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04110124 (2) CITY OF CUPERTINO n ' ' ZUILDING DIVISION PER CONTRACTOR, FORMON� , BUILDING ADDRESS: THERMA CORP PERMIT""04110124 10,A40 BUBB RD V OWNER'S NAME: PERMIT ISSUE DATE AWL DURECT CORP. 1601 LAS PLUMAS AVE4 HONE: SANITARY NO. CONTROUNO. (408) 347-3400 - ARCHITECT/ENGINEER: BUILDING PERMIT INFO _ BLDG ELECT PLUMB MECH 0 0 0 0 v00 LICENSED CONTRACTOR'S DECLARATION z C I hereby affirm that 1 am Ilceread under provisions of CTaPRr 9(commencing Job Description .Zz, with Section 7")of Division 3 of Ne Business and Professions Code.and my licence is mfu1lfmman f tnY -3 27c/ve Co.,,. PG. SUPPORT TO AHC/MOTOR AMP/EX. FAN acto, TIYF l.e-�! u ARCHITECTS DECLARATION y< I und[rmamd my plans shall he used as public records JyU 3O Licensed Professional OWNER-BUILDER DECLARATION 0 I thereby affirm that 11. exempt from On Contms Co :Any c Law for The r� 500 whicfolloh on reason.permit t 703 nce usimnsand mprve.derumh.or Any city or Moslem v K m which requires a pemtit w cnr.wct,alter improve.JemnlL h,or repair any stmcmrt .$20000 ' prior to its issuance.also inquires the applicant for such Permit o flea signed statement 5.� that he is licensed.ursuant to the provisions of Ne Comucam',license Law(Charter 9 Sq.Ft. Floor Are Valuation (commencing with Section 7")of Division 3 of the Business and Professions Code)or. WOut he is exempt comfrom and the basis for the alleged e.prion.Any violation of Section 1031.5 by any applicant for a permit subjects the applicanfto a civil Penalty of e Occupancy Type not mom than firs hundred dollars(S5Oy. D I,as owner of 0e,property,or my employees with wages as their sale compensation, Will do the work.and Ne swcture is not rumored or offered for sale(Ski 1014,Business _ p Required Inspections ' and Professor.Code:The Cmunerms License law docs at apply to as owner of . . q - propenywha W ildsmisr,owns thereon.and who docssach work himself orlhrough his own employees,provided that such improvements Me not intended oroffered for sale.IL huilder,the buildingMe Orden of proving thats sold withinoneyear of completion,r Ne owner- a.In.).r will have the burden of Nat he did not build or int for f provin6 Prove purposo - � .. .. sale.). D I,as net of the property,a xcimively contracting with licensed contncm.to ces suuct dm project(Sec.7014,Business and Professions Cade:)The Contractor's Li- _ ns law docs not apply to an owner of property who Wilds or improvea demon.and who contracts for such pmjccts with a com actors)licensed pursuant to the Comrectors License Law. D I nor exempt untie,Sec. .B&P C for Nis reason Owner Data, WORKER'S COMPENSATION DECLARATION 1 herby,affirm antler penally of perjury ow of the following declaral.ok D I have and will maintain a Certificam of Commnuo self-imam for Workeh Compcn. scion,az provided for by Section 3700 of du Labor Code.for the Performance of the work for which Nis permit is issued. X1 have and will maintain Workers Compensation Insurance,az required by Section 00 of the Tabor Code,for the performance of the work for which this pconil is issued. My Worke�rs C mpensaIion Insunn¢eanicr end Policy number art: Canicrl)' PAT 1/:aCf_ 'A/6111✓PoII Nm: WJ/lj-;'Uc o 03 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he completed lithe Permit is foronc hundred dallars($100) of Ices.) I certify that in Ne performance of the work for which this permit is issued.I shall not employ any person in any manner so w,to become subject o the Workess Compemation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should ,become subject In Ne Worker's Compensation provisions of On LiMew CMe,you muss .J O [Mwits comply with such provisions or this permit shall he deemed revoked. z�y CONSTRUCTION LENDING AGENCY tel. 