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05100063
CITY OF CUPERTINO ' eve e « 77 • —BUILDING DIVISION PERMIT CONTRACgT,OR I,NwF,ORMATInN at d, '-Z,�..� uan.,u.na.:va. 3s`S"&� YS�-•,.'fir, i. BUILDING ADDRESS: CUNNINGHAM ELECTRIC PERMTTND'05100063 10081 P EWS NAME: PERMIT ISSUE DATE WILLIAM KUNCZ 1376 VIA DEL LOS GRA14DE ONE: SANITARY NO. CONTROL NO. (408) 590-7111 ARCHITE.CTIENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH E 0 0 �r440,z LICENSED C IC ONTRSDECLARATION lob Descrip1hecbY Affirm that amtermd underons OfCOPmf9(commcneing ' with Section 701118 of Diviakan 3 often Betsineuand Pmfesvont Cede,and my license is inIHfnmeandoff S/ UPGRADE ELECT PANEL. (200A4P) p/ j ? Licenu Clue — LSDECLARATION OF S ® e Dam a Cumrotor 0. RY 9 A shall x used DECLARA ION q 1 undenunJ my plana shall bo used u politic mcnrd � y[ D V c Z sad Licensed Professional ,� oo✓ OWNER-BUILDERDECLARATION aI IWmbyonamuemptfromuneClos Licene Law for th fallowing .Sec 113Business and Professions Code:Any city county which requires a Permitto cnnnnuct.alter,Improve.demolWh,or mpWr any structure g� 1 S O On$ _aPyr prior LLI,,Issuance.also mms yulthe applicant for such permit to file a signed statement gg that he is licensed Putman,to the provisions of the Conuumrl License Law(Charter 9 Sq.Ft. Floor Area �, U On B (commencing with Mellon 7000)of Division 3 of the Business and Profession Code)or "" that he is exempt therefrom and the bub for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant aro a civil penury of 3 A IR 99WFF uo Occupancy Type trot mom than few hundred dollars(5500). ❑I.as owner of the property,or my employees with wage As ftk=Is comPensNon. will do the work and the#".turn is not intended or offered for sale(Sec. Business Required Inspections and Profession Code:The Conss e nsummes License Law donut apply to an owner of q P property who but Ids or improves thereon,and who does such work himself or through his own employees,provided that such improwmanu are not intended wOEerad forsakes If. a however,the building or improvement Is sold within one year of completion,the owner- builder will have ter burden of proving that An did not Wild Of improve for purpose of sats.). L as owner of the property.em exclusively contracting with licensed contractors w construct the projen(Sec.7044,Business and Professions Code:)The Conosmb U. cense law doss not apply to an owner of property.who Wilds or improves thereon.and, who contracts for such projects with a eanuactor(s)Ikened pursuant M the Contractors Lie'.law. ❑lamexemptunderSeo .B&PCfmdJsmaem er Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: I have and will mumin a Cenifnnm of Consent be self-imamfor WorkcfaCompcn- satlon.as provided for by Section 3700 of the labor Cade,for the performance of do workfor which this permit Is issued. u ❑1 haw and will maintain Workers Compeaton Insurance,As required by Section 3700 of the Labor Code,far the performance of sire work In,which this Permit is issued. My Workers m nsmo Insurance tinier and Policy numbcrae: )gyp Canis: Polley No.: Z —O D;-Ip I CERTIPI ATEOFEXEMPTION FRO WORKERS' COMPENSATION INSURANCE fNWsectim need not becamplemd if use Permit is foonchundreddollam($100) or less.) 1 unify that in the peRmmn.of the work for which this Permit is issued,l Nall nm employ any person In my manner an as In become object to the Workera'Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should become subject er the Worker's Compeeuadon provision of the,IaMr Code,you muss OZ foMwiun comply with such Provision m Nis permit shall be domed cooked. i"•' CONSTRUCTION LENDING AGENCY (—� IZI Ihemhyafllrm the them is a couuuclum Imulugagnecy for the Per(mmanoar CL the work for which this permit is issued(Sm.309'1,Civ.C.) ' W� Q Lender's Name Q z Lender's Address U Q 1 unify that I haw read this application and sbm unit dm above information is {T. •,'• comem 1 agree in comply with all city and county Ordinances and mm laws mining to Q rU' Wilding conwuction,and hereby autWadm represenutwa of this city to cmer upon eh W above-mentioned property for inspection pugmaes. (We)agnea to saw,indemnify and keep harmless the City of Cupertino Against Vi Ilabllltea.judgmcnW,costs and expcetsu which may In my way some against said City L) in conuencof the s rmit. APPLICANTCUNDERSTANDS Antiof aND WILL COMPJY WITH ALL NON-POINT Issued by: Date �— SOURCE LATIONS. - �' - Re-roofs Sian Applian onenmam Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or fuuuo Wilding ocupantatam or handle harndous material Zu deRd by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety tion 2ss3x(.n ✓ All roofs shall be inspected prior to any roofing material being installed. ❑Yui C Wits the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove M IL havardnm air cmuminants u defined by the Bay AMA Air Quality Management all new materials for inspection. ❑Yes u I have mad the hoardmonmuniabroulrements underChapmrd.95 oftae Califor. Hcolth&SafctyCodc,Section 25505,23377 and25531.I unJcrslund th&Ifthc Willing runt etuo my have a mount.that it is my resPanlMlhy to malty the ao.P.t of theimmcn ' hmumWmepdortolssu aC roes arOcenpanay. Signature of Applicant Date ners ptnrrixe .gent Dam All roof coverings to be Class"B"or better Community Development ' 8 10300 Torre Avenue i Cupertino CA 95014 Telephone(408)777-3228 � CI OF Fax(408)777-3333 JPEI�TINO Building Department JOB ADD ESS: PERMIT # �� - �` 1 ©S"/ 00063 OWNER'S NAME: ; c�f-h PHONE # GENERAL CONTRACTORrt roeeaclzFAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical 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 ( l;. CITY OF CUPERTINO 0 Ste/ G CU oryo NO PERMIT APPLICATION FORM N#/loO 2� Building Address: Mailing Address (if different from building address): Owner's Name: Phone#: <�'b k Contr c or: > License#: 5 Contact: Phone: Oiw 3s3 -P5 3 o Cupertino Business T icense#: Fax: 1% 3s3 Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential 4 -0 e//Q i Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Pro t: ` 6 Q CJS Occupancy Group: Type of MnRuction: Please check this box if the project is a / second-story addition: ❑ Project Size: Standard Large ❑ Major ❑ 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> IM 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 1 of 3 CITY OF CUPERTINO CUPERTINO PERMIT APPLICATION FORM 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 Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interce for 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 InstaWAlter 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 BREMAIl2HAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BRENff7URN Relocation of Fumace 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 Rc tl�Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Re air/Alter HeatingMECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 ;_ CITY OF CUPERTINO CUciao EI�TINO PERMIT APPLICATION FORM QuantityFee 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 BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bidg Permit BUILDING 13TEMPSVCS Ternp 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 Cbane BUILDING 3of3