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05070205CITY OF CUPERTINO h•�.� r{F-- m4r�+ax pw<n. �', BUILDING DIVISION PERMITCONTRACTOR INFORMATION ,+,+fhi4a's. ..sb •�,�. ; , ^:: d+Y'£w ,—seg ;s.. BUILDING ADDRESS: FISHER POWER AND DATA INC PERMRN0.05070205 21063 CHRISTENSEN DR "VER'S NAME: PERMIT ISSUE DATE PEARLMAN DALE L AND DARA B 949 INDUSTRIAL 2005 PHONE: SANITARY NO. CONTROL NO. (650)325-5768 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I anliamod under provisions of Chapter 9 (commencing with Section 7") Of Dhrision 3 ofdie BusineV YIJ Poug aimm arka.and my license is iicfail see ana.ffe t// COVERT EXISTING SUB PANEL TO Ja PBOX��g _ Lea �� amse L �® Date - --`a � enmrguh - s RE ROUTE CIRCUITS TO MAIN PANEV ARCHITECTS DECLARATION I uMc nd my plans shall W used u public rccords &aa/9- 2005 Licensed Prof.srhoul OatNE. DECLARATION erierDER 1 hougo a(firtn on 1 am exempt from direbe Conms Coo Li..nu Law for my followingmazon. Try!str BusinessitCo d.: MYcity pr county pQCgs,, p ins nnn [I.,? `' improve, ore pair structure permit t alcor, improve• which myuircs a pumit ata construct. d Yd i7 h Permit on ed tohatWiucensed e.aboreyuims the applicant rorthe sucContrarm's the LawJsumment Sq. FLFloor Area .. ""Valuat ��2'00� tprior Lice se malhminranwthSectaminlhepmvivinon3macnmrneauansevonsCndter9 (commencingwitbhereon Division30 the Business and professions Calc)tar Any violation that he u exempt therefrom and Ik buts F. Ne Wegnd cwnpuw. Any violaJon of slid the APN Number Occupancy Type Section 7031.5 by airy applicant for a permit subjects the applicant in a civil penalty of net mnrt than five hundred d.nam (M). 32654005.00 ❑ I.uownuof Biepmpmty,ormyemployaswimwaguumeirmlcco Kmdon• Required Inspections will do the work and theameart is not intended m offered forsaic(Sec. 7064, Bum. and Professi.ns Code: The Com eters License Law docs not apply to an owner of ,employ who builds or improves thereon, and who doessuch work himself ser through his awn employees, provided that such improvements arc not intended or offered Tor sale. if, however, the building or impmvament is sold within one year of compaction, the owner. Wilder will have the burden of pmvi., Nat he did con build or improve for Purpose of .I.J. ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to consumer Ne project (Sec. 7014, Business and Pmfcswons Code:) The Conmctals Li' cense taw docs not apply a an Owner of property who W nm or impmws Berton. and who concocts for such projects with a contracum(s) Iiansed pursuant to the COnnSma License Law. ❑ I am aempt under Sec. ,B& P C for this reason el Data WORKER'S COMPENSATION DECLARATION I bemby alGmt under penalty of pujury one of the following decimations: ❑ 1 have and will maintain a Cer ifints of Consent to self -insure for Worker's Comycn- sation, as provided fm by Satio r 37M of dre Labor Cade, for the performance of da work for which this permit is issued. I have and will maintain Worker's Compensation Insurance• u required by Section t 3 of the Labor Code, for the performance of the work for which this permit is timing My Worker's COMMonatioo/n''I�Insurance /cca�rrier and Policy number me: `� 046,M9317 -0L/ Casrier�Jlt�I FA21 al/ Policy No.: - CERTF� MON FROM WORKERS' COMPENSATION INSURANCE (This secdot need not W completed Vital permit is fmone hundred dnllars (5100) ser less.) I certify that in the performance or the work for which this Permit is issued, 1 shall not employ any person in any manner so as to become subject m the Worleeri Compensation laws.