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04060051 CITY OF CUPERTINO 'r" °-" '��*" ''t= ✓y�` " - ' t - r BUILDING DIVISION PERMIT °CQNTRA T't R"1INF0RMATI0N =' BUI LDING ADDRESS: RJ ELECTRIC PERMITNO.04060051 OW NEWS NAME: PERMIT ISSUE DATE KAREN NE: SANITARY NO. ri� CONTROL NO. IF (408) 281-3337 ARCHITEC17ENGINEER: BUILDING PERMIT INFO BLDGEIPCr PLUMB MECH 0 0 0 0 u0' LICENSED CONTRACTOR'S DECLARATION rle F I her�Y �IBrm sll.s I,m littered under P vlsiorls of Chat 9(commencing Job Description U wish Scaion]4ylry) fDivision3of NC Business an fcssiam Cod. dmyliccnscis p in full farce ,f ccs, p� e iq? ue,nae Class �— Lle.g 447UQ ELECT. SERVICE UPGRADE DW-��. [-to Da¢ Contractor Nlllr 141 eSto ARCHITECTS D TION Y�< tunic nJ my punssha Wrsxdupu ie records JUN 2004 JyU ;aw Licensed mfcssinnnl g OWN -eILDER m CLARATION Imp pQ�� 0 0 1 hcmhy (Sec than I nm exempt form 0e COnlsactaCode:A n e Law co she 00 follwhnwinCmasort ermitt ID3Lm5.Busiussmprove,dsiors lih.orrny city nr county �tl m which requires a permit m csmslruct,alcor,improve,demolish m repair any smumuse priortu iuissuanm.auu to torte lhovisio so the Commoner oforsuchermit toiernse Law (Chapter Cha mens £ ' (comehe ncingwit Ps�ant Ino)of Division ofthedre Business urne:and Predications Code)or Sq. Ft. Floor Area Valuation (coy unit he I. mg mu thee.]fang the, 3the ad a,rd vend rm.A.Ii Cndc)of Ihat he u exempt th,refrom and de buts for the alleged cvmPuon.Any violation of Sectlan'IB31.5 by any applicant for a permit subjects Oe applicant w a civil penally of 3•7819 TQs'lfler 0 0 Occupancy Type not more Nan five hundred dollars(S500). P Y YP ❑I.as owner of thcpropmy,mmy employers with wagesu Neer sole compettsallon, will do the work,and the structure Is not Intended of offered foraalc(Sec.Rim,Business and Professions Code:The Cion actor's License Law docs not apply to an owner of Required Inspections property who builds orimproves demon.and whodoessuch work himself or through his own employees.provided Our such improvements are not intended uroffened formic.If, however.Ne building or hnprovemenl is sold within one year of completion.the owner- builder will have the Wrdcn of proving ws he did not build or improve for purpose of ase.). O I,as owner of Ne property,am exclusively communing with licensed contactors to consulter the project(Sec.]Ota.Business and Profesaloru Code:)The Contractor's Li- _ toss,Lew does not apply to an owner of property who Wilds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant o the Conmactors License Law. 1 am exempt under Sec. .B k P C for this mason Owner Dat WORKER'S COMPENSATION DECLARATION 1 hereby affsm under penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Convent to ulf-insure for WohefsCompen- sation,as provided for by Section 37M of due Labor Code.for the pedon ance of Me work for which this Notion is issued. 0 1 have and will maintain Worker's Compensation Insurance,as;required by Section 37W of Ne later Code.for the performance of the work for which this permit is issued. My Workefs Compensation Insurance carrier and Policy number are cl cr.!: 1+4 k'Fi^a �lity}7o.:1'6U7 I f-5-?.a% CERTIFICATE OF EKEM wv FROM WORKERS' COMPENSATION INSURANCE (Thu section need not W complcwd it be hermit is for one hundred dollars(SIM) or lrok) I cenify that in the performanc of the work for which this Perron is issued,l shall not employ any penin in any manner set as to become subject to th,Workers Compensation Laws of California.Doc Applicant NOTICE TO APPLICANT:IL after making this Cenificau of Exemption,you should become subject m the Worker's Compensation previsions of the Labor Code,you mus Z forthwith comply with such provisions or Nis permit shall W domed revoked. 'ZOCONSTRUCTION LENDING AGENCY [...� 1 hereby union Na there is a commotion lending agency for tie performance of x the work for which thu permit is issued(Sec.301 Civ.C.) Izl Q Lender's Name -.- = Z Lender's Address U Q I certify that 1 hoe read this application and sum that the Move information is LL F correct.1 agree to comply with all city and county ordinances and state laws relating to OU Wilding construction.and hereby authorize representatives of his city to cner upon the r W shove-mentioned property for inspection puryeua (-' C (We)agree to saw,indemnify and keep harmless the City of Cupertino against ret liabilities judgments,ensu and expenses which may in My way encore against said City U Z in consequence of the Craning of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE RE ULAT NS. '/110Y I VY Re-roofs Signator fA iCo.—'.' Date H ARDOUS MATERIALS DISCLOS RE Type of Roof Will Ocapplica or future building Occupant store or handle haaasdous material as defined by Ne Cupertino Municipal Code.Chapter 9.13,and the Health and Safety otic.sc❑cs co 25512(a)? �No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove nit hk> dous air conuminants as defined by the Bay Area Air Quality Management all new materials for in District, Yes CIN. 1 have reel the harardmnsmamrials requirements under Chounti.95 cribs Califor. ria Health 6 SelctyCole,Sections 255115,15533 and 25534.1 understand thatifthe Wilding does not cum irly hoe a anon Oal it u my respmed liiloy to notify the o Cofh m of the requirements whit us`c primromis�fa Ccrdreaeof Occup cy. ` J p, ��/� Signature of Applicant Date owrieror, mieedagen / Dam All roof coverings to be Class "B"or better i ' 4 (C ' CITY OF CUPERTINO o w� aTroe PERMIT APPLICATION FORM / CUPERTINO APN # rl 021 Date: 3''15 O v l � l ZC 0 4 Building Address: L41Mailing Address (if different from building address): �i & ole k Owner's Name: Phone #: e Ike v) Aoj - q'I Contractor: License #: SAV-h Salili 944 2,.9 Contact: Phone: 4cg-2gt-3331 Cupertino Business License#: q U I j Fax: <I0g- 261-g-524 . 232 Building Permit Info: / Bldg ❑ Elect ® Plumb ❑ Mech ❑ Job Description: Residential CSI E\'t-l-fica( 5ifviw- ctiad2 Commercial ❑ Sq.Ft. Floor Area: _ $/Sq.Ft.: Cost of Proj ct: Occupancy G up: 1200 � Type of onstructio Please chec this bo -irIe pro ct is)a Cluifi« second-story a ditioo:— J Pro'ect Size: Standard CEJ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 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 Ind/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 BELE 200 Elec Svcs 600V <= 200A ELECTRICAL 1 BENERGY Energy BUILDING l BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING Zs'Jbn 1of3 �� CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group 'BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINITRCEP 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 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 cfm MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO uantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb 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 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 Chane BUILDING 3 of 3