05070056 CI TY OF CUPERTINO °^°a•»x •- r "3' '' `
BUILDING DIVISION PERMIT y CONEC1tAC' 'ORINI'URMA`�T4'N -
T�7.-;'. ,�It�4',
BUILDING ADDRESS: ALL THINGS WIRED •INC Pr"MITN.05070056
ER'S NAME: PERMIT ISSUE DATE
SHIRLEY WANG
ONE: SANITARY NO, CONTROL NO.
(806) 214-9473
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
Yop LICENSEDCONTRACfOR'SDECLARATION 7obDescri Description
O
1 lam by affirm that 1 un licensed under proWa
voof Chapter 9(commencing p
i with Section 7IX0)of Div Wan 3 ardor Business and Pmfua ms Coda,and my]team is
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in full I=anderfect 54cJ REPLACE DAMAGED MAII�'1�
N? License Clear Uc.I
Dam — Contractor mt The pr kii.dof Vast
NAWD
3 DECLAIIATION
? csrad isms I W used c records .
�� Prof on �ia 2005
OWNER-BUILDER DECLARATION
F I Imreby of no that I am exempt from the Contractors License law for the
S:00 following reams.(Section 7031.3.Business and Professions Cam:Any city or county
$ which requires a Permit to cnwrucL alcor,improve.demolish.or repair my structure
£�4< prior In its issuance,also requires the applicant forsuch permit to Ill..signed atsmmant N $2000
that he is licensed possomim the provision of the Consacmrs License Law(Ch.pmr9 Sq.Ft.Floor Area 'Valuation
see TFg (commencing with Section 70DD)of Division 3 of the Business and Profession Code)or
�.. that he Is exempt therefrom and the basis for the alleged exempdom.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
e10 0 Occupancy Type
not team don five hundred dollars(570%.
❑1,u owner of Ilio property,err my employes wlO wages u thdr mle eompenutlon,
will do the wart,and theawctem Is notinmadedoronerad found.(Sec.7044,Bud= Required Inspections
and Professloru Code:The Conuutors License Law does not apply m an owner of q p
property he Wilds or Improves Nercon,and who does such wart him"I f err through his
awn employees,provided that such Improwmmu an,notimended orone ed foraale.if,
however,the building or Improwment is mid wlNm one Sen of completion,the owner.
builder will have the burden or proving that ha did net build or Improve for purpose of
"I..).
❑1,as owner of the property am exclusively contracting with licensed contracmn to
construct the project(Sec.7044,Business and Professions Cade:)The Commutes U.
cone Law does not apply b an owner of property who builds or Improws Neuron.and
who contracts for such pmjccm wish a coseracwr(s)licensed pursuant to she Commutes
License Law.
❑lamencreptunderSec. ,B&FCforthtsmmon
1370 ar Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penury of perjury one of the following declandoa:
haw and will maintain•CeNfieate of Co...,m self-have for Workers Camper.
"Stan,as provided for by Station 3700 of the Labor Code.for the performance of the
for which this permit is issued.
have and will maintain Workers CnmPeaadOn Insurance,u required by Section
of the Labor Code.far the performance of the wok far which this permit Is Issued.
Workers�ammen�u[-d'on Iama, carrier and Poilry numbenre:
er.�'b*M� P'a<r.a o" Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sacdw need not McamplemJ lithe permit 4 foram hundred dollars(SIOU)
or less.)
I eerily that In the performance of the work far which this Permit Is Issued.I"I not
employ any person in my manoru as m became subject to the Worker'Compertation
Laws of California.Data
Applicant
NOTICE TO APPLICAND If,atter making this Certificate of Exemption.you should
became subject to she Workers Compensation provision of the Labor Cade.you muse
.,O fordt rnmply wish ouch provisions or this permit Mall bo dcemed revoked.
Z"' CONSTRUCTION LENDING AGENCY
F I hereby affirm son New is a construction hndin a
gnry for Ne Performance of
R'i ti duce wok far which this permit 4 issued[Sec.3097.Cl,CJ
Le
a Q Landers Nurse
=z Lenders Addrtx
U Q I cmdfy and I haw read this application and ads this the above Inform W on is
Gw E" correct I airs In comply with all city and county callousness and ensu lam relating an
0U building construction,and hereby authorise representations of this city in enter upon she
W above-menduned property for Inspection purposes.
6. (We)agree be sew,indemnify and keep harmh"the City of Cupenh"t agalrm
a..t V2 liabilities,judgments,cots and expenses which may in my way acers against said City
OT In waequence of the irandnia it.
F7 APPLICA U ERST S A WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU S. _
—�r— 5 Re-roofs
of App rc HAZARDOUS MATERIALS DISCLOSURE Data Type of Roof
WIII the applicant or future building=upset ante orhandic huudous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health ad Safety Section 25532(07 , All roofs shall be inspected prior to any roofing material being installed.
❑Yes l9 NU
Will the applicmi or future building occupant nae cqulpment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I
t hmardnus air contaminants u donned by the Bay Area Air Quality Management all new materials for inspection.
rict❑YeaI haw mad Ne haurdnumamrlesrequirements underChapsr 6.95 of the Califor.
Health&SaletyCam,Seniors 73505,25533 and 25334.1 understand thanif the Wilding
not currently haw a ten n is my responsibility m m01'y Ne occupant of Ne
ire m melp' rmiuuan •CcniOcata of acupmcy._„
Signature of Applicant Date
S All roof coverings to be Class"B"or better
or autho'nMilagent Data
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
aC10F Fax(408)777-3333
IrUPEI�TINO
Building De artment
JOB ADDRESS: PERMIT#
/10 IFS6,Af, n S-0-7 Dans
OWNER'S NAME: 9 PHONE #� —C - /
GENERAL CONTRALTO /( (ye FAX #
I am not using any subcontractors: ? ( -
Signature Date
Please check applicable subcontractors and com Tete the.--owing ' ormation:
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
�l ' Tile
Owner/Contractor Signature Date
1 71,MR CITY OF CUPERTINO
CUPER0 PERMIT APPLICATION FORM
0,y0 �oOaS�
JPAPN# � 5/ Dat —
Buildin Address: v ailing Address (if different from building address):
M M C14 9570/�4
Ownr Dame: Phone#:
L.2a ZiOS - -7 -a C76>
Contract r: License#:
,u, �d� 54S 0>
foxContact: V Phone: Cu pert no usiness License#:
"ri C Fax: � ; 6 0 oG(p60
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Job Description: Q
Residential ,Q, �Q o,µ / aa 12ercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy Group:
Type of Construction: Please check this box if the project is a
U I-j second-story addition: ❑
ro'cct Size: Standard M, Laze ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
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 <= IOOOA ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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CITY OF CUPERTINO
` CUPEI�TINO PERMIT APPLICATION FORM
uanti Fee ID Fee Description Fee Group
13MISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOM IP New Comm Plumb PLUMBING
BOVERTRAE 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 rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie I PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000.cfin MECHANICAL
BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREM 3USWAY Remodel Busways ELECTRICAL
BREMFLYT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> I 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
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CITY OF CUPERTINO
CIO CUPEkTINO
PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BREMSIGNAD Rmdl Sips 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 Inspection 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
EPEFMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG F Address Chane BUILDING
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