( Cahfomia. Dam Applicant NOTICE TO APPLICANT. If, afar making this Cenifcata of Exemption, you should ha.mc subject to the Worker Compcnution provisions of the labor Code. you mug r.Mwi th comply with such provisions or this permit shall be deemed Baked. CONSTRUCTION LENDING AGENCY I thereby affirm Bal Bert iroacd(See.3 Icnding agency for me perfurmancc of . ' docLa work fur which this permit is issued (Sec. )f9'!, Civ. CJ ' Lorick% Namc , Lendcr'i Address j 1 comfy Bat I have read this application and gala that the eWme informatics. is ' comet. I agree to comply with all city and county Ordinances and sure laws relating to building construction, and hereby authorize representatives or this city to enter upon the above-menuoned pmpcny for inspection purpose& (wc) agate to save, indemnify and kap harmless the City of Cuperim. against j Iiabili0es.judgments. Cosa and expenses which may in my way&cc= against said City in of the goarming of his APPLICAeNTCUNDERSTANDStAND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. Re -roofs Type Of ROOF Signature of ApPlicaOU Date HAZARDOUS MATERIAL, DISCLOSURE HAZARDOUS Will ince applicant or future building apt store or handle h allous material az defined by the Cupertino Municipal Code.e, Chapter 9.11, and the Health and Safny • ,Scction255314)? 11 All roofs shall be inspected prior to any roofing material being installed. ❑Yes . INe If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use cyvipmem Or devices which emit haudous air canammants as defined by th. Bay Arta Air Quality Management all new materials for inspection. District? ❑Yes AN. 1 have read the haarBms mawliss myuin menu under Chaptcr6.95.f tW Calirmr or. Health & Safe,code. Sauaru 25505.255 3 arta 25534.1 undersand that irBe when, docs not currently have a tenant. Bat it is resporuibilitY u nudfy the oaor., Of the gairtm_nawhich mug xmtopor ..rac.mnesta.ro.cumcy. Signature of Applicant Date ' All roof coverings to be Class "B" or better Own mm�dr agcm Data I0 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Elk: Lot: APN ........: 32654005.00 DATE ISSUED.......: 07/29/2005 RECEIPT #.........: 30586 REFERENCE ID # ...: 05070205 SITE ADDRESS .....: 21063 CHRISTENSEN DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: suem COPY # : 3 OWNER ............: PEARLMAN DALE L AND DARA B ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-1652 METHOD OF PAYMENT AMOUNT OTHER 103.16 TOTAL RECEIPT 103.16 VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL • NUMBER ------------------ VISA VOICE ID DESCRIPTION 501 FINAL ELECTRICAL ENERGY RECEIVED FROM ....: JEANNETTE FLORES CONTRACTOR .......: ANTHONY FISHER LIC # 21713 COMPANY ..........: FISHER POWER AND DATA INC ADDRESS ..........: 949 INDUSTRIAL AVE CITY/STATE/ZIP ...: PALO ALTO, CA 94303 ........: (650)325-5768 STELEPHONE FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL BELEC200 METERS 1.00 29.43 0.00 29.43 0.00 BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 BSEISMICRE VALUATION 3,200.00 0.50 0.00 0.50 0.00 TOTAL PERMIT ---------- ---------- 103.16 0.00 ---------- 103.16 ---------- 0.00 METHOD OF PAYMENT AMOUNT OTHER 103.16 TOTAL RECEIPT 103.16 VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL • NUMBER ------------------ VISA VOICE ID DESCRIPTION 501 FINAL ELECTRICAL ENERGY CITY OF ® CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 0,5070-Z APN # Fee,Descri tion Building Address -Mailing Address (if different from building address): Owner's Name: 1��rc� �trl�-tai Phone #: X108- 99�-/ y5 Contractor: R skarpptoer /Zkr License #: X10 �3 `%/ Contact: I Phone: 65Dqp q-35GU i s&v- Fax: 650-99y-356.1 Cupertino Business License#: / %/ Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: cpnvO Svbpanel —T�) ---T e�,aX Residential 9 !Z1'AUJe QiMul1S 'TU PCP'i &fWl Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: 3 0` Occupancy Group: Type of Construction: Please check this box if the project is a second -story addition: ❑ Project Size: Standard 1 Large ❑ Major ❑ BBOILERS Quantity Fee ID Fee,Descri tion 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 BBOILERS 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 1 of 3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO 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 rinkler/Backflo 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 App liance ELECTRICAL 2 of 3 CITY or CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch —ELECTRICAL BREMSIGNS Remodel Sips, 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 Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electfical, 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 PLLONGRNGC Planning LR Comme/ Multi -Faro PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3 J •