04040119 CITY OF CUPERTINO I' '" '' -'" '
BUILDING DIVISION PERMIT CO ItRACT R
' NF
BUILDING
BUILDING ADDRESS: DEBCORf INC PERMIT 9004040119
OW HER'S NAME: PERMIT ISSUE DATE
DEBCOR. INC
( ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
°00 LICENSED CONRACTOR'S DECLARATION
tI hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Descript
with
Suction 7001)nr Division 3 of Nss e Business and Praf.ssions Code,and my license is
„ in full force and effect, ADD GAS LINE
License Class Lic.N
Dam Contractor. APR 21D 2004
eeq�q ARCHITECTS DECLARATION
Y a i understand my plans shall W used as public recerds
DWU
;aaLicensed Pnsressinnel BUILDING
OWNER-BUILDER DECLARATION BUILDING
<� 1 batch,naso affirm on 11. exempt from the Contractor's Co License Lew for the
❑O following reason. penton 71131.5,Business and Professions Code:Any city fir county
'e m which am iias a permit m rims the
alter,improve,demolish,or repair any auumum
Y-a that heor ,licensed na c.pitroau rc to the pro inion .1 Tar such Comm ire's LUC .Low stmcmcm
(commecingwit pSectio701of Division 3 of
Comsinessnd Professions
(ChapterCode)
Sq.Ft. Floor Area Valuation
(cat he is
(commencing therefrom
7 and lir basis
r O the Business and on.Any
Crnle)of
that he is exempt thcmfrom and the basis for the alleged exemption.Any violation ar
Section 7031.5 by any applicant for a permit subjects due applicant to acivil penalty or 3 6VAPT1b @*cr0 0 Occupancy Type
not more than five hundred dollars(1500).
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and lie structure is not intended or offered fossil.(Sec.70,l.Business
and Professions Cade:The Cmuracmr's License Law does not apply to an owner Of - Required Inspections
property who builds or improves thereon,and who does such work himself or lhmugh his
own employees,provided that such impowcene s are not intended ormifered forsile.If.
however,Ne building or improvement is sold within one year of enmpletion,the owner,
builder will have the burden of proving that he did not Wild or improve for purpose of -
sale.).
1,as owner of the proper,am exclusively COhmC ing with licensed contractors to
Comthe project(Sec.7044,Business and Professions Code:)The Contractors Li.
came Law does not apply to an owner of property who Wilds or improves themon,and
who contracts for such projects with a continuants)licensed pursuant the Conuacmr's
License L.
❑1 am exempt under Sec. .B a P C far this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty or pe jury one of the following declarations:
I have and will maintain a Cenificam Of Consent m self-insum for Worker's Compcm
tion,as provided far by Section 37W of the Labor Code,for the performance of the
work for which this Permit is issued. -
❑I have and will maintain Worker's Compensation Insurance,n required by Section -
37W of the labor Code,for the Performance of the work for which this permit is issued.
My Worker's Compensation Insurance Cartier and Policy number am:
Cartier: Policy No.:
CERTIFICATE OF EXEM"ION FROM WORKERS'
COMPENSATION INSURANCE
musscetion need not W completed if the Permit is formic hundred dollars(1100)
fir loss.)
1 certify that in the performance of the work for which this permit is issued,I shall not
employ any Proven in any manner so as of become subject to the Workers Compensation
Law.of California.D.C.
Applicant
NOTICE TO APPLICANT:IL after making this Cenifieatc of Exemption,you should
become subject to the Worker's Compensation provisions of the L Thor Code,you must
,J a7.v forthwith comply with such provisions or this Permit shall Wticemcd mvoked.
OCONSTRUCTION LENDING AGENCY
[-r I hereby afriom that there is a Combination lending agency be the performance or
!Yi Ne work for which this permit is issued(Sec.3097,Civ,C.)
W Q Lender's Name
z Lcnder's Address
U 0 1 certify th it l have read this application and sante that the above infomutiun is
W Hechoed.I agree to comply with all city and county ordinances and state laws rotating to
ClU building convection,and hereby authorise represenmtives of Nis city to enter upon the
r a above-mentioned propcny,for inpectOO PusPOUi
(We)agree to save,indemnify and keep harmless the City of Cupertino against -
wFy , liabilities,judgments,costs and expenses which may in any way accmc againelsaid City
in U his rmit.
APPLICANCof the granting of tAND
TUNDERSTANDSWILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR •REGU TIONS.
^l$ Uy Re-roofs
Signature of Applicane/Conaraaor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WilltheapPlicamn.Municiputure al Code Chapter
store handle Health
und Safety
al
as defined by the Cupeninn Municipal Cude,Chapter 9.1;end the Health end Safely
ode,Section 25532(a)?
❑Yes ❑Nu All roofs shall be inspected prior to any roofing material being installed.
Will the applicant ormture building=upon[use egmpmcm or devices which -If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
...tell
❑Yes El NO
I have mad Nc tharardens materials requirements under Chapter 6.95 of the Cantor-
Inis Health Is Safety Code,Sections 25505,25533 and 25534.1 understood that if the Wilding
s not currently hove a tenant,that i is my responsibility m Citify the.,a,.[of Pic
uiremens hien stbcmefp' if andom ficenircamaraeaponcy. Signature of Applicant Date
�- oe
Owner Lir authorize)agate Data All roof coverings to be Class 'B" or better
OF CITY OF CUPERTINO
CUPEI�T
CITY
PERMIT APPLICATION FORM /
N#3bb ( 7 OSS- Date: y� / �^oel
Build in Address: Mailing Address (if different from building address):
Owner' Name: Phone#:
?>eL ro.--, I �w c oT
Contractor: License#:
Contact: Rtc,h W44.�ve-f—PPhone:r/09'-W-/3736 Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb Mech ❑
Job Description,/
Residential Commercial ❑
Sq.Ft. Floor $/Sq.Ft.:
Cost of Pr 'ect. Occupancy Gr p:
4'vo
Type of Co traction: Please check t ' bo if a project is a
v second-storyaddition: ❑
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
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
tof3
ju CITY OF CUPERTINO
'
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME In ection 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
BREMABU AN 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
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 Si s Add Branch ELECTRICAL
BREMSIGNS Remodel Si s, Mar uee ELECTRICAL
2 of 3
CITY OF CUPERTINO
,zan?'A &
CITY OF PERMIT APPLICATION FORM '
Curtki INO
Ouantity Fee ID Fee Description Fee Grou
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING .
a
ICOM Seismic Commercial BUILDINGICRE Seismic Fee Res BUILDING
IAL S ecialIns ection BUILDING
IM Swimming Pool BUILDING
MP Tem ora Power ELECTRICAL
PERM Tem orar Bld Permit BUILDING
SVCS Tem Dist Svcs ELECTRICAL
IC Business License BUILDING
TRIC Electricals foot ELECTRICAL
ITFEE Elec Permit Issuance ELECTRICAL
FEE Mechanicals . foot MECHANICAL
ITFEE Mech Permit Issuance MECHANICAL
ITFEE Plumbin Permit Issue PLUMBING
BG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
3 of 3