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04010111 CITY OF CUPERTINO �CONTRACTOI2 INF.OTtMATION k BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIAN BUILDERS INC. PERMIT NO04010111 ER'S NAME: PERMIT ISSUE DATE NE: SANITARY N0. CONTROL NO. ARCHITELT/ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH' (_7 E 0 O O LICENSED CONTRACT'OR'S DECLARATION 1 hereby affirm that I am licensed under previsions of Chapter 9(commencing Job Description with Section 7W1)of Divii n3 of Ne Busine�s e�n�P, rcCoal a my license is ^ y in fa 11 fo a d effect. /� yy z Dam Amp ✓ REVISION--LIGHTING & ELECT. RECEPTACLES t-o Wm °ntr,tar NO NEW PERMIT ISSUED/ORIG. #04010072 ijl ARCHI I /t��.N c< l under land m plans is rc Ns /lam LF/ kiU ;o1 Licensed Professional g 1 DECLARATION t o i 1 hereby offi at 1 1. a re from Ne Comes Co License Lew for my O D fallowing reason. e tion]IDL5 usincss and ve de Professions Code:Any city ar county x$ which its s issuance.permit 1.ne cons cl,alter,improve,h Perm demolish,or rcpaigned structure LZi Prime Ni6 enseursuantto mnhrvisiosofcant fo..uch Pcri0oienseIt a Law(ch.cmcm ££ < that heencinnwJPuction7NcofDivinnsnortheBthe tsinessndProfsaonsCodmr9 Sq.Ft.Floor Area Valuation$32 z S that heis..with Section of Dorms or m theeged Business and An,nnsdus.of Natio 7 exempt any applicant li and Bte Per Ins be alleged Min exemption.Any violation of Section man five any applicant fore permit subjects the applicant to a civil penalty of APN Number Occupancy Type ' not mare Nanfi.enunarcaamlan(ssol). P Y YP 0 1,n owner of the property,or my employees with wages As their sole compensation, 35907005 . 00 will tlo N,work and Nesvuctute is not intended proffered forsale(Sm.7064.Business and Professions Code:The Conuanors License Law doss not apply to an owner or - Required Inspections property who builds orimpreves chemon,and who doessuch work himself orthrough his own employees,provided that such improvements Are n0dolended oroRered forsale.If, however,Ne building or improvement is sold within one year of completion,Be owner- builder will have the burden of proving that W did not Wild or improve for purpose of -� sale) 0 I,ea no,of Ne properly,am exeluaively contracting with licensed contractors N construct the procet(Sec.7044,Business and Professions Code:)The Contractor's Li- ccue Law does not apply to an owner of property who Wilds or improves themon,and who contracts for such projects with a contraetor(s)Iicemod pursuanOo tW Contractor's V C� License Law. C ❑I ase exempt under Sec. .B&P C for His mason Dam WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one or de,following declarations: ❑I have and will maintain a Certificate of Cmns,ntto self-Insure for Worker's Compen. nation,nae provided far by Section 3700 of the Labor Cod,,for to perform..of the work for which this permit is lolled. 0 I have and will maintain Worker's Compensation Insurance,to required by Section 37M of the labor Code,for tW performance of the work for which this permit is issued My Worke sCM enation Insurance Nn�a�Policy number rt: Policy No.: CERTI KATE OF EXEh ON FROM WORKER COMPENSATION INSURANCE (This section need not W completed Ethe perii is forms,hundred dollen(;1(111 or less) 1 certify Nat in fee performance of the work for which this Permit is issued,1 shall not employ any person in any manner so u to become subject to the Worherd Compensation Laws of California.Date ,. Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the labor Code,you mus .JO forthwith complyn m th with provision Permit shall W mc deld rcvmkcd. . 