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07050214 CITE'OF CUPERTINO BUILDING D;'r]SION PERMIT +CN' 1 GTC'1R IVaIM�TION PERMIT NO. BUILg116,.A11p1"NAR LAP DR TBD - 70 BE DETERMINED 07050214 l G tS l PERMIT ISSUE DATE OWNER'S NAME: 05/22/2007 SANITARY NO. CONTROL NO. )NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: ELECTRIC SERVICE UPGRADE BLDG ELECT PLUMB MECH 0 0 0 1 0 p LICENSED CONTRACTOR'S DECLARATION JOU Description i w" I hereby affirm that I am licensed under provisions of f Ch9(commencing Zwith Section 7000)of Division 3 of the Business and Professions Code,and my license is <e in full force and effect j ? License Class Lic•# ❑ Date Contractor F ARCHITECTS DECLARATION 7 a a I understand my plans shall be used as public records )yV e U.l- Licensed Professional C)a OWNER-BUILDER DECLARATION �"s I hereby affirm that I am exempt from the Contractors License Law for the ci o following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to constructalter,improve,demolish,or repair any structure o n prior m its issuance,also requires the applicant for such permit to file a signed statement o, Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ,>q.Ft.Floor Area j F=❑ (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 APN Number Occupancy Type not more than five hundred dollars(5500). Q 1,as owner of the property,or my employees with wages as their sole compensation, will do thework.and the structure is notintended oraffered forsalc(Sec.7044,Business Required Inspections 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.). 00(las owner of the property.am exclusively contracting with licensed contractors to nstmct the project(Sec.7044,Business and Professions Code:)The Contractors 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. Q 1 am exempt under Sec. B&P C for this reason Owner (!: �,�-�---- Date �'ry WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: Q]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. Q I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Cade,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number arc: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is formic hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any mart er jo as to become 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 E r I hereby affirm that there is a construction lending agency for the performance of a> the work for which this permit is issued(See.3097,Civ.C.) W Q Lender's Name a z Lender's Address U 0 1 certify that 1 have read this application and state that the above information is LL correct.I agree to comply with all city and county ordinances and stale laws relating to Vbuilding construction.and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspccuon purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against ,Fy to liabilities,judgments,costs and expenses which may in any way scenic against said City U z in consequence of the granting of this permit. Date 2 2nr� ►—t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by 7'��2'I�/C�� Re-roofs f Signature oApplicant/Contractor Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future building occupantstoro or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(x)? / All roofs Shall be inspected prior to any roofing material being installed. Cl Yes 940If a roof i 3 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 contaminants as defined by the Bay Area Air Quality Management all new rr aterials for inspection. District? Q Yes VA. I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the require must be met prior to issuance of aCcnifFl atcofOccupancy. Signature of Applicant Date All roof coverings to be Class"B"or better . �— . Owner or aulhomcd agent Date CITY OF CUPERTINO ITEM 1 OF 1 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot : APN 32E39047. 00 DATE ISSUED. . . . . . . : 05/22/2007 RECEIPT #. . . . . . BSC00001416 REFERENCE ID # . . . : 07C50214 SITE ADDRESS . . . . . : 1081 PHAR LAP DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER ED AVAKIAN ADDRESS . . . . . . . . . . CITY/STATE/ZIP , RECEIVED FROM . . . . : ED AVAKIAN CONTRACTOR TBI, - TO BE DETERMINED LIC # 00096 COMPANY TBI, - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY 1,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BPLANCKREP HOURS 1 .00 87. 14 0 .00 87 . 14 0. 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 87 .14 0 .00 87 .14 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 87. 14 3097 --------------- TOTAL RECEIPT 87.14 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO CITY OF CUPERTINO V;. ,"W CITY OF PERMIT APPLICATION F6M CUPEkTINo �1 C�uo4q CPN# Date: 77 /orr Building Address: :Mailing Address (if different from building address): 1 oti8 1 PW LAP Pa-, CkJPF i,lQ 01 Owner's Name: Phone#: F�b AIAXI AA) 4(ot. Contractor- License#: C- 1 A 4-7 Contact: Phone: 4&- 10 Cupertino Bu ines License#: WMZ0S HA 2,A Al ASIS l g Fax: 4`& •5-7 q •�4t�o Building Permit Info: Bldg 0 Elect [;K Plumb ❑ Mech ❑ Job Description: s."vi Cz, on;PW�F- Residential [" Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: L60Occupancy Group: 9 _ Type of Construction: Please check this box if to project is a �Z second-storyaddition. .-Iroject Size: Standard ❑ Large ❑ Maj)r ❑ Quantity Fee ID lee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Bol ler<= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1 M 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 Cor stax—Resi/Mobile BUILDING BELEC 1000 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 1A3 CITY OF C'UPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Com n. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP N-,w Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE B MR Permit Fees BUILDING BPFIXTURE Pb1g 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 c ewa a 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 cfrn MECHANICAL BREMAIRHAN A/C_Jnits <= 10,000 cfm MECHANICAL BREMAPPLI f,ppliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT bighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relc Furnace> IOK btu MECHANICAL BREMHEAT Beater Installation MECHANICAL BREMINHOOD Ing tallation of Hood MECHANICAL BREMMISC Wisc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc t1, Switch & Outlets ELECTRICAL BREMRELOCA Rclocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Ren:odel Res Appliance ELECTRICAL 2 A 3 .7 -N", CITY OF C UPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmc 1 Signs Add Branch ELECTRICAL BREMSIGNS Rem)del Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD �cb Specific Plan BUILDING _ BSEISMICOM Seismic Commercial BUILDING BSEISMICRE ',Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM ,swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Tem uora Bld Permit BUILDING BTEMPSVCS "Temp Dist Svcs ELECTRICAL BUSLIC Lusiness License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mec:h Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Phmbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING 3 3f 3