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05060017 CITY OF CUPERTINO BUILDING DIVISIONPERMIT %CUNeTRACTOR I1j f RMATIONr BUILDING ADDRESS: R K ELECTRIC INC PERMIT"5060017 OWNER'S NAME: PERMIT DUH DATE Adkk POWER TV ONE: SANITARY NO. CONTROL NO. (510) 770-5660 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH l� CMl� l� 40o LICENSED CONTRACTOR'S DECLARATION Job Description (� 1 Wroby affirm shat 1 am licensed under provisions of Chapter 9(commencing withS.Lion 70(X)).f DiviMon 3of the Business and Profusion Code,end my iicenu is In ren mroe anderteet. q ADD 2 CIRCUITS (FOR A/C & t,nZ Licenec CI s Lk. z Dam Gnntwor WATER HEATER) 3� ARCHf7EC S DECLARAT ON I undcruand my plans shall 4 u ro %Nb used public 5G Licensed Professional OWNER-BUILDER BUILDER DECLARATION R M I gesso .Them on 1 am exempt from 0e Contractor's :Any C Law for the RM p o whicfolloh re masa Permit t AD er Business and Profusion Code:Any oily or rounty a�$ftii which its i ms•o.also re sires Me slier,ret or demolish.fi repair any ummen, f Z^ Pam alicennce,Amrequiros thevnien ret far such Permit to file Law(Chapter i=< (Met Wcommo licensed punment ro the provivion oro(am B sincia al Prue law(Cosi or Sq.Ft. Floor Area Valuatimb,15 2 5 that he I. exempth Sectfrom and M buts n 3 the al eg a exec end Profession latom of $ that he b exempt Ncre(rrm and Ne bub(m the alleged emmptim.Any vloledon of Section 70313 by Any applicant for a permit ubjects the applicant to a civil penalty of APN Number Occupancy Type not more than 050 hundred dollen(5500). ❑I,a owner of Me property,or my employees wish wages u Clair sale compensation, 31618035 . 00 will do Newark,and Ne soumurm is not intended proffered for ands(Sec.7061,Business and Profession Code:Code:The Cannacmes Licence Law dues not apply m an owner of /jJry Required Inspections property who bulldauimproves Nemon.and whodocssuch work himmlrar through his U // ownemployces.provided thatsuch improvements amnot intended uoffered forma.If, /I n however,Ne buildingvthorden of ement is provingwldwdiinot war of completion,Me of //VJ/ builder will have the burden of proving that be did not nulla u improve for Me own r. am.). ❑i,as..of the property,sun reclusively centre Ging with Imemmd cenusemm on C...U Ne es not (Sec.7010,Business and property who n Code:)Theves the ton. red O� cease law tlaa not apply m to want of property wire licensed or improves Norman,and who contacts for each projects with a comrmror(q Ilcenmtl punumt to Ne ConuactoYe Licence Law. Q O l am exempt undo Sm or moon Data Nb Owner WORKERS COMPENSATION DECLARATION I hereby Alum under penalty of perjury was of Ne following declaration: 1 haw and will maintain•CaNOnm or Consent ro self-inure for Workers Conniver. Amion,a provided for by Section 3700 or the Labor Code,for the Performance of Ne work for which this permit is issued. 1 new and will maintain Worker's Campinsurance,tioninsurance,u required, required by Section W of the labor Code.for Ne perfmhvmmar the work for which this permit is hi ed. My Worker's Compensation Insurance Laniu and Policy number art: Cartr, � ieAQPJ6 Fr*11 PoliryNo.; 88A20 64X CERTIFICA OTE F E%EMMON FROM WORKERS' COMPENSATION INSURANCE rGasucucm need not bC completed if 0e reach Is forma hundred dollen(SIM) or loss) 1 certify that in Ne pcTform mm of the work for which this permit Is Issued,I"I not employ any portion in my mamerm as to become subject to de Worker{Gompenaaion Laws or California.Date Appllcam NOTICE TO APPLICANT:If,after making this omincom of Exemption,you should became subject to Ne worker's Compensatimn previsions of tie labor Code,you mat .,zforthwtO comply with such provision or this permit Nall to Clamed mwked. .. ,Z, " CONSTRUCTION LENDING AGENCY (-C rte., I hereby affirm Na Nem is a construction lending Agency for the Performance of ' W' the work for which this permit Is issued(Sec.3097.Civ.C.) W� Lender's Name . =z Lender's Address . U0 1 certify NAI I ben reed this opplicamn and sum Nat the above information is ' Iy! Comma.I agree in comply with AI city and county ordiwxes and sure laws miming m 0rUbuilding construction,and hereby authorizerepresentativesm a of this city enar upon the ��•+a Gft shove-mentioned Properly res inpecuon purposes. [..i (We)agree to ave,indemnify and keep hamlu s tie City of Cupertino against i..i ti liabilities,judgments,Cosa and expenses which may In my way carve agaNst aid City U in consequence of the granting of this Permit, APPLICANT YN=STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date SOURCE NS l 05' Re-roofs Signatur of pplicamsConmmun Den, HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as denncd by the Cupertino Municipal Code.Chapter 9.12,and Ne Health and Safety coda,section 2553:(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes on Will the applicant or futum Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit havardoue air comm emanu as denncd by the Bay Area Air Quality Management all new materials for inspection. District? D Yes Xi Nu I haw real the ha rdun mamrials requirement.;under Charter 6.95ofthe Califor- his Health d:sarnycode,Scniou35505,25533 real 25534.1 understood thin if the building Jou but currently have a tenant,that it is my responibility m muly tie occupant of the requinemera st Dim AD or Signature of Applicant Date Owncron thori79de col D lg� sir All roof coverings to be Class"B"or better Community Development 10300 Torn Avenue j Cupertino CA 95014 Telephone(408) 777-3228 C OF Fax(408)777-3333 SUPEVINO Buildixig Department JOB ADDRESS:/o5 q0 ��M�u PERMIT# 6 S66ao / 2 OWNER'S NAME: w "(f PHONE # S(p 7o—dq CONTRACTOR 141A FAX# S' o)170 -54 I am not using any subcontractors: A2 As, Signature Da Please check applicable subcontractors and complete the following information 66 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing ✓ Electrical K G 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 Tile Owner/Contractor Signature Date ITYOFCITY OF CUPERTINO c� CUPEI�TINO RPERMIT APPLICATION FORM v APN# Building Address: Mailing Address (if different from building address): 75�✓TA1 4 w Owner's Name: Phone#: 'QawEtz Tv Contractor: License#: d7 t 2q o Contact: Phone: 6jto-77o-..,(o4 Cupertino Business License#: v6 Fax: /o — 77o -_C,664 102 301 Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: ) NLW ci gzA m-- Ar"IT- - 20A,a , ov I AWW G A,,sr- -u/we0- N 6 tai Residential ❑ Commercial 300, 3 OV Sq.Ft. Floor Area: AJ/A $/Sq.Ft.: Cost of Project: 52 S oo Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ Project Size: Standard 91 Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> IM 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 <_ I OOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi. BUILDING BINVESTIGA Investi ation fee BUILDING I of 3 q I CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb 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 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 cfm MECHANICAL BREMAMHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Ligbting LightingFixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Mise Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL '1. 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 2of3 l CITY OF CUPERTINO CUPERTTYOF O PERMIT APPLICATION FORM QuantityFee 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 Insection BUILDING BSWIN4 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 Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING i 3 of 3