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05060131OC zC a`> 4� Uz VC O� 6 U� CITY OF CUPERTINO . BUILDING DIVISION PERMIT CONTRACTOWINFURMATIU 3A BUILDING ADDRESS: JD ELECRIC PERMIT N0.05060131 OWNER'S NAME: PERMIT ISSUE DAM NED BRIT ONE: SANITARY NO. CONTROL NO. (408)639-(5305 08 63 - ARCHITEC (ENGINEER: ARCHITTI BUILDING PERMIT INFO BLDO ELECT PLUM MECH O O O O LICENSED CONTRACTOR'S DECLARATION Job Description licensed under proviuou of Chamr 9 (mmmerem, I bereby affirm mut i wan de P with Section TOM) of Division 3 o the Business and Patfcssiom Code, and my license 4 In full torts and effect .X 'S 'to (0 UPGRADE ELECT. SERIVE (200AMP) Class License ChiLic.g Data A —do @Y' Charxmr _%Sj i ARCHITECTS DECLARATION P� I understand my plane shall m Used as public records U \, Licensed Pmfngonel OWNER -BUILDER DECLARATION I hereby .(Seat that 11. exempt from the Conlnctofs License Law for the following maw n. 703 LS, BUsNer. and oli Code: Any city or county '00f permit improve. de fi mash which requires a permit re enwroe4 aloe inmar omment it1 i37rta. h Permit I ed Pdmwits iuumce.aim such untto On The appNISof far such PcrmiuLine.. aw(Chumcm that be es limn wit pursuanttothe provision of mw Canuxur'and law (Chodter9 Sq. Ft. Floor Area /x� y ✓ Valuation (commercial;withScalon?abed of Division of the CNS) of V / \1�A eged muendon. Any Net be 4 swops therefrom and Ur bu4 for the alleged esempmon. Any viohuon of that he 111 I1 fl 341 N3rii38t8er00 - �/ ��Ut/ v,tffff,Occcupancy Type �aRmnr�wh aarppplEmt fw( pemi[mbiec Neapplian[MaciAlpenItyof 5001. I, u owmf of mm pMPMY, M MY MPlayeu wiM "rA ss theit WIC MMPenadan, Required Inspections will do the wmL and [Instruction is Out intended in offered farsale(Sec. 7044, Butirraa and Professions Code: The Conuactora License Law does not apply w in want of q P property who builds or impatiens thereon. and who doessuch work himselforthrough his own employees, provided Out such impatvemau a, notintended araOaM fmaale. if. hmvover. Use Wilding or improvement is sold within oro year of cemplemon. the comer. Wilder will have the burden of proving Net he did not build or Improve fm purpose of sale.). ❑ 1, an awner of the property, am exclusively contracting with licensed cannon to construct the project (Sec. 70,14, Business and Professional Cede:) The Comhwwe'a Li- cense Law dote not apply in an owner of property who builds or improves thereon, and who contracts for such projects with aeomacur(s) licensed pursuant to the Conawtots License law. C] I sun exempt under S.A. . B @ P C far this recon Owner Date WORKERS COMPENSATION DECLARATION I Inanity affirm under penalty of perjury ane of mu following ministrations: I have and will maintain a Cerdfiate of Consent Io wlp4s me far WmIxesCompen- aa,an, u provided for by Section 37M at the later, Code, far the performance of be work for which Nis Permit is issued. ❑ i have and will maintain Worker's Compensation Insurance. as required by Section 3700 of the Labor Cade, for Ne pegormarece of the work far which thin Permit 4 butted. My Warkefe C,om/pememon Inaunntt artier end Polity nu, 76 0036_ �T/t FDan Center. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' ' COMPENSATION INSURANCE (This woman =it an, becompleted lithe permit 4 terrane hundmA dollen ({100) or leu) I unify, that in On performance at the work for which Nis permit 4 inucd. l shall not employ any peace In any manner an in to became subject in mm Warken' Compenadon Laws of California. Dau Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you should became subject w Ne Worker's Campemadon provisions of On IaWr Cade. YOU most faMwith amply with such provision or this permit Nall be decreed evoked. CONSn1UCrION LENDING AGENCY , 1 bercby affirm Nat Nen 4 a construction lending agency for the Performance of On work for which thin permit Is Issued (Sec, 3091, Civ. C.) Lender's Name Lender's Add. 1 certify that 1 have read this epplicadim and sue that the aWve information is y, correct. I a{ma in comply with all city and county ordinances and sure laws relating w hereby wthon rproves of Nis citywenia upon Ne anon-gcansauctlro.and purposes. ebeve-mentionedproperty forimpactionkeeph and hop CITY of Cupertino st (We) agree to gyve. indemnifyexpansion id City liabilities, may in m w expeUsamit. may in any way eecmc eggng raid City thecatsend In conxgmnce of the r tlng of this Permit. APPLICANT UND]Jl N S AND WILL COMPLY WITH ALL NON -POINT Issued by: Date �J sOURCE REGUL{MD/t G 40-0-5 Re -roofs Type of Roof Sigmturo of AlNlir Due H n RDOUS MATERIALS DISCLOSURE Will On applicant or future Wilding occupant gam or handle huardou material as defined by the Cupertino Municipal Cade. Chapter 9. 12, and the Health and Safety ode. SchonYa 25532(¢)7 ❑fture 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 the applicant or f(u'W'm Wilding occupant use cyuipmenl at devices whicM1 It hanMou sir conumimm s u dearud by the Bay Ane Air Ouality Mamgement all new materials for Inspection. District? ❑Yea Iham mW the haardausmamdals requirements under Chapter 6.95oftheCalifm- nieHcnlN@Sgely Code.Smmom 357115, 27573 and25534.1 unmenund thalf the Wilding does not coma vee mmu% Nu It 4 my responsibility m notify Use occupant of the uquimmemnwni u e et pd or w Issuance of a ceniiate or occupancy. Signature Of Applicant Date �'- All roof coverings to be Class "B" or better Ownmoreudmm d m D� ,� Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: o;08So a eLee lAgAe PERMIT #0 / 6 j 3 ! OWNER'SNAME: /Yeb X�+- PHONE# 0!T—;lSS 5175 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information Owner/ tr ctor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical 30 El�c ick 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/ tr ctor Signature Date F� CUPEI,TINO CITY OF CUPERTINO PERMIT APPLICATION FORM APN # S 3 �s3 Date: Building Address: Mailing Address (if different from building address): afibSo a erz CA�� Owner's Name:Phone #: y08- ass-S'1�r Contractor: License#: 67868 Contact: Phone: Y46.634 - C3e 5 t- Fax: o8-" S % Cupertino Business License#: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential V JZ*6t- elect SeFA4-e,+6 oAvfCommercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: G� CW- Occupancy Group: Type of Construction: Please check this box if the project is a second -story addition: ❑ . Project Size: Standard ❑ Laze ❑ Major ❑ BBOILER5 r Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <=100,000 Btu MECHANICAL BBOILER2 Boiler > I OOK 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 > IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of ��`� CITY OF CUPERTINO PERMIT APPLICATION FORM 2of3 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 Pb1g 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 rinklerBackflo 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 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFD{T Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > 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 BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rcpt], Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 . 0 CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee 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 Inspection BUILDING BSW1M 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 I BUILDING 3of3 r