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04120034CITY OF CUPERTINO x ?'P �� '%'• ^"�-'y'yy" T1VWYSRMATTON.y BUILDING DIVISION - - PERMIT .. ,,g*+�v CONWRACTOR BUILDING ADDRESS: GT ELECTRIC PERMIT N004120034 21810 STEVENS CREEK BLVD OWNER'S NAME: - - PERMRL4UEDATE PING TAI' 861 WINDSON HILLS ONE: SANITARY NO, CONTROL NO. •. (408)-362-9473 - ARCHITECUPNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION � - � Job Description.- ' I "by affirm that I Am Released under provisions of Chapter 9 (commencing wiNSoc m70MfiofDIvIzIMSof Na ButineuWPmfesdom Code.Wmylic=is ' in ren term W efreca - UPGRADE ELECT. PANEL (2 0 0 AMP) & • - License Class Uc. g. - GROUNDED- Date GOa ARCHITECTSDECLARATION 1 understand my plus Nil W used All public records , . (/�f ❑ - - Licensed Professional.- ' OWNER -BUILDER DECLARATION I hereby e1Lrre that 1 Am emmpl from as Conlramor's License IAw far the ` J - - •- -- — - - --- following mason. (Section 703 1.5, Business and Pm(esdom Code: Any city or county - which requires a peril to construct. alter, improve, demolish, or repair my structure - �! poor a its issuutee,ala mquisu the Applicant for such permit to file a signed summem Net he b nand to the often canmctars Umn Law (Chapter 9 Sq. Ft. Floor Areas GUyyS Valua}g1600 pursuant Provisions pp nf'fl (commencing with Secdon7000)of Dividan 3arthe Sannessend Rafeuiom Code)or _ I''s 1'f flit �, h Nat he is exempt therefrom W Ne bub far that dlcgcd mamption. Any vlawo,an of -, APN Number -... IJ L, U� n 1�,� i •' l'1 ~ p y • pe - - J / tOGGU araC Section 7031.5 by coy applicant for a permit subjects the applicant a a civil penalty of five hundred dalbrs(f5(D). Outmomthan 00 UG ��- L, asawaror Necompensation, ❑. Noperty,mmYet with wguutlletr role7044. .357160.10. - Required Inspections Business will do am work. and the structure is notlntendedwoRemtl forthe(Sec.70N,Bwineu handed And Protestant. Crude: The Conmemes Limn dour Law doant apply a an owner of q .. p •.. - • . - propetywW Wilds wimpmses therton, and wWdeessuchwwkhimalfea through hisOwn .. employees provided Nat such Improvements ammd intended orolleed forssla if, ---- - - - however, as Wilding or Improvement s sold within am year ofcomplean, the owner. ,,. • : builder will have the Wrda of proving Nas ha did not Wild or Improve for pulpae or - ick k yyy�^, u owner of the property, am exclusively contracting med ing with licecontractors a Wmwcl Ne project (Sec. 7044; Bwineu and Profession Cade:) The Contractor's U. cetse Law does not apply a an owner of property who Wilds or improv Nertm. and, who marmot for such projects with a antnnar(q liaised pursuant a the Contractoes - • - - License 1.4w. - - ❑lamexemptuntivSea -.B&PCfw Nb moon ..-..,.�.., . Dare - - OR MPENSATION DEC I hmay affirm under pealty of petjury one of the following declarations: I have W will maintain a Certificate or Cement touif-luure far Worker's Camper-- mtion, u providrA fw by Section 3100 of Ne labor Code, fw dm pedomeam of Ne wade for which this permit is issued. ❑ I has W will midnight Worker's Comperisation Iruwanm, As required by Section 3700 of the LAW Cade. far the per(wmanceor Ne work In, which this permit is issued. My Wnrste. Compemuim rowans came W Policy number ue; _ Carder: Polley No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (lbbsoNa used not Wcompleted if the permit formula hundred doltan(SIM) or lea) 1 artify that in the performance of the work far which this Permit Is used. I shill not _ employ any person in any mannersn as to become sobjecl atha Wohcrs'Compemation - - - •- -�- ----r. --_._.. _ "-- LAWsofGallfemlaDate __......._.,.. - - - Applicant NOTICE TO APPLICANT: If. after making this Certificate of Exemption. you should become subject a the Worker's Compensation provisions of the Later Caught, you muss forthwith comply with such provisions or this permit shell W account revoked. CONSTRUCTION LENDING AGENCY - - I hereby Affirm