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05080253 " CITY OF CUPERTINO BUILDING DIVISION PERMIT � ��1iCT�n�RINFU�Ri�TA11OI Bu1LDING ADDRESS: MOLCSAN ELECTRIC COMPANY PERMIT NO,05080253 OWNER'S NAME: PERMIT ISSUE DATE JOSEPH AM TERRI KOIZER NE: SANITARY NO. CONTROL NO. (408) 736-4626 ARCHITEC IMOINBER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 Q 2Op LICENSED CONTRACTOR'S DECLARATION Job DeSCflpnOn u I Mreby afnrm that 1 am licensed under Provision&of Chapter 9(commencing a with Section]q)0)Of Division Sof the Business and professions Code,and my license is jginfull farm aneelen ^'egQpAg 2 CIRCITS (FOR MICROWAVE/FURNCAE FOSE STAT) ? Lmenu Cl Lk.• 4? T� n H Date Connecter p ARCHITECTS DECLARATION I urMcnund my plans shall be used as public rccords 76 G Licensed Protestant anal OatNEm exempt DECLARATION $ I hereby.(firm that 11. exempt from the to Carotene'Code: License Law for day p 0 fallowing rouon.tcank i 711313,Buai e. and Pretences Cda:Any<m a county $ which requires a permit u cnnsuw:4 arks[approve,dmnlixh.m repair any atructuro $650 t• i prior it)its issuance,also requires the,applicant far such permiuo file aligned statement �IJU 3/ �< that he is licensed punuanuo the provisions Of be Contractor's License Law(Chaper 9 Sq.Ft.Floor Area .Valuation $ (commencing with Section 7000)of Division 3 of the Businessand Profusions Code)or 9 n that he Is exempt therefrom and dta bub for use alleged exemption.Any violation of Section 7031.5 by try appil.1 far a permit subjects the applicant to a civil Penalty of F' Occupancy Type rut mac than live hundred dollars(S50)). ❑L u owner of the property,Or my employees with wages as their sole cmnpewtim. //.G1S :f- willdothewoh.and the,truclure is not intended of offered for ask(Sce.70th.Bud. Re uired'1�sveCflbn9 and Profession;Code-The Contractors License Law don ret apply u an awrer Of q I? �w property who bunds&improves theretwand whodoessuchwork himselforth It6is own employees,Provided that such improvements am not handed a offered fa sale.IL however.the building Or improvement is sold within am yea of completion,the Owner. builder will have the burden of proving that he did not build or improve for Purpose of ssk.I. ❑1,as owner of the property,am exclusively connecting with licensed connectors to construct the Project(Sec.7044,Business ted Professiaa Code:)The Contractors U. come Law does'nm apply to an ownur of property who Wilde or Improve daemon.and who co amm for such projects with a eonusouHs)licensed pursuant m the Contractors License law. ❑I am exempt under Sm, ,B&PC for this noon Owner Data WORKER'S COMPENSATION DECLARATION I hereby,alarm under penalty of perjury am of the following declarations: hawed will husband.•Cenifinm of Consent to ulFiuurt for Workers Compen. �371fprovided far by Section 3700 of the Labor Code.for the performance of the thc whiehthispermhiaissmi and will maims t Workers Compensation Insurance,u mquind by Section Labor Code,for the performance offt work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number sur: Cards, c�`rr.ro �ra,A�� Polity Na.: Q . C KATE OFE 1MON PROM WORKhRS COMPENSATION INSURANCE (This smikat raced not mcompletad trust permit[,future hundred dollars($100) or land I sonify that in sac Performance of the work for which this Permit is issued,I Nall nor, employ any person in any manner an as an became subject an the Worsen'Compensation Laws of Callfomis Data Applicant NOTICE TO APPLICANT:IL after making this Corinne of Exemption,you should became subject to the Worker',Compensetion provisions at the Labor Code.you muss .J z forthwith comply with such provision or this permit shall be deemed rewked. Zti CONSTRUCTION LENDING AGENCY (—t I hereby alum that Nero i,a construction lending agency for the performanw of E the wish for which this permit is issued(Sec.3097,Civ.C.) W�Q Leader's Name D 1. z Lenders Addrea U0 I really that 1 have mad this application and seta that the above inform W u r is . LL.!'. torten 1 agree m comply with all city and county ordinance,and state lam relating to O Wilding construction,and hereby mahaum mpresentatives of this city to cola upon flue[d7 above-mentioned property fa inspection Purposes pL (We)agree io sew.idcmnify and kmp harmk,s the City of Cupertino against Wliabllido,judgments,costs and expenses which may In try my accroc againstsaid City V z In eonmgnence of the funding of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:S4��&o Date cry 9--p . SOURCEREGU i -- — '6=ZQ-1�S Re-roofs Signsu ,o A.Iacm Coo..m Data HAZARDOUS MATERIALS DISCLOSURE Type Of Roof WIII the applicant or future building occupanuum ahadle ha n lou,material u denncd by the,Cupertino Municip We,Chapter 9.13.and It.Health and Safety Inwa do.Section 2s532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes o WIII the applicant or future Wilding Occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It heesrdna air contaminants u fined by the Bay Area Air Quality Management all new materials for inspection. that ❑Yes No I hew mad the hazardous materialsomp lrcments underC'Iupter6.95 of the Califon Health&SafetyCode.SxGau 25305.25533ed2553a.1 un@rswd uuifthe Wilding es ret currently haw a tartans that it b my respoaibiwy an naify the aceupant of the uiremcn kat mutbemm priorw issuance arc Ccrunata of occupamy�'.y'��.s�—`', Signature of Applicant Date ownerer at.amadvada em V::?ata All roof coverings to be Class "B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 aClOF Fax(408)777-3333 UPERTINO Building De artment JOB ADDRESS: PERMIT# D �6 OWNER'S NAME: ,/ PHONE # - GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followinginformation 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 ontractor Signature Date CITY OF CUPERTINO CUPEkTINO PERMIT APPLICATION FORM O S24�0 APN# r/ Z o s Date: G l'j Building Address: / Mailing Address (if different from building address): Owner's Name: �D , J Phone#: b Contractor: License#: t Contact: Phone: - Cupertino Business License#: p) Fax: Building Permit Info: 1.�S�al� Z G /Gu Tg- ��ao uovatx� / � �iYv NDc,—e. Fuse—5TaT Bldg ❑ Elect p Plumb ❑ Mech ❑ Job Descriptio Residential Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: oy Occupancy Group: Type of Construction: M t rec, Please check this box if the project is a ✓ econd-storyaddition: ❑ Pro'ect Size: Standard l/ 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 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 9�- 3v17� 1 of 3 73, z,3 i ' CITY OF CUPERTINO CUPEf�TINO PERMIT APPLICATION FORM 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 BOVERTRAE 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 InstalVAlter 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 BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREM 1BAT 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 He ing MECHANICAL BREMRESAPP I Remodel Res Ap liance ELECTRICAL 2 of 3 CITY OF CUPERTINO CUPEI�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 Ventllation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inection 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-Faro PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING • 3 of 3