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03090232 CITY OF CUPERTINO - < a' '' BUILDING DIVISION PERMIT CON:TRACTO INIFORMATION: ^wx, BUILDING ADDRESS: PERMIT NO03090232 0 3 0 9 0 2 3 2 0209 RITITTZRA.DC) PAT OWNER'S NAME: FERMITISSUEDATE NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MF.CH !00 LICENSED CONTRACTOR'S DECLARATION Job Des��s�� rz 4 u C I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing WA D U with Section 70CA))nf to., Sof the Businem.rel Pmfeminns Cnde.and my license is 'V s in full foamed effect. i#? License Class Lic.N ELECT PANEL UPGRADE 3 h, Datc Contractor OCT $ 2003 qQ ARCHITECT 5 DECLARATION i d a I understand my plans shall M used as public records tyU Licensed Professional p'DS OWNER-BUILDER DECLARATION BUILDING ]<8 I hereby affirm that I am exempt from the Contractors License Law for the :02 following remon.(Seed..7031.5,Business and Professions Code:Any city or county e m which rcqutms a moral In construct,alter,improve,demolish,M repair any structure PriMlo os issuance.also requires the apPlicam f.r such permit to file asigncd nammcnt a that he is licensed pursuant to the provisions Of the Contractors License Law(Chapter 9 Sq. Ft.Floor Area Valuation 2�0 (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or $ that he is exempt therefrom and the basis for the alleged exemption.Any violation of 36939006 . 0 Section 7031.5 by any applicanlfor a perch subjects the applicator o a civil penalty of APNNumber Occupancy Type not more man five hundred dollars(s500). Pane Y YP ❑1,as owner orthe property,m my employees with wages as their sale compensation, �" will dothewark,Codec heCont is rots License Law ntapplytoan,Business Q — ROUGH '•"�DT� and Professions Code:The wsf Contractors License law docs not apply to an owner of EC Y9RR99 nS own emywyees,dwrimprovsuch imgandwho are ctended himselfor through his SOL — FINAL ELECTRI AL ENERGY howemplyecsilding or that orprsuchtmp,ovcm wit in not intended or latiredm,the woo a, SOS — FINAL ELECTRICAL however,Nebuildingorimprovementissoldwithinone year or completion,the purpose of builder will have me burden of proving Net he did not build or improve for purpose of NK(m owner of the property,am exclusively contracting wit licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractors Lb cause law does not apply to an owner of propeny who Milds or improves thereon,and who contacts for such projects with a comractor(s)licensed pursuant to the Convector's License Law. ❑lam exempt un rF`ec. ,B&P C far this Masan O 1 ZL��(AM a DaleQ1.9 VO E A INS TOWDEC RRA�TJON 1 I 1 heathy affirm un er penalty of perjury one of tls�feifowin,declarations: 1 hats and will maintain a Certificate of Consent self-insure for Worker'sCompen- sation,as provided for by Section 3700 of the Labor Code.for to performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,m required by Section 37W of the labor Cotle,for Ne performance of Ne work for which this pcamit is issued. My Workers Com pensalimn Insurance carrier and Policy num her art: Came,: Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE musecedon need not W eamplemd If the permit is foronc hundred dollars($RxB o,less.) 1 certify that in the perfMmance of the work far which this permit is issued.I shall not employ any Person in any manner so m to Weems subject to the Warkcrs'Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Ccntficam of Exemption,you should became subject to the Worker's Compensation provisions of the labor Code,you most �Q forthwith comply with such provisions or this Permit shall M deemed revoked. h CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of X> the work(.,which this permit is issued(Sec.3097,Civ.C.) � Landers Name 2 z Lender's Address ;)Q I certify mal 1 have read this application and state that the show information is . yF correct.l agree to comply with all city and county ordinances and smte laws relating to �U ahowng construction,and herebyoinspection rposes. tatives of this city to enter upon the W shove-(We) greeoul to averty for inspection keep hs. (We)agree to cove,indemnify and kith hay in an the City of rue against against V) fiatuincomm,muce, costsand expenses which they inanyway accrue against mid City J7 Aconsequence of UNDERSTANDS of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ;Code. RCE RE NS. d Re-roofs ta re t P c HAZARDOUS MATERIALS DISCLOSU are Type of Roof Will the applicant or future building necupant store.,handle havardous mmmial fined by the Cupertino Munici Cade,Chapter 9.12,and the Health and Safety Scctton 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑YesWill the applicant a,future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove hazardous air contamtrmms defined by the Bay Arca Air Quality Management all new materials for inspection. re I? ❑Yes 1 have read are hammous materialsmquirements under Chapter 6.95 of the Collier. mancalth&Safety Cotle,Suctions 25515.25533 and 25534.1 undmemnd thatif the building does not carte ly It amnamh mal it is my respamibility m amply the occupant of the rcyuiremenL 'c st he met prior to issuance ora Cenificas,of Occupancy. Signature Of Applicant Date U All roof coverings to be Class"B" or better O ser t r d Dam CITY OF CUPERTINO 2-3 aC10F PERMIT APPLICATION FORM CUPERTINO APN# Date: Building Address`,_2b 3 d 9 S t �7/�1•RL�� /o V Owner's Name: L Phone #: 996 ZO3 6 Contractor: 91 Q/ � ^i '� License#: 4 k ,5 93 6 Contact: b a _ e2 61_ 3 3-7 D Cupertino Business License#: .Da Tding Permit Info: Gl 'G R h P� Gt�j cd a /U D 2X7 Elect Plumb ❑ Mech ❑ Jo escription: Residential Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: i Occupancy Group: Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING 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 BBOILERS 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 BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 233 / -*16 7 Sz(m--, CITY OF CUPERTINO CUPEYOF PERMIT APPLICATION FORM Quantity Fee 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 Multifamily 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 BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE PbIg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste lnterce 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 .S't0nn/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAHMAN 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> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREN MISC Misc Apparatus ELECTRICAL BR I-101 PP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 � b - CITY OF CUPERTINO CITY PERMIT APPLICATION FORM ' CUPEkTINO Quantity- 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 Sips, 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 sq foot PLUMBING ZADDCHG Address Chane BUILDING • 3 of 3