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05040074
CITY OF CUPERTINO -: BUILDING DIVISION PERMIT CONTRACTOR NFORMATTION „* BUILDING ADDRESS: PERMIT N0. R K ELECTRIC INC 05040074 Q410 14QM;�FTRP9 RE) 43 OWNER'S NAME: PERMIT ISSUE DATE NE: SANITARY OL NO. ARCHITECT ENGINEER: BUILDING PERMIT INFO BLDG ELER PLUMB MECH ties. LICENSED CONTRACrOWS DECLARATION Job Description_ ' f� C I hemby affirm Our 1 am licensed under pmvisimu of Chapter 9(ecourc ing b with Section of Division 3 of NC Business and Prafea inns Code,end my license is ! / / smIn men Cl and err` (0 Lk.a N ( Qp POWER FOR COMPACTOR 7 ! ;�= LkemxGl , Tins 'jar[ nr� Dau 1 Cantrazm [a,.la1 ARCHITECTS DECLAR ON c u I uMcrsund my plans dull he uxd as public nmmds I � � �, \ ., f ;wt; Licensed Professional OWNER-BUILDER DECLARATION. iE I hereby affirm that 1 am exempt from the Commuctor's License Law for she no following mason.(Section 91Y3 L5.Business and ProNsdons Codd:Any city or county e y$ which requira pcmbo m co.,,she,improve,dcmalish,at.,.it any etrucure prior m its coot am.also sequins the applicant far Rich permit.file a signed summent the he is licensed pursuant m the provisions or NC clumn mit Lwcme law(Caapm,9 Sq.Ft. Floor Area Valuat5 n S ¢�$ (commencing he Is xempt Section and the Division 3of the s ageBusd ess andexempt on.MionsCMc)or .. that io r campy therefrom and the aper for the alleged exemption.Any violation of Section 7031.5 by any leddapplicant s($50permit subjects Ind applicant to acivil penalty of 33��'NI4'§er00 Occupancy Type sat mom Nan five hundred dollars(5500). 1,as owner of the property.or my employees with wages as their sole compensadon, will do the work,and tie structure is Out intended or offered(.,sale(Sm.70m.Business and Professions code:The ornament License Law does not apply m an Owner of Required Inspections propcny who Wileam improves lhamon,and whodaes such work himselfordrough his own employees,provided that such impmvemenu art not intended or offered for sale.If. however the building or improvement is sold within one year of completion,the Owner- builder will have Ne burden of proving that he did not Wild or improve for purpose of sale.). ❑h as Owner of Uu p open am eatlusively contracting with licensed cormacurs to common the projett(Sec.TBsa,Business and Professional Code)The Conlrazuri Li. cm xic Law does not apply to an owner of property who Wilds or imp.ves demon.and who contracts for such projects with a contractor(a)licensed pursuant m the Contractor's License Law. ❑ I am exempt under Sec. .B&P C for this reason Owner Data WORKER'S COMPENSATION DECLARATION / 1 hereby alarm under pecolly or perjury oro of the following deehrations: I have and will maintain a Cenificam of Consent to self-insure for Worion s Compen- 1371M on,pe provided for by Section 3700 of the ISWr Code,for the performance Of the k for which Nis permit is issued. 1 have and will maintain Worker's Compensation hoursom,pe equmad by Section of the Labor Code,fm the performance of the walk far which this permit is issued. Wmkees Comianumion In ice ortiu and Polity/nu.msb,per art: rier, a5 baa.{! FV Policy NaA"g6OMI HAZ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (TTS¢corn need not W cmmplemd if the permit is formic hundred dollars($109) per kms.) I unify Ihm in to performance of the work for which this Permit is issued.I shall not employ any person in any manner an as to became subject in the Workeri Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making Nr Ceniricau of Exemption,you should Wc.me subject to IM Worker's Compensation previsions of thc Labor Code.you must .J O forthwith Comply with such provisions or Nis pe.it hall W amount revoked. Z " CONSTRUCTION LENDING AGENCY [-. I hereby affirm that them is a construction lending agency for the performance of a tic work for which thr permit is issued(See.ID .Civ.C.) 441 Lender's Name z Lender's Address U Q 1 certify that I have mad this application and sou that the show infor osiun is E' coma I agree to comply with all city and county ordinances and sum laws elating w DU Wilding conmruclion,and hereby authorlm mp Camostiws of his city t0 cater upon led (47 move-mentioned pmperty for smpcc4on purposes. (We)agree to save,indemnify and keep harmless the City of Cupcnino against y liabilities,judgments,costs and expenses which may in any way accrue against said City U z APPLICANTOof ON the RraTANDSthis ND Wlpermit, COMPLY WITH ALL NON POINT Issued by: Date ;7' S. S4�� '411`1110'; _ Re-roofs canUCo0 ct r au -W .I ' MATERIALS DISCLOSURE Type of Roof Will the appllcam in fumfe building occupam smrc or M1andld hmasdous mnmrial defined by the Cupenina Municipal Cock,Chapter 9.13.and the Health and Safety de.Sectionz553z(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Ye Will the.ppOnnl.r rata.Willing attupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove h ha nrd.as air conumiaams u defined by the Bay A.,Ail Duality Mmagemem all new materials for inspection. District? ❑Yes o 1 have lead the Waardausmauriar requitemcnts under Chapter 6.95 of the Califor- niaHealth&SafetyC.dd,SectionsVi505.35533 asW .I unkrsuru thmif tie Wilding d dy a an Nat iy r mY ihility m naifY IM oauPa^s of the y.�meatsw h Ibc me raft cdnirma err cap Signature of Applicant Date .wad, .Tired agcm Dam All roof coverings to be Class"B"or better F Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building Department JOB IADDRESS' D � S ' i"1 f PERMIT #©S�� Q(�? OWNER'S NAME: PHONE # 5to GENERAL CONTRACTOR: (Z FAX # ^)p I am not using any subcontracto :� 'y Sigr6Ve Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical 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 Own r ntractor Signature Date aCITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM APN # 3l b G o (�3 Date: Building Address: Mailing Address (if different from building address): NL4io Own r' ame: Phone#: Co aFf EI� _ License#: 1-4—?';kq O Contact: Phone: SSo-1-11,11-10 Cupertino Business License#: 1 0 h2M6 Fax: 510 O t Building Permit In o: Bldg ❑ Elect IrPlumb ❑ Mech ❑ Job Description: Residential Elr Commercial Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ Project Size: Standard ❑ Laze ❑ 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 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of P-6 6 � - 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 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 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> IOK 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 MW BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO CUPEYOF PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group 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 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 Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3