04030055 zCITY OF CUPERTINO an •:= w ed?•y'; •7r�t v1P --y�*,� s�a� /��f
BUILDING DIVISION PERMIT 'vQC'f'f��QR'SA .C,�l�lYl�lt�ll\ .�
BU ILDING ADDRESS: DEBCOR INC PERMIT NO
04030055
OWNER'S NAME: PERMIT LSUE DATE
DEBCOR
DNE: SANITARY N0. CONTROL NO.
ARCHITRCI?ENGINEER: BUILDING PERMIT INFO
p BLDG ELECT PLUMB MECH
'lOC LICENSED CONTRACTOR'S DECLARATION O
I bertby affirm that 1 am licensed under proisiom of claim,9(commencing Job Description
E4 with Sudan 7")of Division 3 of ibc Rust.and Professes Cook,and my license is
^M
in full fortaand erceca Lic.e REPALCE FURNACE/NEW ELECT METE�I ®
NALZ
n z_ Licenseclue
q Dam Can tmnor
7W ARCNI'IECTS DECLARATION
? l underwnd my plum shall N used u public rtenrdr MAR 1 8 2004
30 Licensed Prufecarmul
N OWNER-BUILDER mDECLARATION
+� E 1 hereby affirm Nat 1 1. exempt from Ute CnntnnCo License taw for the BUILDING
>e O following action.armi(Section c.1.5, 4 Business and improve.
duium Code:Any city or county v
+,B� which acqulma a pvnit re eowmct Piro=Improve,demnlir t nr e a ig any amount
t,ja pnormslitsimn rmm,Aban mant(o requirestheinion ofiMCon Permit tofileasi w(Chmment
(CommischnW parsuant to the of Division
of tN Commcmrs Lrmnse6uts Cook)
Sq. F[.Floor Area Valuation
B
(Commencing roompthherfro and
bessison3 nftNeged Business My
Code)of
Wt N u 31.5 b therefrom and the bur for the alleged exemption.Any l mostly of
Section7031.5by htry applicant for a pend objets Ne applicant m a civil penalty of 1YPe
not mora Nan five hundred dollars(5500). 3 o'a L�A]sW IgCIO O Occupancy
❑I,uowncr ofth property,mmy rmployw nice aegmuthe'v sets compensation,
will do thework,and the Incurs isnatim ended uroffered fouam(Sm.?GM,Bochum
and Profeumna Cade:The Consommes Llama Law d.not apply to an owner of Required Inspections
Property be buildsor improves Nefcon,and who damssuch wart himself orthrough his
own cmploy ou.provided met such improvements am not transmit at offered for sales IL
however,the building or improvement is sold within ane year of completion,The owner.
builder will ban the burden of proving that he did not Nim or improve for purpose of
ale.).
El 1,as owner of the P OPWY•Am exclusively contrseling with licensed convectors he
construct me pmject(Sec.7614,Business and Profmsslom Cade)The Canine ns U.
eeme law does not apply In an owns of progeny,who Wilda or improves timrton,and,
whocon M for such pmjecu with A consactnr(s)licensed purauam Or the Contractors
L a w.
one rSm. B&PCf did moon
Own Dam
WORKER'S MPENSATION DECLARAT O
1 hereby a(Bn under Penity of perjury arc of the following doslaradom:
I have and will maintain a Cen ricam of Consent m self-Imam for Warier,Compen-
ution,u provided for by Section 3To0 of m,Lao,Cade,for the perfmors.of the
work for which this permit is issued.
❑I ban and will maintain Workers ComPensNon Insurance,u required by Section
5]00 of me IaNr Code,far tN perfunaneeof the wars forwhich mu penis VI issued.
My Warkcr's ComPsonak n Imursne eamia and Policy number art:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
moss) w(Ther sen treed not Ncompleted IftN pcnit is for one hundred dollars(SI W)
I eenify mat in be perfananee of the work for which this permit is issued,I shall not
employ any person many enumerate es to become subject to me Wo seri Compensation
taws of Celifomia.Dam
Applicant
NOTICE TO APPLICANT:If.after making Nis Cenincero of Exemption.you should
become subjmr m the Workus Componsman provisions of me f1Nv Code you mus
.J Z faMwim comply with such provisinm or this permit shall he occurred rented.
zO CONSTRUCTION LENDING AGENCY
F INmby aRn rise.dart is ammusmtinn rending agermy for me peffemon.of
Ri> the work for which mis penit iI issued(Sec.309],Ci,C.)
Q Lesotho's Nne
z lender's Address
L)Q I certify met 1 have read this application and sum mat me move intonation is
(L (~ caeecL I apace to comPly With all city and county ordinances and aur laws rotating to
O V Wilding contraction.mW hereby aumarire represenuticns of this city to enter upon tN
In Hove-m.judgdpts.101 (or impere.2.on rpoma
d (We)agree to save,indemnify and keep hapless tN City of Cupertino against
fA anC.tiea.Judpme 6 E
th coca inti expettsesw ch may in anyway acme against mid City r
V Z in comegWe of mcgrantingof mix it
APPLI ERSTANDS AN ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR R ATIONS.
1611116411.ord IiclnVContnnu 3— Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will me IpPlinnt or future Wilding occupant stem or handle Immodest mammal
m ad by the Cupertino Munici I Cade,Chapter 9.12,and the Health and Safety
ode.Semtian 25532m)?
[3 Y. All roofs shall be inspected prior to any roofing material being installed.
o
Will the applicant or comm build' Occupant rte equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It ha ordnm air canmminnts a d red by me Bay Area Air Quality Management all new materials for inspection.
7ni.M..Im&Sar.lyC�,S.-i..25505.25
nie,?
❑Yes o
Ihaveresemehoadnusmamrialsmqu' menBunderClupmr6.95ofineCalifor-
d 25534.Iundcrsundmuifmh Wilding
s not cu d a ronan4 met It i maponsihility m runty the occupant of the
ulre L mu&N met p' I ceo(H CcniOCaroofSignature of Applicant Date
ner rauthonvcdal it pate All roof coverings to be Class"II"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT#
SLY,
!97454Z-[ i1tG y' cS03005S'
OWNER'S NAMEPHONE # -$31,3-30
GENERAL CONTRACTOR: FAX# S31—
am not using any subcontractors: 3 'd
Signature Date
Please check applicable subcontractors and complete the following information:
60 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
CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM D °3e ° .. S
CUPEkTINO
APN# 3// / 7 Date: &e
Building Address: Mailing Address (if different froom puilding address):
/ 35-a- S. 57zzSevorS Vioccc-r C,4 957 7
Owner's Name: Phone #:
3)jg-3c'op /ncc D8'-4s 3 9 -/S 3a
Contracto License #:
oWP46-z /& Y to
Ctact: ''// Phone: yoE--8'3I-•1530 Cupertino B siness License#:
Nf/A*lS�' 7" Fax: $3/-`/3 -3'23 41
uildi Permit Info:
dBld El ct Plumb ❑ me(h
Jobescription:
Ri5sidential C�- Commercial ❑ 17 A
Sq.Ft. Floor r,n , 1 — 61 11
Cost of roject: Occupancy Group:
Type of C traction: Please check this box ❑ project is a
second-story addition:
Quantity Fee ID Fee Descri tion Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERl 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
BMITIGATC Comm. Housing Mit. Fee BUILDING
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gn� CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BNUCOMNM New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTHAE 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
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAMHAN 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 Furnace> 10K 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
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
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CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM -
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BREMTHEATR Theatrical Ligbting 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 Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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