05080162 CITY OF CUPERTINO X
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: CALIFORNIA POWER AND LIGHT PERMETNO05080162
1089 NOVEMBER DR
OWNER'S NAME: PERMIT ISSUE DATE
LAYNE YOSADA 8887 LILLY AVE 08/19/2005
ONE: SANITARY NO. COMROL NO.
4088470520
ARCHITECVENGINEER: BUILDING PERMIT INFO
BLDG EUCT PLUMB MECH
trop LICENSED CONTRACTOR'S DECLARATION r D 0 0
W I hcmby affirm Nn I am licensed under provisions of Chapter 9(commencing Job Description gp
-< with Section]OINI)of Division 3 of NC Businevsand Prefcasiuns Code,and my license is L•r� V f�
Ln mu mm and eryn UPGRADE ELECT. PANEEL (2O0AMP)
License Class LIc.N
Dam 6. ! Convenor
e' �T�ARCHIIECTS DECLARATIO 4 _ C�
a�''i 1 u red my pl all be used a public records �*7 .t-p�3
e G Li ec el {res Wit
1005
OWNER-BUILDER DECLARATION L{(;gy�`tlfIXpq/VT/pl �
<f 1 hcmby.(Bras o that I am,Bump,from the feednnors License Law for the {
LI O following mason.(Section](1313,Business and improve.
donons Code: ,.I,an or county ryJI/a;[� I1
em which mgoira a permit m cnmvuct,alter.improve,dcmoR h,m repair any mroclum rI 1/Y 21�o 0�
that h.nissuame.alw myuims lM applicam(orwch permiuo 0lc asigncd smmmcm ,
< mmheiscingwidpunuoattn th)o(Diaionsn of Contractor's License) io Chapmr9 Sq.Ft. Floor Area Valuation
x~$ (dumases xempt Senfor Wn0 th Diasis f r o(mc alleged
exempt Profusions Cade)or
ey Nm he u exempt thererrom and the beers for the alleged exemption.Any violation of
Section 703 any applicant for a permit subjects the applicant to a civil penalty of
nm man mann fvew<nanamd amlan(ssoo). Occupancy Type
❑Lssowmr .slid property, remyemntended with wagasstheirwle compensation.
will do Nc won,and me structure is not intended or Law
clues
s not.(Sec.]1166,Business
and Prrywh W cane:The wsllrannra Crane use dna net apply ll an ewmr is Required Inspections
propertywho buildsorimproveschireon,artasono tomssuchworkh r.fre orNmugh his
own employers,provided that wen improved wit are not our of d mpluti ed for ole If.
builder.mebuildingorimprovement issoldwithinoto Kar or completion.pas uowner- l
builder will haus the burden.f proving that be did not build or improve for puryose of
sale.).
❑1,as owner of the property.am exclusively contracting with limned convectors to
construct the project(Sec.7066.Business and Professions Cade:)The Contractors Li-
anas law docs not apply ban owner of property who builds or improve thereon,and.
who Contra=for such projecu with a convanor(s)licensed pursuant to an,Convactora
License law.
0 1 am enmpt under See B&P C fm Nis reason .. -
Owner. Dam
WORKER'S COMPENSATIONDECLARATION '
1 hereby Non under penalty of perjury use of use(allowing declarations:
I have and will maintain aCenifiate of Consent to elf-insum for Wor on'sCompcn-
sasion.az pmvided for by Section 370 of dm labor Code,for the performance of Ne _
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insunna,m required by Section
37Wo(thc labor Code,for the per(armanee of dm work for which this panni,is Issued.
My Workers Compensation Insurance carrier and Policy number am:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W cemplemd if me permit is furore hundred dollars($IOI)
or less.)
