05030098CITY OF CUPERTINO
BUILDING DIVISION PERMIT
ICON-RAC�TORANFORMATIONN
--1 a
BUILDING ADDRESS:
CUPERTINO ELECTRIC INC
PERMITN 05030098
OWNER'S NAME:
PERMIT ISSUE DATE
ZONE:
SANITARY C OL NO.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Jb Description
op
t, incomif Chapter 9 (commencing
1 back, efhrm the, I am liecneod malou o
i with Sdction7")uf DIVlslaa3oftht BUsine andPafcssio s ode gQm}�liccnm is
in full farce and crha!)
�p /
Liccvc class �-Lwg I
DEMO CURB & TREES
s O Data 75 i
CHEECTSDECLARATION
R
t I understand my plans shall k used as public rteoms,
Licensed Professional
DECLARATION
S Oren
1 AM CUILOER
1 hereby alarm License Law for Ck
11. cxdmpe from dr C
cadre, o C
i following moon. it ]0,str Business and Cole: Any city as county
(Saturn
improve, demolish. rie any structure
2 which requires a Permit m construct flue imprr
hch
permith,
^ e,also su a sig
also mquims doapplicantof forthe Conrcrmiuocense, Lawned (Chapter
of its tensed
littaudPuration700)ofDiviomoflkCanlaanessandPrYlaw(Codur9
Sq. Ft. Floor Area
Valuation
that he I
(comiasis(on , oflkc,cd Business and Professions CtWC) or
(commencing with 0
ma
g (cat
exemption. Any violation of
it ta, Ad,
Nato r therefrom and dm aper far
hep,
3 lgMtpltpelp 0
Occupancy Type
be cts dud
Sectionm 31.5 b for a permit subjects Ne applicant to &civil penalty of
by e,ry
in. red dant
Am marc Nan Rue hundred ciollan (5300].
I,uownerof and lifaycny, myemploydes with wagesaz Blair talc
Required Inspections
(See. 7044,
r 7044, Business
will dothework- pods: swmumisnotintendedorflemat
awduanot caury
and Professions Code: To Canuacmh Litems law lou not apply to an owner
is
thereon, and who does such work himselfor his
property who Wilds or ed
*at such not
ownemployees,provided Notsuch imps
the ale.own If.
ear ofdmoRered
sold wiitin the awned
however, the Wilding or a sold within ane year of
CS
of potent
improvefar
builder will have dr handed of proving Nn k did not Wild or improve far pu,pou of
sanstr
/
/
❑ 1, as owner of Ne property, am exclmivdly contracting with licensed conaacm,s la
construct project(Sec. 70ad,Business and Profecoom Code:) Contractor's
_
pro n
d man owner of property who Wilds or improves Corton, and.
terve law dors not such
whocontractsLa for such projects with a eontsactor(s) licensed pursuant to the Contsacmh
V�
Lan
0License..
� I am exempt under Sec. . B @ P C for this reason
Owncr Data
WORKER'S COMPENSATIONDECLARATION
I hereby &from under penally of perjury one Of the following declarations:
1 ban and will maintain a Certificate of Consent to calf-insure for Worker's Cumpen-
odion, az provided far by Section 37W of the labor Codd. for the pdtfmmance of the
work for which this Permit is issued.
II have and will maintain Workers Compensation Insurance, u required by Section
7 of Ne labor Code, for the performance of the work for which thisPerra t is issued.
CWorkers Cntgpenya' n nee tion: POIry Noit y WC
CERTIFICATE OF EXEMPDON FROM WORKERS'
COMPENSATION INSURANCE
(This semion need not Meompleted if Ik permit r faroac hundred dollars nIM)
at leas.)
1 anify dem in the performance of the work far which this p .1, r issued. I shall am
employ any person in any manner sO u w become subject to the Workcrd Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Ccrtificau of Exemption, you should
became subject to one Worker's Compmuatian provaiMo of due ISM, Code, you mob
toMwith comply with such provisions or Nis Permit Affair k deemed ranked.
5
CONSTRUCTION LENDING AGENCY
1 hereby affirm that facts is a construction lending agency for the performance of
s du work for which this permit is issued (Sec. 3097, Co. C.)
Lender's Name
w Lender's Address
1 rarity that I have mad this application end scam Nal the about information is
' coned.) agree to comply with all city and county ordinances and sou laws relating b
building construction. and krtby auNoms representatives of this city to under upon the
U akve-mentioned Pmperly for ins,action puryn s.
(Ws,) agree to save, taciturnity and keep hbmless ft City of Cupertino against
0 liabilities, judgments, Costs And caresses which may In any way accrue against said City
in consequence of the granting of this Permit.
APPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
soURC ULA /
Re-roofs
Type of Roof
9/ �� O5'
Signature of Applicant/Con�� Data
HAZA,R US MATERIALS DISCLOSURE
Will de, applicant of future building occupant bort or handle hansdous material
u defined by Ik Cupertino Municipal Cods,. Ckpm, 9.12. and the Health and Safery
IMLCuric. section 25532(a)7 J a
❑Yes 2
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will du applicant or future building occupant use equipment or devices which
11 havarJaus air contaminants u defined by the Bay Area Air Quality Management
all new materials for inspection.
minO`i u
Ycs �a
f
I have read the haardrms matenalssequimmcnu underC WPur 695 of fad Calirm.
A!. Health& Safety Calc. Scctiodca 5S)5.25533 am12533a. I understand Ne, iftk Wilding
does not tune dy haus, a uaant that it r my rupouihility m notify de occupant or the
requireme'. hichso bk poor w isuame or a Cerdruau of Occupanry.
Signature Of Applicant Date
5-S o
All roof coverings to be Class "B" or better
Owner or authorand agent Dam
CITY 0,
�UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADD SS:
Cv,Ce-pNo Ear c r c
PERMIT #
os d 3 D
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR: ev?,gx;,2Ti alo G
FAX #
I am not using any subcontractors: `Z�'Q�r� 3 —
Sig tore Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
Date
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
Owner/ Contractor Signature
Date
ll
0
t
a(hifill
CITY OF
CUPEII;TINO
CITY OF CUPERTINO
DEMO
PERMIT APPLICATION FORM
05-a 3 o a ye
APN # 3 0 /
Date: 3 _O J—
Building Address: �>✓J �� L60
p
Owner's Name:
Phone #:
yo& - gog
Contractor:
License #: l.7 !J 9.3
Contact: ,Z' C ZG (Z /\ 6 --CA)
Phone#:
Applicant/Contractor:
CU19rF2j /rv0
Building Permit Info:
Bldg lect Plumb Mech
Job Description: P(E htO O V PP 15 1 r'" C-5
Residential: ommercial:
Sq.Ft. Floor Area:
$/Sq.Ft.:
Architect/Engineer:
Valuation: /61000
Type of Construction:
Occupancy Group:
Qty. if
ADDlicable
Fee TD
FPP T)Pcrrintinn
BPERMFEE
Bldg Permit Fees
BUILIDNG
BSEISMICOM
Seismic Commercial
BUILIDNG
BSEISMICRE
Seismic Residential
BUILIDNG
BPLANCHK
Plan Check Fee
BUILIDNG
BUSLIC
Business License
BUILIDNG