04010123 (2) a CITY OF CUPERT'INO
BUILDING DIVISION PERMIT 000NTRACTORKINF $„QRM ,'T ”
N_
BUILDING ADDRESS: JMC ELECTRIC ""'1%4010123
OWNER'S NAME: PERMIT ISSUE DATE
MAT, ZAnKQVqT<Y 147R RTRT) AUR
ONE: SANITARY NO. CONTROL'NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT . PLUMB MECH
0 0 0 a
3 0 o LICENSED CONTRACTORS DECLARATION
�ZF❑ 1 Wrcey firm Ihnt I am limancd under proviai tus of Chapter 9(mm ser.is Job Description
W with Sermon ))uf Divi¢lonJOf the Bu¢inw�./+�dProfcsslum Code.end myliccns is
<< in full forte a of ht� s� L
qi man Cl /:�' Lie.N �OP3y(o ELECT SERVICE UPGRADE
DF, ConlnMrarCc IL .
e AR ITECTS A ATION
y 1 understand my pens shall M used a pest .cO,&
o Licensed Professional
g OWNER-BUILDER DECLARATION
I heresy M.that I em exempt from she Conlnaofa License Lew for the `
O D following manors,(Section 71171.5,eosin...and Pmfcssinm Code,:Any city or county
which squires a Permit to ennssnu:L alter,improve,demolish,or mpair any structure
iy prior to its issuance.also m4uirh lW applicant for such permiuo file a signed statement
< that W is licensed pursuant to the pmvisions Of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 7000)of Division J or be Business and Prefwions Code)or
�l
that he I.exempt Ne¢fmm and the bank,for the alleged eaemplhm.Any violation of
Section 7001,5 by any applicant for a p Orth subjects the applicant to a civil penahy of 3 iArp1.PA,T`idle o 0
nut mon than five hundred dollars(5500). O"O2 0" r Occupancy Type
❑1,as owner of the property,or my employes with wages as their sole com penntion,
will dathe wom and Ne heComrcma'mendedoroffendsfortapplyale in an,owner of /- Required Inspection
soons
and Frtywhobu Cade:The mtoemors License,nd who taw does not apply lf an rough of q P
own enywhos.buildsorthcreprove who an
ch work himsellorthroughhis ,.
ownemployees,pmvidcdthhaver is sold anuart notintended nroffereded.h.fo ssae.IL
budder ill building or improwmenng sold wi i in of year of mprove for
Ne ownco
budder will have the Wrticn of proving Nat W did not Wild or improve fur puryose of —{
cal..). /
1,as Owner of the ro n em exclusive) channeling❑ P . $ Y g with licensed)Theonuaemn to ] LL
construct the project(Sac.704d,Business and m,who m Code:)The Convacmra Li V�-t i
whoa lawdoesr awn plrjean with
ofproper(whoosedpor imp ms es Norton and. J
woo contracts far such projects with a conmhor(q licensed pursuant m Ise Contractors
Liceve Law. >+
❑lam exempt under Sec .B&PCfm this reams .
Owner Dam
WORKERS COMPENSATION DECLARATION \
1 hereby in.under pentlry of perjury one Of the following dedmtiaes: �4
1 have and will maintain a Chtificate of Consent o sel4imum for Worth's Compcm
cation,as provided for by Section 7700 of the Labor Code,for the performance of the
work for which this permit Is issued. \
❑1 have and will maintain Wmkcfs Compensation lnsunncc,as required by Section
7700 of Nc labor Code,for the performance of tle work for which this permit is issued.
My Worker's Compensation lnsunnm carrier and Policy number am:
Carver: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This stins need not Wcompleted If the permit is for one hundred dollen(S Md)
Or less.) a
I cenify that in lbb4tEfyomne.of the work for which this Permit is issued,1 shell not
employanyperso inymmnCJr s¢as J me subjut to f Workeri Compensation
laws of Califumia. d
Applicant
N IC TO APPLICA .If,after making this Certificate of Exemption,you should
We bject to the rkcrs Compcwtion provisions of IW Labor Code,you must
.J O loMwith comply with such prnvisiom Or this permit Aall W dcamcd revolo d.
z" CONSTRUCTION LENDING AGENCY
IWrehy Mrm that Nen its cmnaulinn,endingagency for be Pedurmanm of
Cli IW work for which this Permit is issued(Sec.3097,Civ.C.)
tV Q Lenders Name,
5 z Lcndar's Addmsa
U Q 1 eerdfy in..I have read Nis application and sate that No shelve infomsalun la
Uy P correct,1 agree to comply with all city and county ordinances and aura laws misting to
0U building construction,and hereby authonn represemroiwa of this city m chic"pon the
.1 ovcmentioned property for inspection purposes.
(We)agree to saw,indemnify and keep harmless the City of Cupertino against
HIn liabilities,judgments.costa and expenses which may In any way same against mid City
UZ in consequence of Ne granting of this pumit.
^ APPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO RCE GULAT ONS.
? B Re-roofs
Si urc of pelt " Comne ar am Type of Roof
HAZARDS MATERIALS DISCLOSURE
Will applicant or future Wilding decorator room or handle huudous material
as defined by the Cupertino Municipal Coca.Chapter 9.11.and the Health and Safety
code.18"Yoesn 25532(.)T dNa All roofs shall be inspected prior to any roofing material being Installed.
Will the applicant or future building Occupant use equipment or okybes which If a roof is installed without first obtaining an inspection,I agree to remove
It bmamous air comamonnts u defined by the Bay Area Air Quality Management all new materials for inspection.
Istrih7
❑Yes ,rl No
1 hammed Ne h=Mrd iuss my dab nyuimmenu under Chapmr6.95 of thc Califor.
nix Healed&Safely Cade,Seeuom 25505,25577 and 25534.l unticntend shat if f Wilding
dms not cmrent,y haw a mnane Nat it k,my msponsihility m nodly the.c.Pam of Ne
myulmstl which ustWmes prior m issuance of a CeniGear_0' spumy, Signature of Applicant Date
0 era uth.mndagcnt s All roof coverings to be Class "B"or better
12 CITY OF CUPERTINO
► CITY OF PERMIT APPLICATION FORM ° ( � 23
CUPERTINO
APN# ' Date: (^\ ^Q
Building Address: _ d
2i
vb �6
Owner's Nam Pho #:
Contractor: �FY({ License #: ig& 6-0
0 7 0 aL
Contact: Cupertino Business License#:
B,qkling ermit Info:
Bld Elect Plumb ❑ Mech ❑
Job scription: Sc��Ce PP�t//r foo
residentialCommercial ❑
Sq.Ft. Floor r $/Sq.Ft.:
Cost of roject: I\ 0 Occupancy G up:
Type Construction: AL—
Quantity
—Ank
uanti Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> l 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> IOOOA ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
za BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. HousingMit. Fee BUILDING
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Sm CCITY OF CUPERTINO
y CUP TYOF O PERMIT APPLICATION FORM
QuantityFee 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 Conus Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res 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 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
BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Fumace> 10K 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
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CITY OF CUPERTINO r
CUP TYOF O PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
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 Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimmin 'Pool BUILDING
BTENT 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
BMISCELL Building Misc Fees BUILDING
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