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07030014t00 :ULj :Z raa =Z iae )yU � } 1 �co < °m V ^vr LL :so La t 13UILDINt; DIVISION PERMIT BUILDING ADDRESS: 19050 STEVENS CREEK BLVD OWNER'S NAME: UNITED POLARIS ONE: ARCHITECT /ENGINEER: LICENSED CONTRACTOR'S UbCLAKAt tun I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and cffec License Class �� Lic• A _ C Dam, :;I— Con ARCHITECTS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER - BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the 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 prior m its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($300). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's 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.). ❑ 1, 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- cense 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. ❑ 1 am exempt under See. B,& P C for this reason Owner - Date _ WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declaration. ❑ 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. ❑ 1 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 C �C �opvJ A ' and Policy nu rare: Carrier. C /V �V kSFolicyNo.. e'0 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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY ►��. I hereby affirm that there is a construction lending agency for the performance of <Yi 5 the work for which this permit is issued (Sec. 3097, Civ. C.) aQ Lender's Name Z L.endees Address V 0 1 certify that I have read this application and state that the above information is r correct. 1 agree to comply with all city and county ordinances and state laws relating to 0 J building construction, and hereby authorize representatives of this city to enter upon the above - mentioned property for inspection purposes. a(We) agree to save, indemnify and keep harmless the City of Cupertino against Hliabilities, judgments, costs and expenses which may in any way accrue against said City U z in consequence of the granting of this permit. ►-r APPLICANT UNDERSTAND&AND WILL COMPLY WITH ALL NON -POINT SOURCE WN // HAZARDOUS MATERIALS DISCLOSURE 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)? ❑ Yes No Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Yes Po I have read the hazardous materials requirements under Chapter 6.95 of die Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant "t it is my responsibility to notify the occupant of the remuiremcnt / which must be mckbrkr to issuance of a Certificate of Qccupancy. or Date - WONG ELECTRIC INC 4067 TRANSPORT (650)813 -9999 PERMIT NO. 07030014 PERMIT ISSUE DATE SANITARY NO. CONTROL NO. BUILDING PERMIT INFO Job Description PROVIEE & INSTALL POWER FOR EXISTING (6) TENANTS 200A 200V 3 PHASE & PANEL 100AMP Sq. Ft. Floor Area 3 7 5 0 7 C 4 6 APN Number Issued Re -roo Type of Roof (1) TENANT @ 100AMP (1) HOUSE $5000 Required Inspections l__*_'� All roc fs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class To or better CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT Sec: Twp: Rng: Sub: BLk: Lot: APN ......... 3'7507046 DATE ISSUED.......: 03/02/2007 RECEIPT #.......... B3000000593 REFERENCE ID # ...: 07030014 SITE ADDRESS .....: 1)050 STEVENS CREEK BLVD SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............: U14ITED POLARIS ADDRESS ..........: 19050 STEVENS CRK BLVD CITY /STATE /ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM CONTRACTOR ... COMPANY ...... ADDRESS ...... CITY /STATE /ZIP TELEPHONE .... FEE ID UNIT QUANTITY ---- - - - - -- ------- - - - - -- ---- - - - - -- BELEC200 METERS 8.00 BSEISMICOM VALUATION 5,000.00 EPERMITFEE FLAT RATE 1.00 TOTAL PERMIT : METHOD OF PAYMENT --------------- -- CREDIT CARD TOTAL RECEIPT : OPERATOR: amyw COPY # : 1 RECEIPT INTERFACE WO)NG, STEVEN L LIC # 20368 WO)NG ELECTRIC INC 4067 TRANSPORT ST P'�LO ALTO, CA 94303 (650) 813 -9999 AMOUNT --------------- 274.86 --------------- 274.86 VOICE ID DESCRIPTION -- - - - - -- --------------------- - - - - -- 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL AMOUNT PD -TO -DT THIS REC NEW BAL ---- - - - - -- 235.44 ---- - - - - -- 0.00 ---- - - - - -- 235.44 ---- - - - - -- 0.00 1.05 0.00 1.05 0.00 38.37 0.00 38.37 0.00 ---- - - - - -- 274.86 ---- - - - - -- 0.00 ---- - - - - -- 274.86 ---- - - - - -- 0.00 REFERENCE NUMBER -------------------- MASTERCARD VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- 501 FINAL ELECTRICAL ENERGY CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM o7o3op► 4 APN # O,7 �/� _ J`�O Date: 7— Building Address: Mailin Address (if different from building address): �E 1/ � J CAC' � C tl , O�vner's Name: Phone #: Z/'03 2 sl S - Z Contractor: License #: Conta t: _ p Phone: �l Cupertino Business License #: J�liG Fax: MECHANICAL Buildii Permit Info: )P,°,—J et— J)eov- i;e TcN0*-U 0 Tc=.✓r 4ic/r C ( ) Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential ❑ Commercial Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 1000 -130 l Occupancy Groin tL - Type of Construction: - Please check this box if the project is a MECHANICAL second-story addition: ❑ Project Size: Standard ❑ Large ❑ M,ijor ❑ Boiler > 1.75M Btu Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boil °r > 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 Irid/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elee 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Ele,� Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING of 3 F CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rndl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL Theatrical Lighting Fix ELECTRICAL Vent Fan Single Duct MECHANICAL ventilation Systems MECHANICAL BREMTHEATR BREMVENFAN 13REMVENSYS BSCBLVD Scb Specific Plan BUILDING BSEISMICOM S eismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING Special Inspection BUILDING BSPECIAL BSWIM Swimming Pool BUILDING -remporary Power ELECTRICAL Te nporary Bldg Permit BUILDING Temp Dist Svcs ELECTRICAL Business License BUILDING Electrical sq foot ELECTRICAL BTEMP BTEMPPERM BTEMPSVCS BUSLIC ELECTRIC EPERMITFEE MPERMFEE E lec Permit Issuance ELECTRICAL Mechanical sq. foot MECHANICAL MPERMITFEE M, ,-ch Permit Issuance MECHANICAL Plt mbin2 Permit Issue PLUMBING P .umbing Fee sq foot PLUMBING Planning, LIZ Comme/ Multi -Fam PLANNING PPERMITFEE PPLBG PLLONGRNGC PLLONGRNGR Plannin , Long Range Residential PLANNING Address ChallgP, PT TTT nn.Tr_ _ - _ ZADDCHG �Gne /s /Z� SOD i9v.,P /anc�IS 3 of 3 1 C1Tlf OE 17UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777 -3228 Fax(408)777 -3333 Buildina Department JOB ADDRESS!�1(vuefj PERMIT # -� CAP 4,- i�, ,��, OWNER'S NAME: t -rte Ifoe--A-1`3 PHONE # GENERAL CONTRACTOR: c.,0 oAJ G- i'�. L - --J C FAX # I am not using any subcontractors: .,ignature Date _ Please crnecx a ucaoie Sll►J WLUa%-w101 SUBCONTRACTOR aL«. _-I� .-•- -- --_ . _ BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date