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04080036 CITY OF CUPERTINO " + a ' •W BUILDING DIVISION PERMIT CONTRACT INFabRMA'CI,OJV r; BUILDING ADDRESS: PERMIT NO. 04080036 OWNER'S NAME: PERMIT ISSUE DATE )NE: SANITARYO. N OL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 _oo LICENSED CONTRACT'OR'S DECLARATION Ib Description F 1 hereby effifm that 1 an licensed under provisions of Chapter 9(comOOSClIp mencing _ 'j with Sealion] qof Division3of NC Huvnesa and (essi°na Codc,and my license is P � in full rc nd cf�u. �,,� Saaz ween s�Lie.«` INSTALL DUCTS HEAT PUMP/WALL UNIT Dare — conlraelor ° CONTRACTOR: AZORES AIR & w 1 unticnN unJ my plans shall he used uEpubl'Ic a �/ /�/Y;'Ts®eL E Licensed Professional i 3 OWNER-BUILDER DECLARATION '+cslaE I hereby ol'farm that 1 am exempt from the Contractors License Law for the AUG /8 2004 G O following mount(Section 7031.5,Business and Professions Code:Myaaty or county X m which requires a pmmil to construct.alter,improve,demolish,or repair any structure prior to its issuance.also requites the applicant for such permilto f le a signed statement FSCthat he is licensed Pursuant m the provisions of the Contractor's Llccnm law(Chapter 9 Sq.Ft,Floor Area U 0 ret (commencing with SCedoa 7000)Of Division 3 of the Business and Pro@tsions Code)or31111 i 3 Nat he is exempt domfmm and Nc basu for the alleged exemption.My violallo"of Secure.7031.5 by any applicant for a permit subjects on,applicant toacNil penalty of APN Number - ccupancy Type not more Nan five hundred dollan($50)). , Lssowner or mem norm nm I 36908041 . 00 - 1 ❑ t pc y, y p ended wtm cared for alei(Sec. 044,Business will dothework ands: swctureisnot intended or offend(oralepply tooan oweo and Professions Code:The Convector's License law does not apply to an Owner of Required Inspections property who buildsar ed that suchimprovements andwho doessuchworkhimselfor edthrough his ownemployees,provided pr markold within one ear dedefc or offered formsdon owner builder builder ,the buildingvthor improvementishathwithin Oneyam of completion,the Ownac builder will have the burden of proving Net he did not build or improve for purpose Of si ❑1,as owner of the propany,am exclusively convecting with licensed convectors to conatnet the project(Sec.7014,Business and Professions Cede:)The Contracmr's J. cease law docs not apply to an owner of property who Wilda or improve thereon,and who contnets for such projects with a contracmr(a)licensed pursuant 1°the Contractors License Law. ' ❑1 am exempt under Sec. B&P C for Nis mason Owner Daae WORKER'S COMPENSATION DECLARATION 1 hereby ellirm under perally of perjury one of me following declarations: I how and will maintain.cwtifacam OfCon...I to self-Ireton fee Worker's Compere- , noon,as provided for by Section 37W Of the Labor Code.far On performnrce of Lha work for which Nis permit is Wind. ❑1 have and will maintain Worker's Compensation Insurance,as required by Sectian 37W of the Labor Code,for the performance of the work for which this permit is ounce. My Wor r'a Compenaadon tonna carrier and Polity number are: P CERTIFICATE OF E)( Pf10 O WORKERM S' COMPENSATIO aNiY1 So"NCE (This main.need not W complevJ if the Permit is foronc hundred dollars($1041) or less) 1 cenify that in the performance of Its work for which this permit is issued.I Nall not employ any person in any roomier as m become subject m the Workers Compenaadmi Lawn of ca(iroraia.oate Appiicam NOTICE TO APPLICANT:If,M.,making this CentOcate of Exemption,you should become subject to the Worker's Compmtsntion provisions of We Labor Code,you muss .Jz forthwith comply with such provisions or this permit anal[W deemed revoked. . z., O CONSTRUCTION LENDING AGENCY [-. I henhy aMrm Nat Nerc I,.construction lending agency for the performmceof O:> the work for which this permit is issued(Sec.3097,Civ.C.) O Lenders Namc D z Lenders Address U 0 1 certify that 1 have read this application and hum Nn IW aWve information is /T.F correct.I agree m comply with all city and county ordinances and sum laws relating to 0U Wilding construction.and hereby aumorin representatives of this city to enter upon the above-mentioned propcny for inspection purposes. (We)agree to save,indemnify and keep hannlcsa the City of Cupertino against H fn liabilities.judgments.costs and expenses which may in any way accme against said City U z in consequence of the granting of this Permit. r-i APPLICANT UNDERSTANDS VO WILL COMPLY WITH ALL NON-POINT Issued by: Date 5 GULATION ,7_40 7/'� r' a FAppI I/Convactor J Da"-te'! Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type Of Roof Will Ne applicant Or future building occupant score or h`antlle haveNuua material u defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety couc.scade°zss3z(a)7 y All roofs shall be inspected prior to any roofing material being installed. ❑res {�No 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 lm elms air conmminants as defined by the Bay Area Air Quality Management all new materials for inspection. / District? ❑Yes pie. i have read the hmallous materials mquimmcnts under Chapur 6.95 of me Califor- niaHcalN&Safety Code,Scctiore25505,25533and25534.1undcrsnndthauifthc Wilding Jac not eunenlly have a tenant.Nat iL y rcaponsihility m no the occupant of the m ichmost aanaofaWnifcamofOccupancy. Signature of Applicant Date eroraamonxadagenl All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEI�TINO Building Dep4rtment JOB ADDR © r?2ZI111600 !�- l/ 6 36 OWNER'S N 1tl lCol3b6l PHO 97 -Z Z GENERAL CONTRACTOR: FAX 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 AIL Tile �' /Contractor Signature Date CITY OF CUPERTINO v 3 CUPEI�TWD PERMIT APPLICATION FORM N # Date: Building Address: Mailing Address (if different from building address): /l�I-a0 er's Name: Phone#: No ilr6T—2? Y— z c/S ontractor: License #: /09, Contact: Phone: c� Cupertino Business License#: A/ �fJ Ff Fax: - ZZjCF Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: t464-r- d Residential 21" 4 VfAi( U 4;rt Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: a, G Occupancyrot: Type of Construction: Please checi box ' e project is a UAy second-sto addition: ❑ Project Size: Standard K 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> 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 1 of 3 2 am CITY OF CUPERTINO CUPEI�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 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 a 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 Fumace MECHANICAL MFURNOV 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 Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 (Wo i CITY OF CUPERTINO CUPEI�TINO 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 BSWIM Swimming Pool BUILDING BTEMP Tem ora Power ELECTRICAL BTEMPPERM- Tem ora Bld Permit BUILDING, BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electricals foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumhiniy Permit Issue I PLUMBING PPLBG Plumbing Fees foot PLUMBING ZADDCHG Address Chane BUILDING i • 3 of 3