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03090106 clTv of cuPESION t No BUII.DINo DIVISION PERMIT f�CONTRAGTOR INFQRMATIQW;` BUILDING ADDRESS: RJ ELECTRIC PERMIT N%3090106 OWNER'S NAME: 6003 MONTORO DR PERMIT ISSUE DATE CONTROL NE: (408) 281-3337 SANITARY NO. NO. ARCHITOTUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH I� t� +oo LICENSEDCONTRACTOR'S do, SDECLARATION 'lob Description U I Wmb affirm Nat 1 am I'1te stud under pmvisions of CNp¢i 9(commencing p " withsacti'n Iof DiviImA3&q.sinaa end PrA,serha Code.end mylicense is mfhnm aerren. ,/ 1111 f��P (a UPGRADE ELECT SERVICE j n Z License lass Lla 9 F-- vJ^££ Dau �� lar ARCHECLN y pansshIl urupuMlicmen FIN LEC))..0 ' g+ n � r �, IWG UmAmd Pmfcsst al - O:i OWNER-BUILDER DECLARATION SEP 2.4 2003 <I 1 Wreby affirm that I em exempt from du Contractor's License Law for tW 00 following mason.(Section 7031.5.Business end Professions Chat:Any city Or county (�LL which requires a perrnit to construct,alter,improv,demolish,or repair any xouctim ax j, prior to its issuance,also requires the applicant for such permit to File A signed statement F� that he is licensed pursuant the previsions tithe Contractors License Law(Charter 9 Sq. Ft. Floor Area uadon 22F (commencing with Section 7")of Division 3 of the Business and Professions Chat)or L $ Nat he Is exempt therefrom and the bass for Ne alleged exemption.Any violation or 3S624038 . 00 Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of . Type - not mmethan five hundred dellare($500). -' "" - - '-"' '-APN Number Occupancy Y Yp --- ❑L a owner of the property,a my employers with wages a their sole cempenss0on, will do On,work.end the factum is not intended or offered frualc(See.7044.Business JU4 _ ROUGH and Professions Code:The Contractors License Law dace not apply to an owner of ❑S property whoWimaorimprove&Nomrn,andwhodoesanmworkhimaelronhroughhia 501 — FINAL EL CTRI AL ENERGY own employees,pmrmcd that such Improvements are not Intended or offered for Asia.If. SOS — FINAL ELECTRICAL however.the building or improvement is old within one year of completion,Ne owner builder will haw the burden of proving that he did not build or improv for purpose of ale.). ❑1,as Owner of the property,am exclusively contracting with licensed contractors to - --- - - construct the project(Sec.70$4,Business and Professions Code:)The Contractor's U. cense taw data not apply to an owner Of prop.ny who builds or improves thereon,and who contract for such projects with a contractors)licensed pursuant o the Comrutor's License Law, ❑I am exempt under Sec. ,B k P C for this reason Owner Dew WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penally of perjury one of the following decimations: 1 have and will maintain a Cenir1mm of Coaenuo self-insure for Workers Compen. ation,As provided for by Section 37M of the labor Code,for the Performance of the work for which this Permit is issued. - 1 haw and will maintain Worker's Compensation Insurance,As required by Section 3700 of the tabor Code,for the performance of Ne work wh'h this permit is issued. My Workims Com nsatir asunrmemiicrand Policy; e art: cT. Poliry No.: C 1 A OFEXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This suction reed not W completed idle Permit is form=hundred dollars(SIM) or Ices) I certify that in the perfomanec of the work for which this Permit is issued,I shall nut employ any person in any manners As m become subject o lW Workers Compematlon Laws of California.Dew Applicant NOTICE TO APPLICANT:IL after making this Ccnificam of Exemption.you should kerma subject to the Worker's Compensation pmvisions of the Labor Code,you most = ,Z forthwith comply with such provisions or this Farm it shall be deemed hawked. z O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency lot the performance of x Y the work fur which this permit is issued(Sec.3(97,Co.C.) Q Lender's Nam. z Under's Address _ J 0 I certify Net 1 have read this Application and state Nu the above information is Correct.1 Agree to comply with all city and county ordinances and sate laws relating a �U building construction,and hereby au@oris repraenwtives of this city to enter upon the G shove-mentioned property for iapcction purposes. (We)agree to now.indemnify and keep hatmlc s the City of Cupertino agaiat p] limi lities,judgments,costs and cxpcnses which may in any way accrue against mid City in consequence of the grand AS or this permit. APPLICANT UNDE TANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale SOURCER S. 34�4 Re-roofs score of ph anV mranor pert HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant Or future building Occupant store or handle havardove material As derined by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety Code,Section 255320)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the 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 havardousair caramiamia u defined by Ne Bay Area Air Quality Mmagcmcm all new materials for inspection. ,strict? 1 ❑Yes �'NO I have mad the herardtms1materials requirements under Chapter 6.95 of the Califon nice H"'n Safety Coo, ducts 25NI3.25533 and 25534.1 umkrRvm that if the Wilding data not currently sew a ani,Nat itis my maFeasibility to Audi the Occupant of the mquim uwhihm mA1 poor to ismanccofa cera; torr capane. Signature Of Applicant Date / a Duu All roof coverings to be Class "B"or better Ow r author gem '( CITY OF CUPERTINO o 6 CUP TYOF O PERMIT APPLICATION FORM �3 APN# 24� 0 Date: Building Address: 01 62S D l 4Q4 Owner's Name: Phone#: Contractor: License #:� � ` r� o�t t G -- I 'D Contact: Cupertino Business License#: B ding Pe it Info: Bld Elect Plumb ❑ Mech ❑ J66'Desc ' tion: ntial C' If r N r (q If C/ (sl' ✓o e Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Grou Type of Construction: / 0- QuantityFee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1 M 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V > 1 OOOA ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BLNVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 i G �4 `��' CITY OF CUPERTINO CUPEf�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamil Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIIvIE 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 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 Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BRENLUUiAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Fumace > 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 2 of 3 ,,,F�of CITY OF CUPERTINO cuPErZF PERMIT APPLICATION FORM uan Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Sips 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 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 Issuance PLUMBING PPLBG Plumbing Fee s foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3