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05060130BUILDING DIVISION PERMIT JD ELECRIC 5060130 9a'dSIA gas YaINvLYAJ SANITARY y0p LICENSED CONTRACTOR'S DECLARATION Job Description rd Ii1 hereby Afton that I Am licensed under previsions of Chapter 9 (commencing a< with Section 700D)of Division 3 of the Business aha Predications Code. And my license is 'i in lull (O Lie. st 6x7868 UPGRADE ELECT. SERIUE (200AMP) Dam_; —3.e=O Conuacmr O P_Ler.. tr 7W ARCHffECI'S DECLARATION '3 , U I und.nu tel my puns shall W used As public «cords / OWNER -BUILDER DECLARATION I hereby Arlon that I am exempt from Ne Contractor's License Law for the following mason. (Section 7011.5, Business and Pmfeasans Code: Any city or county which mq.t. •permit m eommuct, alter. Wpmw, demolish. or repair my structure prior m its issuance. also requires slueapplicant for such permit in file • signed summem that he is licensed pursuant to the provisions of t e Conmctur's Lice se law (Chapter9 (commencing with Section 7000) of Division 3 nide, Busieesamd Pmfessions Code)., this he is exempt themfmm and the basis (m she alleged exemption. My visitation of Section 7031.5 by any applicant for a permit subjects the applicant an a civil penalty of not mom than five hundred dollars (M). ❑ I, as ownerofthepropeny, ormyemployces with wagesassie,lrmlecmnpenmdon, will do The wart, and site structure B not Intended nranend for We (Sec. 70th. Businbu And Interactions Cad.: The Germaufs License Law does not apply m an owner of property who Wilftis orimpones themon.and whodoessuch work himselforthreugh his own employees, provided thatauch impmwmenu Are mninuended oronemd forsale. IL however, the building or improvement is old within one year of er nple0on, the owner. builder will have sire burden of proving Nat he did not Wild or improve for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors, to commuct the project (Sec. 70th, Business and Professions Code:) The Contractor's LI- ccase law does not apply to an owner of pmpeny who Wilda or improves thereon, and who convects for such pjeeu with a conentor(s) licensed pontoon m the Contncm/a License Law. ❑ lamexemptunder See ,B&PCfn thisreamn Owner Dau Is WORKER'S COMPENSATION DECLARATION 1 hereby Anon under pally of perjury one of the following declwions: 1 have and will mdnum a Certificate efConsam m self-insum for WoenesCompen- 1 haw and will maintain Worker's Compensation resonance. As requited by Section D of the labor Code, for the performance of the work for which this permit is issued. (This section need not he completed if the permit Is forone hundred dollars (SIM) then In the performance of the work for which this permit is lined, l mall not my person In any mmlnerm As in become object to the Worken'Compensadon become subject to the Worketa Compensation provisions of the labor Code, you most vJO forthwith comply with such provisionsor thin permit mail be Accountmwked. Z' " CONSTRUCTION LENDING AGENCY [-n tN+ I hereby Afton that then lsaconstmctinn leading agency ren ft perfesmsnce of C'M the work for which this permit u Issued (Sec. 3M, Civ. C.) al.0 Iendcfs Name z Lender's Addreas U Q 1 certify that I cow mad lids Application and sou this sire Above information is U, !'. corms. I agree In comply with dl city and county ordinances and rete laws teasing In C) rV^ Wilding convection, and hereby audtmim represemowe of this city m enter upon the W ,bow-mendowd property for inspection purpoma (We) agme in an. indemnify and keep haonleas the City of Cupertino against n.mN Ilabilid"Judgmenuic ran durensa which may in my way seems gains) said City V In consequence of the ndnyy'' of this Permit. APPLICANT UND T%NDS AND WILL COMPLY WITH ALL NON -POINT Issued Re -roofs Type of Roof Will tW applham or future building occupant bm or handle hamol us matedai As defined by the Cupeniw Municipal Code, Chapter 9.13, and the Health and Safety Required Inspections Date �j '),0 de, Section 35133(*)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes hi. Will Oc applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove It hazardous air conumimnts as dcftned by the Bay Area Air Quality Magcmcnt all new materials for inspection. Diww'? O Yes �(e 01.21133and21134.11mdersunddmifNc Wilding It u my responsibility to nodi" site occ. mt of the Signature of Applicant Date All roof coverings to be Class "B" or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # p) 30 SUBCONTRACTOR BUSINESS NAME OWNER'SNAME: v%PA%4% K v F PHONE # 40 8— #157- 3 Ao GENERAL CONTRACTOR FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information Owt Contractor Signature -a0 Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Ab Elec.+9 c. 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 I A! Owt Contractor Signature -a0 Date CUPERTINO 4W CITY OF CUPERTINO PERMIT APPLICATION FORM 0S' -v6 °13 ° APN # 3 5 "' 13 D S a` Date: 6 -go �- 0,T - Building Address: Mailing Address (if different from building address): p2ots'70 Owner's Name: +MI'A kPotUsviA Phone #: Fog L57 -3A06 Contractor: \ D e`er` %W J License 9: 6a7$6S Contact: Phone: yob -639- 4305 J,P- l= Fax: - q s -954$ Cupertino Business License#: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: e100 Residential U (.,?kDt. Elect' Se?-%) ltt, Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project:,,',DO"�- Occupancy Group: Type of Construction: Please check this box if the project is a second -story addition: ❑ . Project Size: Standard ❑ Large ❑ Major ❑ BBOILER5 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 IM 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 � �-3 I of 3 � p v CUPERTINO . 0 CITY OF CUPERTINO PERMIT APPLICATION FORM 2 of 3 Ounntitv 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 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 BRENLUU AN A/C Units <= 10,000 cf n MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace > I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BRENMAPP 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 BRENMSAPP Remodel Res Appliance ELECTRICAL 2 of 3 . 0 CUPER,TINO 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 Insection BUILDING BSWIIvi 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 3 of 3 J