'Z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the Performance of Ri the work for which this peril is issued(Sec.3097,Civ.C.) - W Q Under's Name Z Lender's Address , U 0 1 certify that 1 have read this application and scan that Um above information is - - ly U cora 1 agree t°comply with y city and county rd.dwSc I and cute laws relating to �. V,V buildcorrect. construction,seetocomply hereby a ithmri>e rcpmy ordinances rdin n es this city laws M]pnn the W shove-mentioned property for inspccbon purposes ty (We) agree to save,m try p Warless Ne City of Cup iso against fq liobilit42A - I d pe ich may in any way seems against naitl City j fJ `1 iAnPPLWq.) c to f' � mtm COMP WITH ALL NON-P INT Issued by: Date ` r� N . Re-roofs n a of m C cmr ` /Dam RDOUS MATERIALS DISCLOSURE Type Of ROOF l WIIltheapplic t or future building occupant store or handle hazardous material As defined by the C dine Municipal Code,Chapter 9.12,and Ne Health and Safety Code,Section 255 (a)7 0yes iixa All roofs shall be inspected prior to any roofing material being installed. Will the applicant or Vmttuure building=open(use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit harardnus air contaminants an defined by the Bay Area Air Quality Management all new materials for inspection. Disviet7 C Yes X. I have road Ne hear su \IDl�rials remains under Chapter 6.95 of the Caller. ilia HcolN&Sefci Co 'Rne /50 c end25534.1.morevtd Nwif Nchuiiding, does not curt, 1 pottsibility asnod[Y the our prnt"f c mwimm°n m p' saaane oraCcnific pTG,eup ,x �� Signature of Applicant Date Owner mina ized age, to All roof coverings to be Class "B"or better CITY OF CUPERTINO '$ `` s-. �y �tgpa� "+ BUILDING DIVISIN 1W ON PERM 'O4`r17 A'VA BUILDINGADDRESS: PERMIAN BUILDERS INC. PERMIT NO04010111 OWNER'S NAME: PERMIT ISSUE DATE :E: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MEC11' YOO LICENSED CONTRACTOR'S DECLARATION 0 0 0 fi 1 hereby of ore mat I am licensed ander provisions of chapter 9(anmmmtlng Job Description ¢ with Section?").f Doiot.3.fth,Busite sand Profc Cod dmylumnscia _.� inb hest, daffect. � 3' (� REVISION--LIGHTING k ELECT. RECEPTACLES C G Dam cut 111///ARCHI Lontr`dlar 1 1 under rand re plans h l is rc Ns �$Wc� NO NEW PERMIT ISSUED/ORIG. #04010072 3 o In Licensed Professional I g 3 t 1DECLARATION 4 I hereby air, m I am c pt frum the Contractor's License Law for the 10 following reason.is dun 71131.5 usincss and Professions Codc:Any city or county m(i which acquires a permit to eons it,nite%improve,demolish,nr repair any,stmetum —iy pHe,toits ismonce.alsu requi.the applicant Torch permil to fila asig^ed statement FFp:O that he is licensed pursuantto the previsions of the Convector's Llmnsc taw(Chapter9 Sq.Ft. Floor Area Valuation$32 Y $ (commencing with Section 70(11)of Division 3 of the E usincss and Prefcasin^s Code)or y 3 Nat he is attempt mctcfrom and the basis(or that alleged exemption.Any violation of Section 7031.5 by my applicant for permit mbjacls me applicant to a civil penalty of APN Number Occu ane T e not mare man Bae hundred douars($500). P Y YP 0 1,as owner of the property,in my employees with wages as their sole compensation, 35907005 . 0'0 will do the work,and the structure is not intended or offered for sale(Sao.709,Business Required Inspections and Processions Code:The Conmamr's License Law docs not apply to an owner of q p property who buildsorimproves menton,and who doessuch work himself orthrough his own employeas,provided that such improvements are not intended oroRered formic.IL however.the building or improvement is sold within one year of completion,me owner- builder will have the burden of proving that he did not build or improve for purpose of salt.). 