03100097 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT $ICONIVAC,TOR INFK ATIbN
B UILDING ADDRESS: AAA ELECTRIC INC \ PERMIT"03100097OWN (408) 557-8899 ER'SNIAMIi 3245 STEVENS CREEK BLV PERMIT ISSUE DATE
NE: SANITARYNO. CONTROLNO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLOC ELECT PLUMB MEC"
!00 LICENSED CONTRACI'OR'SDECLARATION JbDescri hon
i UW
app 1 rtby.from that I am licensedalom oP
under proriof Chapter 9(commencing
.<Gwith Section 7M))nr Division 3a(the Busincasand Profcu;u dmylicenuis
< in full force on a cct.
L;eenm I e I� �( MAIN SERINE PANEL
Dam Contractor
ARCHITI ARATIUN
U I undcrsund my plain shall W mud a puM1lic rtcnNs ,
6
.0 Licensed Profcmionsl
OWNER-BUILDER DECLARATION
0 f 1 hereby (Scc that 11. exempt from the Comns Co License Law for the
)O D following mown. (anti it 7fonstr Business and ve de ore Code:Any city at county
1 @� which reyulms a permit ro construct.eller.Improve,demolish,fie a 4g any statement.Zi the,be. imuonn...rtquim the applicant for such Permit mricaaLow(ataumcm
thin hciacing wit Pumuam bs4M1c of Dialons3 the Contractorsnd Pracoada(Chapter Sq.Ft. Floor Area Valuation .
t $ (commencing pt Sutirn7000)ombasiion3 nflWegedAssanO.n.Anynns Coded abort 1
]] Net he U exempt therefrom and Ne basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a Tremor subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than five hundred dollars(M).
❑I.as owner of The property,or my employees with wages a Their sure compensation.
will do the work,and the swctere is not intended or offered for sale(Sec.7044,Business 304 - ROUGH Iq�fFre� t�OnS
and Professions Code:The Convenor's Littnse Law dins not apply m an owner of C
property who Wilds or;mprov themon,and who daessuch work himulforthrough his 501 - FINAL ELECTRI AL ENERGY
own employ=.pmvided that such impmnmenm are not intended mortered formic.If. SOS — FINAL ELECTRICAL
however.Ne building or improvement is old within one year of completion,dm owncr.
builder will have the burden of proving Net he did not Wild or improve for purpose of
Age.).
0 1.as owner of one property.am exclusively contracting with rttmcd contractors to
construct the pmjen(Sec.7044,Business and Professions Code)The Contncour's Lb
cense Law does not apply to an owner of property who Wilds or improv Neuron.and,
who contracts for such projects with a contracoubt)licensed pursuant to the Conuactar's
License law.
❑I am exempt under Sec. ,B At P C for this mason
Owner DATA
WORKER'S COMPENSATION DECLARATION
1 thereby of ion under penalty of perjury am of tie following declantions:
J Ihaw and will mainW.aCeNfrceto or Continuo ulFinaure for WorkcM1 Compete
salon,u provided for by Section 3700 of the Ube,Code,for the poor.onAnn or the
wink for which This perm;(is issued.
❑1 have and will maintain Worater's Compensation Insurance,u Acquired by Section .
371111 of the Libor Cade,for Ne Performance of Ne work for which this permit is issued.
My Worke Cnmpensadoa lnsunnn carrier and Policy mbar erg); /��/
Carrier. Nth Policy No.:�t,�/_a —O
Cle IPI ATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 0( O_s,I1I�
(This section need not W conancMd if the Permit is for one huhuman, tlnllaYa(SIM)
or loss.)
1 canify Nat in thc performance of the work for which this Permit is issued,I Nell not
employ any person in any manner an As in become mbjecuo the Worker!Compensatlon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Cenifinu of Exemption,you should
Wcome subject to the Workers Compensation provisions of the LAW Cade,you must
forthwith comply with such provisions or this Permit shall be deemed invoked.
ZO CONSTRUCTION LENDING AGENCY
1 hereby glince Nu Nem is a construction lending Agent'for de performance of
X The.,it fur which this permit is issued(Sec.3097.Civ.C.)
YQ Lcndcr's Name
7 z Lender's Add.
;)Q I certify that l hoc mad this application and sum Net din show ororm W un I.
L correct.l gree to comply with all city and county ordimans and sum laws relating to
building consWedon,and emby authorize representatives of This city to caterupnn the
)+4 ahove-meMuned propert r inspection purposes.
(Wc) Adc.N And tech harmless the yA of CupcAno gains(
r/) Iiabili0es,ju n sad expenses which may in any way ucmeE14IMP'OINT
d City I//' %j•-a
j in eonseque a r n mit.
APPLICA ILL COMPLY WITH A Issued by: Date
SOURCE G
nam or di anvctor
Re-roofs
HAZA�IDOUS MA ALS DISCLOSURE Type of Roof
Will the applicenw for um building occumatitom or handle amduusmaterial
as t recd by de C.Km. Musa'iPal Code.Chapter 9.12,and The Health and Safety
Code.3ce0es 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
Will the applicant or fol building occupant use cyuipmenl or dcvicca which If a roof is installed without first obtaining an inspection,I agree to remove
it haysrdous air con=.n u derated by
the Bay Aca Air Quality Management all new materials for inspection.
uuict7
Ycs
Ih.ve aJ. .umisisrecto mcntsundcr Chapuo6.95ofthelifm.
MaHealth& c C 25534.1 undemmM irthe ilding
dors not c sat hthis y res nsihility m nauf t Occup 1of the
requlmmc c m u aCcrdream Signature of Applicant Date
1 k Data All roof coverings to be Class "B" or better
CITY OF CUPERTINO /
CUPEf�TINO PERMIT APPLICATION FORM /
UN# L Date:
Building Address ' ��/�
Owner's Namfle: T-n/n) C-a�o LL Phone #:
Contractor: A License#:
Contact: Cupertino Business License#:
GtJtL1s
lding ermi fo:
Bldg El ct Plumb ❑ Mech ❑
Z J bJob escri n:
ial .per /�(/� /� r` C mmercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: - Occupancy G up: _
ve= e2
(�
Type of Construction:
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 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 <= 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
z/3 �-6
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CITY OF CUPERTINO
C'TMO PERMIT APPLICATION FORM
CUPEkTINO
uanti 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
BNUSFD New Single Family Res BUILDING
BOVERTDa 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 cftn MECHANICAL
BREMAiRHAN A/C Units<= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Fumace MECHANICAL
BREMFURNOV Relo Fumace> l OK btu MECHANICAL
BREWMAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
As BREMPOLE Pole/Platform Fixture ELECTRICAL '
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CITY OF CUPERTIN0
CUPo PNO PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
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
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 PlanBUILDING
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
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