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03090100 (2)` CITY OF CUPER'I'INO�€ ;`. BUILDING DIVISION PERMIT CONTRACTOR INFORMATION.:. BUILDING ADDRESS: DON WADE ELECTRIC CO PERMIT T3090100 An 16320 HARWOOD RD PERMIT ISSUE DATE (408) 377-2323 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDGELECT 0 PLUMB MECH 0 0 0 LICENSED CONTRACTOR'S DECLARATION I humby storm Ila, I am licensed under provisions of Chapter 9 (commencing Job Description ' will Section 7") of Division 3 of the Business and Pmfcssitom Code. and my license is in full farce and effete Class Li License cunes ELECTRIC PERMIT Date. TSContractor/ ARCHITECTS DECLARATION 1 understand my plans anal) W used as Public records C Licensed Pmfcssinnal OWNER-BUILDER DECLARATION tea/ peminLew for the 1 herchy affirm that 1 em exempt from IW Conlrass Any J following aeon.. (Section ]IDLA Business and io Co C Code: Any city car moot, demolish, care improve, de alter, improve,h which squiresnpermit re etres the applicant the Permits a sirnedari mens mem for sucContractor's oiense hatMor its issnsedpu card tcHim to the of the LhalmisranxdparsaaouomcpmarmmtoftheStrsmm'sCuenxlaonsCodtery Law(Cha Sq. Ft. Floor Area Valuation Section 701)0) of Diaiiian 3 ess andexempt Professions Code) or (commencingheisexempt Natio is eaempl thcefmm and the basis for the alleged exemption. the al eged Any of t. Secnot mt?o3Lsby any ror R l pennon subjects the applicant to.civil Penally of � - Number Occupancy vehundpddollant s($500mil notmorothan fiw<wnamaamlars(ssoo). -- - - -- .APN Type _-- ❑ T. as Owner of the property, or my employes with wages as their sole compensation, will do the work, and the sunt is not intended or offered rorsale(Sec.70,U$. Business 304 - ROUGH F TEt and Professions Code: The Convectors License Law does net apply to an owner of � ons property who builds or improves themon,and watcher such work himselfor though his 501 - FINAL EL CTRI AL ENERGY awn employees, pmvided that such improvements am not intended or offered for talc. If. however, the building or improvement is sold within one year of camPictinn, the owner. 505 — FINAL ELECTRICAL builder will have the burden of proving that Im did not Wild or improve for purPse of ral.j. 1, as owner of the property, am exclusively contracting will licensed contractors to 'nstmcl the project (Sec. 7011, Business and Professions Code:) The Contractor's Li- come Law does not apply to an owner of property who Wilds or improves Inertias, Had. - who contracts for such projects with a conoacum(s) licensed pursuant to the Contractor s License Law. ❑Ivo cscm ndcr Sao ,Bek PCf Ibis uon or 'xiNue ire, - \ RKER'S COMPENSAT N DECLA A I hereby of on under Penalty of perj a of the following declarations: I have and will maintain a CcHifi-H or Consent to self-ins. far Worker 'aCmnpcn- sation, az Provided for by Section 3700 of the labor Code. for the performance of the ark for which this Permit is issued. ❑ 1 have and will maintain Workers Compensation Insurance, u required by Section 3700.f the labor Code, far the performance Of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number arc: Cartier: Pol icy N'.: _ CERTIFICATE OF EX EM MON FROM WORKERS' COMPENSATION INSURANCE (This union need not W completed if the Permit is for one hundred dollars (SM) or Ices.) 1 cenify Nat in the Forld maac of the week for which this Pvmlt is issued, )shall not employ any person in any manncrm as to become subject to the Workcri Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making 'his Ccei0cate of Esemption, you should Wrome subject to the Worker's Compensation pmvisions of the labor Code, you must forthwith comply with such Provisions or this Pcrm it shall W deemed evoked. CONSTRUCTION LENDING AGENCY I hereby affirm Nat there its construction lending agency for the Performance of the work fur which this preterit is issued (See 3097, Civ. C.) Lender's Name 12ndel t Address I certify that I have read this application and state that the above t titan is c0ffCcIuiklin 1 ogee to comply with all city and county ordinancesiOf and state laws rmilitia building conswctim, and hereby authorise rposexnutivcs of this city to toter upon the upon V shove-mentioned PmPeny for Inspection (We) agree to save, indemnify and kap harmless the City Of Cupertino agaiml liabilitim.judgmcnts.costs and expenses which may in any way settee against said City hick may to come hm;ea the grantinghis Perrot. '( this APPLICANT DERSTAAl W L COMPLY WITH ALL NON-Is INT SOURC ULATIONS. Issued by: Date / �` `s D3 Re-roofs nature or Ap eam/Uomracmr ate HAZARDOUS MATERIA DISCLOSURE Type of Roof Will tW applicant or future building auto ant store or handle harardous material as defined by the CuNnino Municipal Code, Chapter 9.12. and the Health and Safety Code, Section 25532(.)? ��/// ❑Yin IyN. All roofs shall be inspected prior to any roofing material being installed. 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 it ha>andous air contaminants ss defined by the Bay Arca Air Quality Management isvict? all new materials for inspection. ❑Yes N. 1 have read the havanlous materials requirements under Chapter 6.95 of the Califon nia Health& Safety Coca, Sections 25505.25533 and 25531.1 undustand Nu if the Wilding does not cu sly hast a tenant, thv iI is my memamihility m noir, the ..'ant of th eyuie hich mutat W ma prior),issuacec'f a Ccruhcate'f Accu cy� - %/iJ� J 3 Signature of Applicant Date All roof coverings to be Class "B" or better Gwn a'th icdagenlu r / CITY OF CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 4� D30goloo 1 of 3 Zai 3 7 ff I N# , _ ( Date: Building Address:k2 54 14� Owner's Name: o6�P, i�i✓Cr°�• Phone #: NY6. .14 /1 Contractor: Do.t/ l�/'q.00 �GCc�. i s License #: C° /a 2 7 7 0 3/ Contact: F G t/�o� Cupertino Business License#: 3 Building Permit Info: 11 Bl ❑ ect Plumb ❑ Mech ❑ Job Description: Residential ' Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project �a 6� i Occupancy Grou AdIkk Type of Const Quantity Fee ID Fee Descri tion Fee Group 13APPLOTHER 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 IM Btu MECHANICAL BBOILER4 Boiler> I 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 BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 3 Zai 3 7 ff I �J CITY OF CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity 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 BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING 13PCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPR ITERCEP 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 WaterHeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING OVER A/C Unit > 10,000 cfm MECHANICAL RHAN A/C Units <= 10,000 cfm MECHANICAL PPLI A liance Instal] MECHANICAL SWAY Remodel Buswa s ELECTRICAL FIXT Li titin Fixtures ELECTRICAL URN C Relocation of Furnace MECHANICAL RNOV Relo Furnace > I OK btu MECHANICAL EAT Heater Installation MECHANICAL HOOD Installation of Hood MECHANICAL ISC Misc A aratus ELECTRICAL RAPP OLE Rem Non -Res A liance Pole/Platform Fixture ELECTRICAL ELECTRICAL .1 2 of 3 SAM CITY Or CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Qua Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL vol BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Sips, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb S eci& Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swinuning Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC \ Electlical 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 3 of 3 n J •