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03070206 l OF CUPERTINO �• h' 'x RLHL IN'G DIVISION PERMIT CONTRACJTOR=INFORMATION'_ BUILDING ADDRESS: SOUTHWEST ELECTRIC PERMIT'903070206 OWNER'S NAME: 14510 BIG BASIN WAY PERMIT ISSUE DATE MARSHALL CRART.,qTF, M 07 /2R /2003 ONE: (408) 999-8721 SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MFCH 0 0 0 0 ±op LICENSED CONTRACTORS DECLAR or chapter Fp I bmmy.form that 1 am B«nxa ander ndPredns orchode,L9 my license .Job Description �iW with Scaion]ggl7 ofDivision 3oftM Ousincss and Profcssians Code.andmyliccuc is inei fume and ee` 7/00�// ELECT SERVICE UPGRADE 55p11`,,`IC'/,{An rye t7�'�s i xCl, Contac or F7 Fp Date Lie ARCHITECTS DECLARATION i U I understand my plans shall the used as public records ' coG LiccasculPmfcssional JUL 9 2003 S OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the BUILDING COO following Lemon.(Section]IDIS.Business and Professions Code:Any city or county which requires a permit to consumer,alter.Improve,demolish,or repair any mocom poor In its issuance.also requires the applicant for such permit to rile a signed statement .OGthat he is licensed pursuant intheprovisionsoftheContracwrsLimnulaw(Chapter9 Sq. Ft. Floor Area Valuation [1— (commencing with Section 7")of Division 3 of the Business and Professions Ggle)a, 3 that he is exempt therefrom and the buts for tW alleged exemption.Any violation of 35923013 . 00 Section]031.5 by any applicantfor a permit subjccks be applicant to a civil penalty Of APN Number mom man five hundred dollars a:K0). Occupancy Type I,ssownu of the pmpcny,mmy cmPloYcu wire wagcxu their sole compensation, will do the work,and Be swnure is not intended oroffemd for salc(Sec.70,14,Business 304 _ huuuh and Pmfesumas Code:The Conuschori Li¢m<Law docs not apply m an owner of property who builds or improves,thereon,and who does such work himulforderough his 501 - FINAL L TRI A NERDY own employ.,provided Last Such improvements are noumendol mo@red for sale.If. SOS — FINAL ELECTRICAL however.me building or improvement is sold within one year of completion,the owner. Wilder will base the burden of proving Nat he did not build or improve for purpose of salt.). ❑I,as owner of Ne propeny,am exclusively contracting with licensed contractors to Construct the muco(Sec.]Ma,Business and Profusions Cadc:)The Contractor's Li. ccue,Law does not apply to an owner of property who Wilds or On proves themon.and who contracts for such projects with a convactor(s)licensed pursuant o the Contractor's Licevc Law. ❑ l am exempt under Sec. ,B&PC for this moan Owner Dam WORKER'S COMPENSATION DECLARATION I hereby affirm under pculry of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent o ulf-houre for Worker's Compcn. sstion,as provided for by Section 3700 of me Labor Code,for me performance of the work for which this permit is issued. ❑1 base and will maintain Worker's Compensation Insurance,as mquimd by Senion 37O0 of the latwr Code,for the perfmmanee of the work for which this Permit is issued. My Work rs Compensation In. ce canter and Polity number am: Cartier. S /rN Policy No.: 7L ,. CERTIFICATE OF EK EM PTI ON FROM WO COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollen ISla)) or kits) I coni fy that in the performance of the work for which this Permit is isvucd.I shall not employ any person in any manner se as to become subject to the Workers Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,aper making this Ccnificam of Exemption,you should become subject to the Worker's Compensation provisions of the Libre Code,you muse {Z, forthwith comply with such provisions or this Permit shall W deemed revoked. ZO CONSTRUCTION LENDING AGENCY I hereby affirm cast there is a construction lending agency for the perfurman a of 3' the work for which this permit is issued(Sec.309],Civ.C.) 1.) Lendch Name z Lenders Address :.3 O 1 certify Nat 1 have read this application and sum that she above information is yF correct.l agree to comply with all city and county ordinances and state laws relating to JU building eouwction,and hereby audwrim representatives of this city to enter upon the tq above icS,judncdpmp est for inspection purposes. 0. (We)agree to sae,indemnify and keep harmless Ibe City of Cuprono against L,iZ liabilities,judgmcnls,cosuand of this csmit. may in any way.terve against Mid City J Z A cPLIC NT of me UNDERSTANDS of this Permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued IO by: Date Z SOURCE GULAT �/�/ ornpp —�r O� Re-roofs mDate HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building mcupant store or handle hilarious material as defined by the Cupertino M cipal Code.Chapter 9.12,and the Health and Safety Code.Section 25532(.)?0y. pFNa All roofs shall be inspected prior to any roofing material being installed. Will the applicant of future building occupant use equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove it ha ardous air commainx,u dcfned by the Bay Area Air Quality Management all new materials for inspection. Ludes' ❑Yes I have mail me hanalmismaterials mquimmems under Chap¢r6.95 Oldie Califon nits Health&Safety COM.SCCLOM25515.25533 am12553a.1 understand thatifthe Wilding dues not currently haw a tenant,that it is my respmoihility m artily the Occupant of ON mqui cjm which mustWmm orw'�issu cc ora Ccnifium of Occupancy. Signature of Applicant Date Owner or authonsud agent Date Aj All roof coverings to be Class "B"or better amnCITY OF CUPERTINO CUPERTINO OF PERMIT APPLICATION FORM 3 7 L J 6 PN it Building Address: / Mailing Address f different frbuilding address): Owner's Name: CPhone#: Contractor: License#: 7/QQ y �yrLi Contactl/!/?,r Phone: Cupertino Business License#: J b Fax: Bu ng Permit Info: ]d El ct Plumb ❑ Mech ❑ Jbb,Wescription: Residential ❑ / er ' 1 ❑ 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: ❑ 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> 500Kto 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 BELEr-C1000 Elec 600V<= IOOOA ELECTRICAL BELEC1001 Elec 600V> 1 OOOA 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 1 of3 /�/�7 z7 SamCITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEI,TINO Quantity Fee 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 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 BPINI'ERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Repipe 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 Fumace> 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 BREMPOe/Apparatus ELECTRICAL 2of3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 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 his ection 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