1 certify that in the performance of the week for which this permit is issued.1 shell nut
employ any person in any manner osteo�cymc avbjlc).saUe Workcrs'Compcnsation
Lawsef Califrmi c�wTN-F�wl
Appli ant
NOTICE TO APPLI :If.-after making this Certificate of Exemption,you should
become subject a Wed ers Compensation provisions of Nc labor Code,you most
J O (eMwllh comply with such provisions or this permit shall be deemed mwked.
z V5 CONSTRUCTION LENDING AGENCY
[-r I heaby a(fvm Nm there ism coramoul nn Imcling agony l'o,the performanm tar
!Ythe work for which Nis permit is issued(Sec.3097.Civ.C.)
D.1 Q Lcodcrs Name
CL
Lender's Address
U Q I ccmfy that I have mad this application and fu¢mat the above information is
Iy F correct.I agree to comply with all city and county oNinances and sum laws misting to
QU building construction,and hereby wmodm reprcaensies of this city M enter Open me
med property
purposes
�•'a alave-menuugamus, our fandc.Kuon Whichm. � .
(We)agree to saw.indemnify and keep humiess the City o(Cupenino agues,
N incoisequenc or
coma and expeveamit. they in any Way urnmag......d City
[J,z in consequence of Ne&mining of this permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU ONS.
AS Re-roofs
Signamrcpp, r - em
H ARDOUSMATERIAISDISCLOSURE Type of Roof
Wil").applicam or future building Occupant store or handle hwardous material
as ckfined by the Cupenino Municipal Chapter 9.12.and the Health and Safety
one.Section 25532(.)?
❑Yes Ne All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or Future building Occupant use cquipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hnvaranus ail contaminants ss dcfm by me Bay Area Air Quality Management all new materials for inspection.
avfet?
❑Yes Nu
1 have rtaJ the hsrardmsmamrialsmyuimmcnu undcrCNpmr6.95 of Nc Glifory
ria H.IN&Sec%y Code,Sections 255115.25533 ud 25536.1 undcmmnd Nm if Ibe building
does not torte ore a mount,that it is my responsibility to fury the axupam of the
aqui which must cme,Pd Issuance or acertificamafOccupan� Si nature
If
of Applicant Date
Owner or Djh5rindligent Date All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
4UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
C7 (
Cs" 0/ 1
OWNER'S NAME: e PHONE # S-
GENERAL CONTRACT FAX#
r�621
I am not using any subcontractors: C> g "/f—0,S
ature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical fn a,
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
� - CITY OF CUPERTINO f�CITY OF PERMIT APPLICATION FORM
CUPERTINO
APN# Date:
136.;,7
Building Address: Mailing Address (if different from building address):
-ft
Owner's Name: n Phone#: 46 73
n 2 do CL_
Contractor: License #:
Contact: / Phone: 7763
Fax: Cupertino Business License#:
�?�Jy
Building Permit into: L
Bldg ❑ Elect Ly' Plumb ❑ Mech ❑
Job Description: uPgr c—: e r c o-/ zoo
Residential ETCommercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: c� Occupancy Group:
Type of Construction: Please check this box if the project is a
second-story addition: ❑
Pro'ect Size: Standard ❑ Large ❑ Ma'or ❑
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>HIM 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/ uasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR COnsta --Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC?001 Elec 600V> 1000A ELECTRICAL
BELEfJ200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi I BUILDING
BINVESTIGA Investi anon fee BUILDING
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an
CITY OF CUPERTINO
g
° PERMIT APPLICATION FORM
CUPEkTINO
uanti 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 =Sprnin�kler/Backflo
Repeat Fee BUILDING
BPREPIPE ixtures PLUMBING
BPSEWAGE osal PLUMBING
BPSEWER PLUMBING
BPSPRINK Backflo PLUMBING
BPSTORM 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 Reins ection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfn MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Buswa s ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> 10K btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc A aratus ELECTRICAL
BREMNRAPP Rem Non-Res A liance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/A aratus ELECTRICAL
BREMRECEPT Re ti, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT R air/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Annlinn,e ELECTRICAL
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CITY OF CUPERTINO
CUP TYOF O PERMIT APPLICATION FORM
Quantity Fee ID- Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Si s, 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
t .j 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 Chane BUILDING
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