that Nem IA a construction lending agency for the Performance of the work fur which this Permit is issued (Sus. 3097. Civ, C.) Lender's Name , Under's Address 1 certify that 1 Nva read Nis application W sone Nn the above information is ' coned I agree a comply with all city and county on imnm and sum law relating to building construction, and hereby authadm mpmemoSOM Of thiwity a enter upon the ahem -mentioned property for Inspection purpoaa (We) agree to an. indemnify and keep harmless was City of Cupertino Againstt Iiebilitim.judgmenu, costs and expenses which may In any way seem Against mid City in cmacqunee of the granting of this panic. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO INT Issued by: Date S EGULATIONS. 'n � rDD Re -roofs Type of Roof m Sng pph HA%ARDOU,S MATERIALS DISCLOSURE Will the applicant w filum Wilding occupant sort or handle hater loas material u defined by the Cupertino Municipal Code, Chapter 9.13, and the Health and Safety code, section 25532w)?ss/� All roofs shall be inspected prior to any roofing material being installed. Oyu .Q]Nu If a roof is installed without first obtaining an inspection, I agree to remove Wiil Nc applicant or fut\\ure building occupant um equipment or deWcm which mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? y/ ❑Yu I have mad the haurdnus materials requirements under Charter 6.95 of the Corral. Health Tia HSafctyCode, Sections, 25305,25533 and 35534.1 understood that if the Wilding doe al c ady hem A anent than it b my rtspomlhiliW a nail Ne aapant or ugte surge to h.hmuRhmelpdorainummofaCeirwamof Signature of ApplicantDate All roof coverings to be Class "B" or better OwnDote ria de ht r ' �PEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB RESS: PERMIT # '719110 ' ve C��e l� til vol D lob 3 OWNER'S :-' GENERAL CONTRACTOR: F 2-- I am not using any subcontractors:r Signature Date Please check applicable subcontractors and complete the following information: I am not using any subcontractors:r Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical �L l 166 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 v - Date Tile v - Date I CITY OF CUPERTINO PERMIT APPLICATION FORM ( Z 6— �� APN # Date: 0 2- o -200 Building Addr ss: Mailing Address (if different from building address): 2 l 0 S- Vem cv-eP� M v Owner's Name: I Phone #: Pk!j% -Tou 4061 -8%S -O :6 Contractors . License #: )m MUhSon, C r. c IS 1166 Ed Contact: Phone:( 361--qf�3 Cupertino Business License#: Fax: Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: w\ 100 �a o�7 Awp Gks 7t. . Residential ®� 1' 1 Commercial% ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a - second -story addition: ❑ Project Size: Standard ❑ Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Grou BAPPLOTHER Other Appliances MECHANICAL BBOILER1 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 Iiid/Off/Comm/ uasi BUILDING BCONSTAXBQ Quantity Fee ID Fee Description Fee Grou BAPPLOTHER Other Appliances MECHANICAL BBOILER1 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 Iiid/Off/Comm/ uasi 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 X CUPERTINO Quantity r - L 4 CITY OF CUPERTINO PERMIT APPLICATION FORM Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCONIME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmos herie Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g 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 rinkler/Backflo 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 cfin MECHANICAL'. BREMA]RHAN 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 BREM MC 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 2 of 3 CUPEkTINO (WT CITY OF CUPERTINO PERMIT APPLICATION FORM Quandty Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, 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 Inection 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 Fees foot ' _ PLUMBING ZADDCHG Address Chane - BUILDING 3of3