0 1,as Owner of the property,am exclusively contracting with licensed contractors to O cense a the does (gee.70d,wner of and Professions Code:)The Connectors Li- who claw docs not apply je an with a of property who builds or improves(hereon.and, who contracts Lacu for such projects with a contractor(s)licenced pursuant to me Contractor's License Law. ❑lam exempt under Sec. ,B&PC for this rcazon Owner Date WORKER'S COMPENSATIONDECLARATION I hereby affirm under penally of perjury one of One following declarations: have and will maintain a Certificate of Consent to aelf-imam for Worker's Compcm .he.,u provided for by Section 37M of me Labor Code,for in.perfmmance of in. work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Coda,for me performance at Ole work for which this permit is issued. My Workerh m nsatlon lasumnce carer.and Policy number m: ���Policy No.: CHKoFICATEOFEXEMPI'IONFROM WORKE0. COMPENSATION INSURANCE (This section need not he completed irthe permit is foronc hundred dNlam($100) or less.) I certify that In the per(mrnmes of the work far which this permit is issued.I shall nut employ any person in any manner an u to become subject to the Workeri COmpensi don Laws of California.Date Applicant NOTICE TO APPLICANT,IL after making this CenlBcate of Eaemption,you should become subject to the Worker's Compcmation previsions of the labor Cada,you must - .JO forthwith comply with such provisions or this permit mall be deemed resulted. CONSTRUCTION LENDING AGENCY (~ I hereby affirm mat there is a construction lending agency far the performance of CY. r7 the work fur which this pcmrit is issued(Sec.3097,Civ,C.) QLender's Name r7 z Lender's Address C)Q 1 certify mat 1 have read this application and state that me shove wmitiis (L f~ correct I agree to comply with all city and county ordinances and ante lawss misting e QU abovengcationed commotion, hereby authonprapresenmtives of this city locnterOpen the 457 above-mentioned property for inspection purposes. 6t (We)agree to rove,in By a cp harmless the City of Cupertino against rq liabilitim,judgmcnu d pan ich may in any way accroc against said City C)7 iAnPPLseCyAcnce De r^ f t mit'L COMPW'WITH ALL NON-P INT Issued by: Date j r� SOURC E N . \/�/J Re-roofs 'go u of tc C actor WOODS MATERIALS DISCLOSURE Dam Type of Roof Willmcapplic Iorfumre building uccupintsiorc or handle buvafdous material az defined by me C nino Municipal Cotle,Chapter 9.12,and the Hcaldl and Safety Codc,Section 255 (a)7 �Na All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future thi iwing occupant"m equipment or daviaas which Ila roof is installed without first obtaining an inspection,I agree to remove I harard^us air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. avis] C Yes X. I have mad the hftna50 � menu under Chapter 6.95 of the Califon nia HcalthA Safra CoJ25534.1 undersand thmifthehuilJing, Joe,not carte riaibility tkroviiythececypminf e rcyvimmcnF i ofa CCN`,d/�t Occup cy. •'� U Signature of Applicant Date Owaars uiho iced agcn D to All roof coverings to be Class "B"or better C OCITY OF CUPERTINO10 Z CUPEI�F PERMIT APPLICATION FORM N# Building Address: Z l 5TH Owner's Name: Phone#: Nq2 . ggg Contractor:RG.a W�A42 ?343 License #: 54 �8 �© Contact: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect Plumb ❑ Me Jol?Description: L i�f{TI L�a� GHP7yK�G55 �7n ry Residential ❑ Commercial Sq.Ft. Floor Area: $/Sq.Ft.: 2.320 5P° Cost of Project: �gq�c 4�0 Occupancy Group: Type of Construction: VN • 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 IM 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 1 of 3 .• ,CITY OF CUPERTINO* CITYOF PERMIT APPLICATION FORM CUPEkTINO 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 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 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 Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installatign 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 • 2 of 3 via, WITY OF CUPERTIN� CUP TYOF PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group 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 Si az s, 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 BMISCELL Building Mise Fees BUILDING i 3 of 3 1