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06100223 CITY OF CUPERTINO BUILD-k?,-r, PERMIT r T� � 4 BUILDING ADDRESS: CUPERTINO ELECTRIC INC PERNo. 06100223 21050 MC CLELLAN RD PERMIT ISSUE DATE OWNER'S NAME: HOEFLER WALTER 1132 NORTH 7TH ST 10/11 /2006 )NE: SANITARY NO. CONTROL NO. (408).991-1000 ABUILDING PERMIT INFO RCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p Oz LICENSED CONTRACTOR'S DECLARATION Job Description m C I hereby affirm that I am licensed under provisions of Chapter 9(commencing U m with Section 7000)of Division 3 of the Business and Professions Code,and my license is ;?y in full force and f � INSTALL NEW 200 AMP. METER MAIN t v�z License Class Lic.k F Date Contractor lWit Zoin AC F ,C ARCHITECTS DECLARATION i a< I understand my plans shall be used as public records ;WU U.H Licensed Professional y; OWNER-BUILDER DECLARATION } I hereby affirm that 1 am exempt from the Contractor's License Law for the j p O following reason.(Section 7031.5,Business and Professions Code:Any city or county m which requires a permit to construct,alter,improve,demolish,or repair any structure $5000 Zy prior to 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 Sq.Ft.Floor Area Valuation t- (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 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of p U U Occupancy Type not more than five hundred dollars($500). Q I,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 Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q 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.). Q 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. ❑I am exempt under Sec. B&P C for this reason OwnerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: Q I 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 Workees Compensation Insurance carrier and Policy number arc: Cartier. 2jiR,IMCA4 ACs Policy No.:WC 34 316151 e) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is Cor 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 Workers Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z "" CONSTRUCTION LENDING AGENCY I-►�- I hereby affirm that there is a concoction lending agency for the performance of a > the work for which this permit is issued(Sec.3097,Civ.C.) aA Lendces Name ►7 z Lenders Address V O 1 certify that 1 have read this application and state that the above information is w correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. flu (We)agree to save,indemnify and keep harmless the City of Cupertino against "Ce) liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. y Date V t" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: (�ZW SOURCE RVfGULAjnON,% '7 io v Re-roofs Signature of pplicam/Coulactor Cate HA14DOUS MATERIALS DISCLOSURE Type of Roof 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 roofs shall be inspected prior to any roofing material being installed. Q yes vo. 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 contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes we 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor. nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requiremen which must bemet prior to issuance of a Certificate of Occu cy. Signature of Applicant Date /a 1P All roof coverings to be Class"B"or better Owner or a horizcd a nt Date ., Community Development ,_. 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 "UPEkTINO Building Department JOB ADDRESS: PERMIT # WOTO -Z r ' C LE-u- , -s,.,o C , `15o f 0 6 1 c O OWNER'S NAME: QAP_r-t_ke_' PHONE # p -g000 CONTRACTOR:C,4;,�;r„j - FAX # yo Z7 -85 I am not using any subcontractors: fa Si a e Date Please check applicable subcontractors an com the following information: SUBCONTRACTOR 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 31 r/ ontractor Signature Date CITY OF CUPERTINO .m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp : Rng: Sub: Blk: Lot : APN 35905133 . 00 DATE ISSUED. . . . . . . : 10/31/2006 RECEIPT # . . . . . . . . . 36626 REFERENCE ID # . . . : 06100223 SITE ADDRESS . . . . . : 21050 MC CLELLAN RD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : HOEFLER WALTER ADDRESS . . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : CUPERTINO ELECTRIC CONTRACTOR . . . . . . . : RAVIZZA, EUGENE A LIC # 697 COMPANY . . . . . . . . . . : CUPERTINO ELECTRIC INC ADDRESS . . . . . . . . . . : 1132 NORTH 7TH ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 991-1000 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - - - - - - - - - - -- - - - --- - ---- - ------ --- ------ ---- ------- --- ---------- - --------- BELEC200 METERS 1 . 00 29 . 43 0 . 00 29 . 43 0 . 00 BSEISMICRE VALUATION 5, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---- ------ -- - ------- ---------- ------- --- TOTAL PERMIT 68 . 30 0 . 00 68 . 30 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - - - - -- - - - - -- - - - -- -- - - - ---- - - - ----- ----- ------- - CHECK 68 . 30 5371 TOTAL RECEIPT 68 . 30 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ----------- 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTIN0 Date: APN # Building Address: Mailing Address (if different from building address): z 1 o v rIC Cc L -6.1 C�� z-� c 4 s�i Phone#: Owner's Name: • �� " A QCF L License#: Contractor: 1 -7,4 Co 3 77 Cu EA E - r Phone: Cupertino Business License#: Contact: Building Permit into: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: MzTe ommercial ❑ Residential ❑ IN -Trac, NEw Sq.Ft.: Sq.Ft. Floor Area: Cost of Project: Occupancy Group: S DOU,`�c" Type of Construction: Please check this box if the project is a second-story addition: Project Size: Standard Large ❑ Major ❑ Fee Descri tion Fee Grou Quantity Fee ID MECHANICAL BAPPLOTHER Other Appliances BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I 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 Construction BUILDING Tax BCONSTAX BUILDING BCONSTAX Ind/Off/Comm/Quasi BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile BUILDING BELEC 1000 Elec 600V <= l OOOA ELECTRICAL BELEC1001 Elec 600V > IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3