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02090029ATY OF CUPERTINO 10 a z 0 7 --v� 2-7 APN # .-,6(o 10 0 6 .Z Date: 9 - 'Building Address; 676 �%e:57 %06y/U 2�2U(,//j m, CA 174 r � Owner's I`Aame: C1G 61WO SEr2 n�C' Phone r*gj4 Lf.6 — �q 47 Contractor: License 4T. z cv 7-2 � -�3 3 Contact:Phone ': f�,� Applicant/Contractor: Fax #��� � n J 7 Ct 6 a Buildink Permit Info: Bld y t Plumb Mech Job D scription: -4-w v -Riff6dential: - /C Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engineer: V ion: Elec 600V > 1000A ELECTRICAL Type of Construction: Group: � Y'Ad—'upancy r Quantity Fee ID Fee Description Fee Grou BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILD]]vG BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDI]vG BCONSTAXR Constax — Resi/Mobile BUILDING BELEC 1000 Elec 600V <= 1000A ELECTRICAL BELEC 1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC I Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDI]vG BMNEWMULTI New Multi -Family Res MECHANICAL BNEWMULTI New Multi -family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMIvIP New Comm Plumb PLUMBING µ CITY OF CUPERTINO 11 10 CITY OF CUPERTINO PERMITAPPLICATION FORM Quantity Fee ID Fee Description Fee Group BNUMULTI New Multi -family Res PLUMBING BOVERTIME Ins ection Overtime BUILDING BPBACKFLOW Atmos heric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg 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 Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM StonrvRain Water PLUMBING BPTRAP Kitchen Tra PLLTM13 NG BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Bus,,wa s 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 BREiMMiISC Mise 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 Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL 2 of 3 av", 0 • 1110, CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORINT CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING` BSF&2FAM Sin le & 2 Family BUILDING BSFNA Single Family New Add BUILDING BSPECIAL Special Insection BUILDING BSWIM 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 Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Charge BUILDING BBOILERI Boiler <=100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHATNTICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75 M Btu MECHANICAL 3 of 3 CITY OF CIUPERTIINO CONTRACTOR :NFORM ON. BUILDING DIVISION P BUILDING ADDRESS: PERMIT NO. 1670 JAMES TOWN DR ECOENERGIES INC 02090029 OM ESERRE 171 COMMERCIAL ST APPLICAT 017N/?gA002 PHONE: (408) 746-3062 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH v u u u LICENSED CONTRACTOR'S DECLARATION [hereby affirm that lant license.d, '77�,�,;;,C�,tter provisions of Chapter 9 (commencing DDee JnPbAN L pt SYSTEM with Sectio 7000) of Division 3 of theWness and Professions Code, and my license INSTAL PV SOLAR i4 in fu rce a effect. Licens s C46 Lic. a 3 Date C ctZZ 4 ^ CHITECT'S E ATI 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 $18600 which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement - - , 3 6 �t�) QOI mea Valuation tha(he is licensed pursuani.6 the provisions of the Contractors 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 ekemption. Any violation _ - of Section 7031:5 by any applicant (or( permit subjects the applicant to acivil penalty- of not. more than five hundred dollars S5o0). 1 O 1ARNAT I I ON Occupancy Type ❑ I, as owner of the property, or my employees with wages as their sole compensation, 102 — PIERS ' will'do the work- and the structure is not intended or offered for sale (Sec. 7044,""... Business and Professions Code. The Comractor's License Law does not apply to an -- - - 1 O 3 — - _ - - -' - — - - -- -- UFER Required Inspections owner of property Who builds or improves thereon, and who does such work himself 104 - REBAR or through his own employees. provided that such improvements are not intended or .'offered for sale. If, -however, the building dr improvement is sold within one year of - 105 — _ _ _ ANCHOR BOLTS- - " completion, the owner -builder will have the burden of proving that he did not build or improve for purpose of Sale.). 