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04060019CITY OFCUPERTINO Ot' � '- - zth,�.nsl '' t ', I BUIL", 6 DIVISION PERMIT ACONTRWISTT OAR INF MATION BUILDING ADDRESS: PERMIT "04060019 04060019 OWNER'S NAME: PERMrf ISSUE DATE JAMES AHN NE: SANITARY NO. CONTROL NO. ARCHREC (ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby that 1 am licensed! under pmvidons of Chapter 9 (commencing p (� Bal is with Scction7 )of Division3of the Business and Professions Code. end my license is O) I in roll toes anCEILING FANS FOR LIVING ROOM License lui Lie, a Dam con r AND MASTEREDR-0 ARCHITECTS DECLARATI f I undimmed my plans atoll W used as public recmds CONTRACTOR: ALCAI� 1 LJ Licensed Pmfmd...I OWNER -BUILDER DECLARATION / I hereby aflinn that I tam aaempl from useComaarra Liman Law for IM / '- following rearm. (Section 7!131.5, Business and Professions Cade: Any city or county which requires a permit to conswck alcor, improw, demolish. or minor my Brucnm + L// poor m its issuance, also requires the applicant fanoch permit to file a signed comment that he is licensed pursuant o the provision of ted Contractor's License Law (Chapter 9 Sq. Ft. Floor Area U LJ_ Val On , (commencing with Section 7000) Of Division 3 of the Business and Professions Code) or 0�0 that he B exempt therefrom and the buLL for the alleged exemption. My violation of APN Number Occupancy p y TypeTypeen Section 7031.5 by any applicat fm a permit subjects the applicant to a civil penalty of live not more them hundred dollars (5500). 0 I, u ownm of tie property. m my employee with wages u their mle compensation, - Required Inspections will d. the work and ummumue 0 nm imended ma0aed forsak (Sm.7044. Business and Professions code: The Contractor's Limue Law docs Ant apply n an owner of property who Wilds orimprovestiterme, and whadoucuchwarkhimself.rthrough his Own employau, provided Wtsuch improvements art not Intended arortcred formic. If. however, the Wilding or improvement is told within aro Sear of completion. the owner. builder will have the Wrden of proving that he did not Wild or Improve for purpose of um.). 0 1, as Owner of the propen,, am exclusively contracting with licensed cantracme, to construct the pmjen (Sec. 7014, Business aha Prolcus ans Coda:) The Contractors Li. cense Law does not apply to an owner of property who Wild, or improves thereon, and who contacts for such projects with AconmOm(d licensed Immune to site Commoners License xe exempt am ue La I mpt under See. . B k P C (m m4 won C/y Owner Dam WORKER'S COMPENSATION DECLARATION 1 herby affirm under Penalty of perjury, ane of tha following ciseluai arm I have and will maintain a CeAOcam of Consent he self-insom fm Wmi ah Cont am. as provided for by Section 3700 of the ISWr Code, fm site perfmmence of the work for which this permit is issued. Waters Compensation unm. expend by Semon 0 1 have and will maintain WaterWou 3700.1' the Ube, Code. for the performance of the work for which this parent, is issued. My Workers Compcnsadon bas. canis and Policy number re: Carden Polity No.: <� CERTIFICATE OF EKEMPTION FROM WORKERS' COMPENSATION INSURANCE I'Do.secti.a.md not he completed ifthe permit is forom banded dollars ($100) or less.) 1 certify that in the performance of the work for which this Permit u issued. l Nall not employ any person In my mmnefm N an became abject to the Wmkerr L'.mpenLdan Laws of California. Dam Appllcmi NOTICE TO APPLICANT: If, after making this Cenificato of Exemption, you should become subject to the Workers Compensation provisions of sue Labor Coda you muss Forthwith comply with such provisions "is Permit shall he deemed amused, �. CONSTRUCTION LENDING AGENCY 1 heroby, eRrm that them is a mmmuction lending ageay for the perfmmanee of sue wmle fur which this permit h issued (Sm. 3097, Civ. C.) Lenders Name Lender's Address I mnify that 1 have mad this application aha tum that the amm Information is com em 1 agree to comply with all city and county ordinances and sole laws elating to building construction. end hereby mthodm representatives of this city to enter upon the shove -mentioned property fan inspection (We) a{ee to rave, indemnify and keep h smless the City of Cupertino against whichpurpmes. liabilities.consuent menu, crus and expenses which may in any w.y occmue •{don said City Inconsequence of the grantingof this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: sOUi{�E REGU TIfeA ONS. m _Gl �J (�(q,•�� X T 66 Re -roofs Type of Roof Signs= p[,applicantiContracmr am HAZARDOUS MATERIALS DISCLOSURE me applicant or future building occupant store or handle hu trammel Wil( u &Rned by the Common Municipal Gude, Chapter 9.12. and the N and Safety ode. Section ZSSIi(a)? 1(7(��e All roofs shall be inspected prior to any roofing material being installed. ❑Yes I \ If a roof is installed without first obtaining an inspection, I agree to remove Will sue applicml or future building =open, um equipment or dcvims which ;,it hazudnm air contaminants u defined by the Bey Area Air Quality Management all new materials for inspection. aria? Dyes Ste Ihe. &Sfc,, ehvsN.ona2555,2553ircmenu underomman ftifm lxt2m- Wiring ni es urSafety Cade,Smtimtsast ma myamp125534.1 to notiundwiflho Jou oat currently how a tenen4 Net II u my renpanslMlity to nosily the mcupant of the It squire ch mug poorniapam mncamofomupmcy. SignatureofApplicant Date "— All roof coverings to be Class "B" or better Owner or authorized agent Dom .it UZI CITY of CUPEkTiNO CITY OF CUPERTINO PERMIT APPLICATION FORM D Yd �OOD/7 N # Fee Description Date: / 2 9 BAPPLOTHER Other Appliances MECHANICAL Building Address: Mailing Address (if different from building address): /O/ Z W_ P.l%na p Sb/ Owner's'Name: Ta me d1>✓ f Phone #: 4ed') -2 ' Contractor: 14LCAL BBOILER3 License#: ✓c Jb Conta t: 07ed Phone: S'/a7 �o -ueol Cupertino Business License#: MECHANICAL Fax: 5`' o 6 Boiler > 1.75M Btu Building Permit Info: BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi Bldg ❑ Elect Plumb ❑ Mech ❑ Job Descript � �' �- hh as �l Ka., lZ{d r� , Pez9@mmercial Residential (,fit CMA pl ❑ Sq.Ft. Floor Area: Constax— Resi/Mobile $/Sq.Ft.: Cost of Project: Occupancy Group• Type of Constructio : Elec 600V > 1000A Please check this roject is a BELEC200 Elec Svcs 600V <= 200A second-storyaddition: El roject Size: Standard ❑ Laze ❑ Major ❑ BUILDING 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> 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 r L 1 of CITY Of CUPEI,TINO CITY OF CUPERTINO PERMIT APPLICATION FORM 2 of 3 Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCONfME 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 BPINITERCEP 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 HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 c&n MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL 2 IX Lighting Fixtures EC'LECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > I 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 BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL 2 of 3 CITY OF CUPERTINO CITY PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group 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 Insection BUILDING- ' BSWIM Swimming Pool BUILDING BTEMP - Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUS IC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL NIPERWEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee s foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 r