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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