106 - SEWER & WATER - _ ......... .._ .. ._. .... _ . _ . ❑,I, as owner of the property, am exclusively contracting with licensed contractors to - -2-02- = UNDERFLOOR PLUMBING -- - - - construct the project (Sec. 7044. Business and Professions Code:) The contractors 203 - UNDERFLOOR MECHANICAL: License Law does not apply to an owner of property who builds or improves thereon, ,-and who. contractsfor. such projectswith a contractor(s)_hcensed pursuant to the _ 204 - UNDERFLOOR -FRAME - - - -- - - - - - Contractor's License Law. ❑ I am exempt under Sec. , B & P C for this reason 205 - UNDERFLOOR. ' I NS.ULAT I ON Owner Date 301 - ROUGH PLUMBING WORKER'S COMPENSATION DECLARATION 302 - TUB & OR SHOWER I hereby affirm under penalty of perjury one.of the.following declarations: 303 — ROUGH MECHANICAL ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's 304 - ROUGH ELECTRICAL Compensation, as provided for by Section 3700 of the Labor Code, for the 305 - FRAME performance of the work for which this permit is issued. 306 - HOEDOWNS ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code; for the perfo ane of the work for which this permit is 307 - INSULATION issued. My/�Worker's lC6m�,penssaatio/n Insura artier and �Ptolilitcyy number are: MA_ k & 3 8,4091 - .308 — rT�] SHEE 1 LROCK arrier:`>• Poli No.: / 7103 CERTIFLCATION.OF EXEMPTION FROMWORKERS' 1 -. 30 EXTERIOR LATH . COMPENSATION. INSURANCE'. ''•.,: ' ... -3-10 - ' -- - INT;ERI-OR---LAT-H-----._ ---- -- -. _ .... .. (This section need not be completed if the permit is for one hundred dollars 1 311 SCITCH COAT - (5100) or less.) ., 1 .7 .7 -ROOF-NAIL. I'cerufy lhatin the performance oPthe work for which•this permit is'issued,-i shall not employ any person in any manner so as to become subject to the Workers' 501 - FINAL ELECTRICAL 'ENERGY Compensation -Laws of California.Date y 502 - PLUMBING ENERGY Applicant .FINAL 503 — - F I NAL MECHANICAL ENERGY NOTICE TOAPPLICANT: If; after making this Certificate'of Exemption, you should 9 become subject to the Worker's Compensation provisions of the Labor Code, you most forthwith comply with such provisions or this permit shall be deemed revoked. 504 - F I NAL BUILDING ENERGY ' 'CONSTRUCTION LENDING AGENCY5 O 5 — F I NAL E LE CTR I CAL ' I hereby affirm ihat there is a construction lending agency to the performance 506 - GAS TEST of the work for which this permit is issued (Sec. 3097, Civ. C.) Lenders name 507 - F I NAL PLUMBING Lender's Address 50 FINAL MECHANICAL .1 certify that 1 have read this application and state that the above information is I 5 9 - = NAL GRADE correct. agree to complyawith all city and county ordinancess and state laws relating to building construction, and hereby authorize representatives of this city to enter upon 5 O I NAL ANN NG the above-mentioned property for inspection purposes. (We) agree to save; indemnify and keep harmless the City of Cupertino against 5 - I NAL B UnRKS abilities, judgments, costs and expenses.which may in any way accrue against said ity in co uence of the'giantino f [his permit. kAPPLIN UNDEhSTANDS WILL' OMPLY WITH ALL NO P / '„S Issued b Date0,1OII rl �Z E�CUfLAT >Ilu � /// y< , *nature of of ApphcanUContracto. •" ' r Date. ' _. Date Re -roofs HAZARDOUS MATERIALS DISCLOSURE • Will the applicant or future building occupant store or handle hazardous material Type of Roof .. .. .. - ... as defined by the Cupertino Municipal e, Chapter 9.12, and the Health and Safety ' Code, Section25532(a). •, ❑Yes o' .o All roofs. shall be inspected. prior. to. any roofing.. material-being.installed..... t Will the applicant or lure buildi occupant use equipment or devices which .r If a roof is installed without first obtaining an inspection, I agree to remove emit hazardouscab the. r ° y y Area At Quality Management District'. all new materials for inspection.. Applicant understands and will comply with °Yes all non -point source regulations. ' I have read the hazardous njaterials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533 and 25534. 1.understand that if the building not currently have -a. tenant, that it is my responsibility to notify the oreupant of e,r uirements which s be m prior to issuance of a Certificate of Occupant �G Signature of Applicant Date .. All roof coverings to be Class "B" or better er or authorized agent Date