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03070221 CITY OF CUPERTINO BUILDING DIVISION PERMIT ONT,RACT(lR INFORMAT,IO BUILDING ADDRESS: """'03070221 ERMIT 1400 3 0 7 0 2 2 1 OWNER'S NAME: PERMITISSUEDATB APPLE rQMPUTER NE: SANITARYNO. CONTROLNO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH +00 LICENSED CONTRACTOR'S DECLARATION Ib Description U 1 hereby affirm that 1 am licenaco er pravl. ODSCTIp ,rna of Chapter 9(commencing with Sect, 7 ))orDi Jtc Husyfcxv and Profcssinne Codc.end myliccnsc is ?=Nin full fors fie IC•+'2Zg Oy V Iqz_ a«nae Lm.a y BOILER (2 . 5 MILLION). Da Co erreCONTRACTOR: AIRCO COMMER R®ICES f q ITECTS ATION W 'm rtrnrds re`s 't; LKCnIC m CSSIOnaI 0 bob Oat I.. UILDERDECLARATION NOV 1 ,2 2003 O I hereby.('firm that 1 am exempt Tram the lamins Co License Law for themy L vJ 00 followwhich ire reason.(Scours 703L5. t.alnns and ve de io demolish. Code:Any city or county which rtyuins a permit to conatrwL alter,improve,demolish,ter repair ed structure pdonnslissuance,a LOntin the theapplicantfor Such Permit micensfile ae Law E that he isccenmdpunuonOnthe of Division of the eB usincesnd Proelsw(Chode)or Sq.Ft.Floor Area U�'t�a].4 m O (eommene xempwith heefromon a d the basison]of alleged Any vi Code)or that he is exempt therefrom and the bass for the aticgcd cxcmptlon.Any vlolollon of Section 7031.5 by any applicant for a permit ubjects the applicant to a civil penalty of 3MN202616erO0 Occupancy Type ..I mon than five hundred dollars(5500). ❑I,u owner of the property,or my employees wish wages as their Sete compensation, wit]do deewon,and the structure is not intended orofe.d fo....(SCC.7044,Business R ��red CtIOnS and Professions Code:The Contractor.License raw does tot apply a an owxr of 301 - ROUGH P�'[JMB IMP property who builds or improves thereon,and who does such work himwl(or through his own employees.provided thatsuch improvements are not intended or offered for an,It. 303 — ROUGH MECHANICAL however,the building or improvement Ice Sold within one year of completion,the owner. builder will have the burden of proving that he did not build or improve far purpose of 304 - ROUGH ELECTRICAL Sale 1. 305 - FRAME 01.as owner o(she property,am exclusively contracting with licensed contneton to 308 - SHEETROCK cansrmat the project(Sec.7044.Business and Professions Code:)The Contractors Li cense Law ones not apply to an owner of propeny who build.or improves thereon,and 505 - FINAL ELECTRICAL who contracts for such projects with a eontncmr(.)licensed pun oon to use Contractor's License Law. 507 - FINAL PLUMBING ❑ Iam exempt under See. ,B&PCfor0usmso" 508 — FINAL MECHANICAL Owner DateAlikk 514 - FINAL PUBLIC WORKS WORKER'S COMPENSATION DECLARATION I hereby afrom under penalty of perjury one of the following declarations: I hew and will maintain a Cenincate of Consent to self-insure for WorkeriComp,n- anion,as provided for by Section 3700 of the Labor Code.for the performance of die wan for which this Permit is issued. ❑I ban and will maintain Worker.Compensation Insurance,xx rtyuimd by Sector 3700 of the labor Code,for the performance or Ne weak for which this permit i.issued. My Ce Work pssaion Insurance carrier and Policy omrIxr,am: ERTMCMADF Vq No.:1uqL�ny/ ON FROM WORKERS' COMPENSATION INSURANCE (This section need not tocompleted If the Icnnit is for one hundred dollen ISIOut or les.) ' 1 ceni(y that in the performance of the work for which this Permit is issued,I Short not - employ any person in any manner so a to become subject to be Workers Compeuntion Laws of California.Date Applicant NOTICE TO APPLICANT:Ir,after making this Certificate of Exemption,you about; become Subject to the Worker's Compensation provisions or the Labor CW,,you must z forthwith comply with such provisions or this Permit hall he deemed revoked. tiq CONSTRUCTION LENDING AGENCY I hereby affirm that there its comauctinn lending agency Iter the perfurmance of x > Ih,wort for which this permit Is issued(Sec.3097,Civ.C.) 11 O Lender'.Name 7 z Lenders Add., :.J O I cenify that 1 haw read this application and sunt,that the above information is y F-e correct.I agree to comply with all city and county ordinances and state laws meting to U building construction,and hereby awhorim mpresenntives of this city to enter upon the above-mcnuoncd propertycosts ford inspection ues PLOPOwhich s. (We)agree to Save,indemnify and keep harmless the City of Cupcnino against :i Z liabilities,csqence of the granondOr us .which may to any way accuse egelnsl said City - J',[ A APPLICANT ofD RSTAN of this APPLICANT UNDERSTAND WIL Y WITH ALL NON-POINT Issued by: 5URE ON ^/ •�a, �f Re•roofs Si u ( pelican S, Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or furore building occupant Sloes or handle hasrdoun material a defined by the Cupertino Municipal Cuero,Chapter 9.12.and the Health and Safc(y CWC,section 25532(x) AeNa All roofs shall be inspected prior to any roofing material being installed. W,II be applicantor future building Occupant use cyu,pmenl or devices which If a roof is installed without fits[obtaining an inspection,I agree to remove it hazardous air cnntamirams n deft]by the Be,Ana Air Quehty Management all new materials for inspection. ct❑res7 S� ❑Yes 'P . I have road the hanrdemsmSmrtdS requirements under Chapter695 of die Califon n,a Hea(th&Se@ty CSM,Sections 251415,25533 and 25514.1 undcruand dot ifdte building Jw not currently have.tenor tit is my Its u,mnotifydesanupxmof Ibc mqu,remen most toi 'fmateorOccupan . Signature of Applicant Date own ihorizeJ.gem / „e All roof coverings to be Class"B"or better Son CITY OF CUPERTINO o J 7 CITY OF PERMIT APPLICATION FORM CUPEkTINO PN—# 3>16 (�n O ) '1 Date: 2 Building Address: �U / glU� Mailing Address (if different from building address): Owner's Nam p GU 1 Phone#: Contra tqr: / License#:�-ij r� 3 /�ZrtY�Zuit G S f 61 Contact: Phone:Mo ff 1176 7770 Cupertino Business License#: Fax: VLie776,C Building Permit Info: Blft76ft Elea Plum Mech Job scription: Residential ❑ ommercial Sq.Ft. Floor Area: $/ c� Cost of Projec t/ Occupancy Group: e f Constructio Please check this box if the project is a second-story addition: ❑ 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 1M Btu MECHANICAL BBOILER4 Boiler> 1 M 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 BMITIGATC Comm. Housing Mit. Fee BUILDING a 6r`1 1 of CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM QuantityFee 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 BOVERTINM 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 BPINfERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Cbeck Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Repipe 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 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> t 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 2 of 3 Q CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM ' QuantityFee ID Fee Description Fee Group BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL 15) BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, 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 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 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 Chane BUILDING 3 of 3