurefor WarkersCumpen- sasion,az provided for by Section 37M of the LAW,Cod-,for the P-rrom once Of the work far which this permit is issued. 1 have and will maintain Wmkcea Compensation Insurance,as mquit-d by Scrota 37M of the Labor Code.for the performance of Ne work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Carie'. Polity No.: CERTIFICATE OF EKEM MON FROM WORKERS' COMPENSATION INSURANCE - I-nd,section need nor W campleNd tribe permit is Image hundred dnlla.(SIM) Or less.) I anify Nat in the Performance of the work for which this permit is issued,1 shall not empI oy any pe man mann tol�comc�suis mane Workers'Compensation _Laws al Califamaa ¢ ��' ” ��51' - NOT IC APPLICANT:If,after making daps Cision for Evemptio d,y should Wcom comply it Worker's Compensation provision of the Labor Code,you must �z fonhwiN comply with such provisions or this permit shall W deemed revoked. Z N CONSTRUCTION LENDING AGENCY r- thereby affirm that there is a construction lending agency for Ne Performance of (y' > th-work fur which Nis permit 0 issued(Sec.3097,Civ.C.) !+]o Lender's Name z Lender's Address U C I Certify that 1 have mad this application and Mute that the above information is FCorea.I agree to Comply with all city and county ordinances and state laws relating to �U building (We)agee n.to gave. Inde niy Add keep Anomlovuaof Nis city to enter upon the l r U abov--mention l property for inspection puspoms. G (We)agree m sale,indemnify and keep humthss 1M Ciry of Cupena.against FVy liabilitia.judgmcnu.rasa And-apc.which may in any way sec..against said City U in consequence of togernfingOfthis Kmit. DdI ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: o� SOURCE EGULATIONS. A�l Re-roofs Si -rcorAppliMhVConuectarDoth Type of Roof HAZARDOUS MATERIALS DISCLOSU Will 1W applicant or future Wilding occupant atom or handle hmsrdous material ax de0ncd by the CupeTa.Municipal Code,Chapter 9.11,and dM Heabb and Safety Code.Section 15531(.)? All roofs shall be inspected prior to any roofing material being installed. ❑YesNu Will the applicant air rut m building Occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove emit hanrdaus air con rmin.nts az defined by Ne Bay Arca Air Quality Management all new materials for inspection. District? '' ❑Yes &No 1 have mad the hanrdnus materials requiremcnts under Chapter 6,95 of the Caron, no Hcahh A Saha,Codc,Scerim,25505.25533 And 25534,1 undersand that if the building docs not currently have a¢rant.that it is my mspomibilu to no ly the occupant of the require us Itch srWmetpdormbg.mreofaCcmrcam faeapaney Signature of Applicant Date L� —� ��' All roof coverings to be Class"B" or better Ownc r.uthmirad egcnt Date � f � 0 0 N W • °0 Oo C ...� oTfY Otl i!D e set ,f plan' and specifications - 4t uu the job at all times and ft is un oT N ul to make any changes or aherattons 1 ame without written permission from n r e Juilding Dopt., City of Cupertlno, 0 'e stampirry of this plan and specf t!gno N Hf LL NOT be hold to pormit or tD b* g: c )pi wal of tht violattcn of any �c a• "tkc r+��Raflr 9r �Wt`M 191y n n r) 110PI �J u N G - OCITY OF CUPERTINOO CITY OF PERMIT APPLICATION FORM CUPEkTINO APN# Date: Building Address: /a 7lc--- carr—ver— ,/fir Mailing Address (if different from building address): Owner's Name J/ . Phone #: i 6E) 6S—/_i a v Contractor: [. License #: C —/o / ��6c/�,'G /-7i L Polk 04 Contact: , PhoneC O&) w c o Cupertino Business License#: Fax: C5464:).3 dd—)-{coo 71 Buildin ermit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential 'Co r al Sq.Ft. Floor Area: _ $/Sq.Ft.: Cost of Project: n r Occupancy Gro Type of Construction: / / Please chec this box if the pf ct is a second-stor ddition: 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 Flee 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 � � / a� CITY OF CUPERTINOS CUP fyOF O PERMIT APPLICATION FORM 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 Heater/Vent 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 BREM3USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREN HEAT 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 {cx CITY OF CUPERTINCS CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Sips 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 Ternp 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 s foot PLUMBING ZADDCHG Address Change BUILDING • 3 of 3