'T. 1 hereby affirm that there is a construction lending agency for the performance of fYa� the work fur which this permit is issued(See.3091.Civ.C.) aA Lenders Name z Tenders Address U Q I certify that 1 Mss mad Nis application end sou that Ne about information u U, F-' corms 1 agree to comply with all city and county ordinances and sus laws relating to O U building conso.ctiun,and hereby satiation represnmisu of this city to enter upon Ne � Uj above-mentioned pmpeny for inspection purposes. (We)agree N save,indemnify and mcp harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accma against said City U z in consequence of IN granting of this permit. '—' APPLICANT///111111��NDfff...RSTAND�S AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale SOUR ,RCaN�IT qN r{/j!/./ / Re-roofs Si roof Appli avaor Dam HAZARDOUS ' t1AZARDOUS MATERIALS DISCLOSURE Type of Roof Will IN applicant of future building e.Chapter sem.1 or handle Health and az refined by Nc Cupertino Municipal Code.Chaper 9.12.and the Health anJ Safety Code.Section 25532(x)? 9l� All roofs shall be inspected prior to any roofing material being installed. Dyes Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove ®emit ha,mmous air conaminants se defined by the Day Area Air Quality Management all new materials for inspection. District? D Yes ptf 1 have sad the hmardous materials requimm[na under Chapmr6.95 of the Califor- nia Hmlth&Safety Code.Sucum¢25505.25533 and 25534.1 understand that if the Wilding - does not cu Troy a mnam,Nat it is my responsibility u notify the occupant of tic rtymamc /jt Prior to [y Signature of Applicant Date o�,'<aage //// All roof coverings to be Class"B"or better Community Development +yam 10300 Torre Avenue u Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 IOUPEI�TINO Building De artment JOB ADDRESS: PERMIT # 163,/o ®y OWNER'S N -Z)OXEr PHONE GENERAL CONTRACTOR: /� FAX # 3 Y 7_,Y4 I am not using any subcontractoris: _ Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting ® Linoleum/ Wood Glass/ Glazing Heating 2 z v Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing oofing Septic Tank Sheet Metal Sheet Rock Tile • /2-zi-vY r/Contractor Signature 1 Date ,I e0CITY OF CUPERTINO� �, Z CUP TYOF O PERMIT APPLICATION FORM • APN # 3 5_ Date: Building Address: Mailing Address (if different from building address): Owner's ame: Phone#: Ca/t l►• Cont r ctor, License #: ? GV Con ct: Phone: - 7-3 oe Cupertino Business License#: !7E Fax: Building Permit Info: Bld � ❑ Elect ❑ Plumb ❑ Mech Job Description: / Residential ❑ I-7k Sq.Ft. Floor Area: Ft.: " _ .Y061 Cost ofProjectV O cupan Group: .ZO,den Type of Construction/- Please check this box if th project is a IMEe k r_., second-story ad ition: ® Project Size: Standard ❑ 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> 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 1 of3 ° 7 7' qe allotl * CITY OF CUPERTINP CITYOF PERMIT APPLICATION FORM CUPEkTINO Quantity, Fee 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 rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING • BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER InstalUAlter Water Pipe PLUMBING BPWHEATER Water HeaterNent 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 i 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 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 2of3 %CC01i WITY OF CUPERTINO*tg ' CITYOF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Grou BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL. eA 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 EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Change BUILDING 1 • 3of3 • Community Development 10300 Torre Avenue i It ' rte' Cupertino CA 95014 Telephone(408)777-3228 CITY 0, Fax(408)777-3333 PEI�TINO BuildingDepartment artme JOB RESS: PERMIT # OWNER'S N u P NE of v 0 GENERAL CONTRACTOR: '/up 7Y7- I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: _ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Q / Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal t Painting/ Wallpaper Paving r Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 4r�/Contractor Signature Date