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07020153 CITY OF CUPERTINO BUILDING DIVISION PERMIT CON' ItA.CC3RZI{ RMtTI®N• PERMIT NO. BUILDING ADDRESS: 22100 STEVENS CREEK BLVD AES ELECTRIC 07020153 PERMIT ISSUE DATE OWNER'S NAME: CITY OF CUPERTINO 3310 BASSETT STREET 02/28/2007 SANITARY NO. CONTROL NO. SNE: (408) 986-1320 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH a o 0 a p O LICENSED CONTRACTOR'S DECLARATION Job Description uf-- I hereby affirm that I am licensed under provisions of Chapter 9(commcncing Z with Section 7000)of Division 3 of the Business and Professions Code,and my licensei s INSTALL SUB PANEL FOR LIGHT & OUTLET. INSTALL a a in full force and effect. j ? License Class Lic.# LIGHT PND OUTLET f—p Date Contractor a ARCHITECTS DECLARATION I understand my plans shall he used as public records >yU U.F Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the :C0 following reason.(Section 7031.5,Business and Professions Code:Any city or county < which requires a permit to construct,alter,improve,demolish,or repair any structure u Z} prior to its issuance,also requires the applicant for such permit to rile a signed statement Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area $5000 2 t=—� (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Number Occupancy Type not more than five hundred dollars(5500). 3 5 7 1 0 O C 7 . ❑1,as owner of the property,or my employees with wages as their sale compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li. cease Law does not apply to an owner of property who builds or improves thereon,and. _ who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sea B&P C for this reason Owner Date _ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z . CONSTRUCTION LENDING AGENCY HrA I hereby affirm that there is a construction lending agency for the performance of a > the work for which this permit is issued(Sec.3097,Civ.C.) Lender's Namc Z Lender's Address U 0 I certify that I have read this application and state that the above information is LL coct.I agree to comply with all city and county ordinances and state laws relating to builrteding construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. (Wc)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way ascitic against said City U z in consequence of the granting of this permit. APPLICANT UNDERSTA D WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATI Re-roof; Signature of Applicanontractor Dare Type of Roof HAZARDOUS MATERIALS DISCLOSURE yp Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roof 3 shall be inspected prior to any roofing material being installed. ❑Yes o If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminrats as defined by the Bay Area Air Quality Management all new :materials for inspection. District? ❑Yes Nu 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 75534.1 understand that if the building does not current] have a tenant.that it is my responsibility to notify the occupant of the requiremc t t be met prior to issuance of a Certificate of Occupancy. Signatu)e of Applicant Date d� All roof coverings to be Class"B"or better Owner or authorixcd agent Date CITY OF CUPERTINO C)70q_Dp5q CITY OF PERMIT APPLICATION FORM CUPEkTINO CPN# Date: �b - CX�"-1 o2-^ 2�- 0 7 .. Mailing Address if different from building address): Building Addres12-t g � a o 51.6-ae.t`S C re Owner's Ne: Phone#: am i To�' CU pe/-%. Ac ydff 771 Z? j Contractor: G License#: �c�Q22�S Contact: Phone: q q _ Cupertino Bu Z�icense#: K11q w�di Fax: `� Building Permit Info: Bldg ❑ Elect dumb ❑ Mech ❑ Job Description: r % -1- 0w1�e ( - t Residential ❑ 1A 5 7-1 It S✓ b 4 4-1 �c i% �l Commercial Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: ce C) Occupancy Group: v Type of Construction: P f Please check this box if the project is a U l second-story addition: ❑ eroject Size: Standar Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Bailer<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boil,;r> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ir d/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 Ele z Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 aE(. CITY OF CUPERTINO TY of PERMIT APPL[CATION FORM CUPEIiTINO Quantity Fee ID :Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME N;w Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP T ew Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW At nospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE 11ldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Ga;Piping System Fee PLUMBING BPINTERCEP In i Waste Interceptor. PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Pl:m Check Add Multi BUILDING BPLANCKREP Pl,-.n Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn SprinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Jdt of Drain &Vent PLUMBING BPWATER Ins-.alUAlter Water Pie PLUMBING � PLUMBING BPWHEATER Nater Heater/Vent BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER AC Unit> 10,000 cfm MECHANICAL BREMIAN A/C Units <= 10,000 cfm MECHANICAL p BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BRENTNRApP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BR.EIVIRELOCA Relocation of Hood MECHANICAL BRElVIREPALT Zepair/Alter Heating MECHANICAL BREMRESAPP R-,model Res Appliance ELECTRICAL 2 of 3 `- CITY OF CUPERTINO CITY Of PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rm31 Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Thoatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS V m ilation Systems MECHANICAL BSCBLVD 36 Specific Plan BUILDING BSEISMICOM Seismic Commercial _ BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWW 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 PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Plannin ;Long Range Residential PLANNING ` ZADDCHG - Address Change BUILDING of 3