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03060137 CITY OF CUPERTINOua�'F� A•r' BUILDING DIVISION PERMIT ,,CONTRACTOR INFyORMATION, . BUILDING ADDRESS: _ WILLOW GLEN ELECTRIC INC PERMIT N0O3060137 O (408) 289-9725 N0 WNER'S NAME: 1085 WARREN AVE PERMIT LSSUEDATE ONE: SANITARY . CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH Ins Op LICENSED CONTRACTOR'S DECLARATION Job Description F❑ I hereby affirm that I em licensed under provisions of Chapter 9(commencing p iW with Section7")ofDivision 3ofthc Business and Professions Codc.md my license is ��? in fuBf aefrc5�. }�J 0933 - 200A SERVICE UPGRADE License Clan [1�� Lie.t (. ,Fn DO —¢ Contractor g..a r I11e w�P�eTk &Ie q\a- ,f �[yOOJ'] w,a ARCHITECTS DECLARATION �� /R 'E WIan d my plans N �J all he used nrJs e t, Luc n cd BUILDING�k1 �p< OWNER-BUILDER DECLARATION ✓tJILDING I hereby affirm that I am eaempt bum Nc Cnnuactor's Liecnw Law for the p o following reason.(Section 0101.5.Business and Pndessions Code:Any city or county <m which.quires a permit ,,construct,eller,improve,demolish,Or repair any atrucmre prior to its issuance,also requires the applicant for such permit to file aligned smtemem £ Is that he is licensed pursuant totheprovisionsoftheContractor'sLicenseslaw(Chapter9 Sq. Ft. Floor Area Valuation y (commencing wi th Section]gp)of Division 3 or the Business and Professions Code)or It Nat he is exempt Shamirom and the basis fur the alicgcd exemption.Any violation of 36923028 . 00 Section]031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of AIN wNumber Occupancy netmomnfivehundreddollars(s5W). pane y Type ❑1,az owner of the PropcnY.or my cmploycu with wages u their sole compensation, will do Ne work,and the muaum is not intended or offered for sale(Sec.]Odd,Businu5 and Professions Codes:The Contramori License law does not apply to an owner of Required Ins ections property who builds or improves thereon,and who does such work himsclfor thmugh his 304 — ROUGH ELECTRIg.'AL awn employees,provided that such improvements are not intended oroframd for sale.If, SOS — FINAL ELECTRICAL - however,the building or improvement is mid within one year of completion,d¢owner- builder will leve Loc Wrdcn of proving Nat W did not Wild or improve for purpose of sale.). ❑1.az owner of the propene am exclusively contracting with licensed contractors to construct der pmjen(Sec 1044,Business and P rfnseions Code:)The Contractor's Li Sana law does not apply to an owner of property who Wilds or improver;thereon,and. who contracts for such projects with a contrsctor(s)licensed pursuant to the ContranoYs Leen.taw. C3 1 am satrap.undn Sec. ,B 6 P C for this mason Owner Data WORKER'S COMPENSATION DECLARATION 10 1 heme,affirm under Penalty of perjury ore of the following declarations: 1 Kass mW will for by St eCeni37M of Cumene toCode.fans for Worker's cempcm lotion, r provided thi for mi Section 3700 of Ne IaWr Code.for bur pcAormartcc of Nc work for which this permit is issued. ❑1 ban and will maintain Worker's Compensation Insurance,az required by Section 3900 of NC labor Cada for the Performance of Ne work for which this permit is issued. My Worker's Compensation Insurance noicr and Policy number art: CaTep L+- i o caws YPPeR fn tNut t IB89UU ` yj C TI FICATE OF EKE ION OM WORKERS' COMPENSATION INSURANCE (Thawetiot need nm W completed if I c Permit is forme hundred dollars(5100) or less.) I ceni fir that in the performance of the work for which this Permit is issued,1 mall not employ any person in any manner an as m become Subject o the Workers'Compensation Laws of California.Dna Applicant NOTICE TO APPLICANT:If,after making this Ccni fate of Exemption,you should become subject to the Worker's Compensation previsions of the Labor Cndc,you must .J ,Z forthwith comply with such provialnns or this Permit shall be deemed invoked. Z'O CONSTRUCTION LENDING AGENCY [+ I hereby eRrm Nat there its conswetion lending agency lot the perfurmnmc of ai Loc work fur which Nis permit Is issued(Sec.3W7.CO.CJ 0 Lpndcr INames Z Lenders Address U Q 1 certify Nu 1 have read this application and sate that the above information is ly U corrott I onset m comply with all city and county ordinances Of and Cute Jews mining m �U abow-rocmiums!ion,and hereby auNomereprrsenutivcs of Nis city to enter upon lM aaWve-sh,pd,fr property for inspection plarraowhich Ms. (We)agree to Saxe,indemnify and keep harmkss Ne City of Cupenum against _ Z inconsefmadgmcnts,castsand cxPcvcamit. may in any way¢arta againsuaid City U Z incortsequenccofLoC granting ofNisPermit. APPLICANT UNDERSTANDS AND ILL COMP ITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. /�s . _O V^ Re-roofs mgnaz�fcP ppl¢anVCamrmt pato .J' HAZARDO fATER1AL5 DISCLOSURE Type of Roof Will Nes applicant or future building Occupant wore or handle harardous material az defined by the Cupcnino Municipal Cuda Chapmr 9.13,and the Health and Safety itrict? We.Section 25533(,)? All roofs shall be inspected prior to any roofing material being installed. ❑Ya No Will the a bans or r�buildin nev ant um a If a roof is installed without first obtaining an inspection, I agree to remove pp B v a Air Qu or devices eme n g irhavamnus aircnnmmin,nl/as defined by the Bay Area Air Quality Management all new materials for inspection. �.yyl/'\mSl ❑Yes No I have real the baaartlnus ¢nada requirements under Chapter 6.95o1theCa1ifo- nia Health h Safety Cole,Sections 35505,25533 and 35534.1 undarsrand ther if Nes Wilding does not currently hale a tenant,Lord it ism t.formilehly to nodly the recupmt of Loc rcyuircmc icM1 must cc ora Ccnifcamof Occupancy. so �igna[ureofApplicanl Date Owner inedagent Date All roof coverings to be Class "B"or better 11 '( CITY OF CUPERTINO cuP TYOF PERMIT APPLICATION FORM IN N # j � e O� Date: Building Address: C� to I �s�� le-5 Owner'sSTame: v one #: ewe ]w Contractor{ License #: Contact: MackCupertino Business License#: _ i ding Permit Info: 0 Bldg Elec Plumb ❑ Mech ❑ Job ription: cad e� ideLo ntial ' O� Secvlce_ 9 0 Commercial ❑ Sq.Ft. Floor ea: $/Sq.Ft.: Cost of Project: 6 J Occupancy Group: Type of Construction: Quanti 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> 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 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD EnEgy Add Multi BUILDING BEWESTIGAInvestigation fee BUILDING BMITIGATC Comm. Housing ousin Mit. Fee BUILDING 222 -L Z, 1 of 3 Z