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04120150 CITY OF CUPERTIN ''" = '�'° ' kaav= O - BUILDINGDIVISIOryPER __ �aCONTRACTQRgINFORM QN BUILDING ADDRESS: THERMA CORP PER MIT N004120150 10240 BUBB RD OWNER'S NAME: PERMIT ISSUE DATE Alk DURCET CORP 1601 LAS PLUMAS AVE 12 /21 /2004 NE: SANITARY NO. CONTROL NO. (408) 347.-3400 TARCHiTECTIENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH woLICENSED CONTRACTOR'S DECLARATION Job DCSCr1pCIOn y w1 thereby affirm that I am licensed under pr ons of Chapter 9(commencingaition•]IXgB of Division Sof Jut Busirmss and vt'fssimeCndcad my license is in lf9 inaee F'y?/27�L.�� REVISION-ADD NEW CHILLER/PUMP j5E Qlazs f/ y"' r Lc.p Comrdc F M ARC)B'fECTSonadoATJJON y-t 1 understand my plans shell he ascJ as puMie211 us DyU u,t; Licensed Prarssioml �\ I OWNER-BUILDER DECLARATION s0 I hereby.(Sero thin 11. exempt from the Con tons Co e:Any c Law for my \ ❑O following retina(Semon]11]15,Business and improve. de ivas Code:Any city or i cou ne x m which its requires issuance,pemst tea wires t e alter,improve demolish,nr e 2 sig any suumuw v FZY Pdoeto imensedp muantto rose thecant for such Commermiuoicense Law(ned Chapter < (commencingsedpuction 7")provisions of me Cpmmeusand Proflaw(CTaptm9 Sq.F[.Floor Area Valuation �rQ (commencing with Section]Of10)of Divuionl of the Business and Professions Codc)or .. _ y�_ Nat he is exempt mcafrom and the basis far the alleged exemption.Any violadon of Section 7031.5 by any applicant for a permit subjects the applicant a a civil penally of s t0 0 Occupancy Type not more than five hundred dollars(1500). C9 I,as owner of the property,or my employees with wages as their sole compensiamn. will do me work and the swcmre is not intended or offered formic(ScC.]OM,Business Required Inspections and Professions Code:The Commences Lienee Law Jou not apply loan..of � q p property who builds or improve thereon,and who doessuch work himself or mrough his awn employees,provided that such improwmenm we not immrided confirmed for ale.It. - however.me building or improvement is sold within tine year of completion,the owner- builder will have Ne burden of proving Nat he did not build or improve for purpose of salt.). ❑I,as owner of Ne property,am exclusively contracting with licensed contraction,to toewcl the project(Sec.7W.Boniness and Professions Code:)The Conuacmr's Li. cense Law does not apply to an owner of progeny who builds or improv¢teemon,and, who contracts for such projects with a communal al licensed pursuant o the Contractor's License Law. ❑1 am exempt under Sec. .B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under parWry of perjury one of me following declarations: 1 hunted will maimain aCeni37M of Consent r Cod-insure for Worker's ce of the sermon,r provided(m by Section 3]00 of me Tabor Code,for the performance of the work for which this p<rmit is issued. ,tW✓/I have and will maintain Worker's Comperumion Insurnme,as sequined by Section O]00 of the Labor Code,for me performance of Ne work far which Nis permit is issued. MyW rkc>•5Cn ensation lnsuanec carzicr and Policy man Cram: 1J1 c — d Pali Nn.: !i/✓X �3GGx'I[u CERTIFICA OF EXEMPTIONNW_"WORKERS' COMPENSATION INSURANCE (Thu section need not beeompleted Bthe permit is fare=hundred dollars(SIM) or less.) 1 certify Nal in the performance of Ne work for which this permit is issued,1 shall nut employ any Person any manner so as to became subject to the Workers Compensation Laws of Ctilifinnam Dalc Applicant NOTICE TO APPLICANT:Jr.turner making this Cenificanc of Exemption,you should become subject to the Worker's Co ilanamion provisions of the Libor Codc,you mus( .� z r forthwith comply with such provisions or this Permit shall be deemed mvnked. Z O CONSTRUCTION LENDING AGENCY [-. 1 hereby infirm that Nese is a cons randon lending agency fnrthe performance of a > me work for which this permit is issued(Sec.3097,Civ.C.) mILendcfs Name z tender's Address C.)O 1 cenify that 1 have read this application and sum Nat the above information is W f-' correct.1 agree to comply with all city and county ordinances and smut laws relating to 0U building construction,and hereby aumome representatives of this city to enter urn.me r W ahoy(Wa)agree to ertysave for impactionmi fakeep thha / (We)agmen m ave,indemnify and hich harmless me City tit Cupertino against UN inemiss. meof ts,the ,ats andmir,of thisexpenses nit. may in any way accmc against said City Uz Aconsequenceof the grantingof(hisDWI I APPLICANT UNDE STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ZZ6 soURCE REGUL 1 � Re-roofs 'signazurcorA piflicantemormid, /Date HAZARDOUS MATERIALS DISCLOSURr>J Type of Roof //Will Ne applicant ter future building tacupam smutvou m handle m ds material as dcfned by the Cupertino Municipal Coda Chapter 9.12.and the Health and Safety Code.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Ye Will the applicant or future building Wenicat use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove -mit hanolons air contain mane m defined by the Bay Area Air Quality Management all new materials for inspection. Dislrictl ❑Yes �Nu 1 have mail me hard ous materials requiremtnm under Chapter 6.95mf Ne Calirm- siaHealth&Safny Codc,Sections 25505.25511 and 2557x.l undcrsund douddic Wilding does not currently an mnam Nm it u my reaponehility m many Nc Occupant of the mgmwmems�which t r to issuance of a ccrdfie�arG�apacy.. Signature of Applicant Date?. nt � y owner—�-mca agent Date All roof coverings to be Class To or better • • CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: suem COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35720022.00 DATE ISSUED. . . . . . . : 12/21/2004 RECEIPT #. . . . . . . . . : 28114 REFERENCE ID # . . . : 04120150 SITE ADDRESS . . . . . : 10240 BUBB RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : DURCET CORP ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , RECEIVED FROM . . . . : THERMA INC CONTRACTOR . . . . . . . : PARISI, JOE LIC # 12201 COMPANY . . . . . . . . . . : THERMA CORP ADDRESS . . . . . . . . . . : 1601 LAS PLUMAS AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 951331613 TELEPHONE . . . . . . . . : (408) 347-3400 •EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPLANCKREP HOURS 4 .00 348.56 0.00 348.56 0.00 __________ __________ __________ ---------- TOTAL PERMIT 348.56 0.00 348.56 0.00 METHOD OF PAYMENT AMOUNT NUMBER ------------------ CHECK ___ ___________CHECK 348.56 9206 TOTAL RECEIPT 348.56 *CITY OF CUPERTIN# CITY OF PERMIT APPLICATION FORM CUPE TINO ria APN # Building Addres Mailing Address (if different from building address): 0 0 v Owner's Name: _ Phone#: / Contracto License#: Contact: Phone: V6 3-7y?-3ya p Cupertino Business License#: '/ /CF/Rr H 7-t Fax: Y-y-7V7-9 VzS Building Permit Info: Bldg l J Elect L9� ❑ — - Mec C� Job Description: �,.. Residential ElL �� me>rcial p Z Sq.Ft. Floor Ar Cost of Pro` anc ccupGroup: q•�/ Type of Co struction: - Please check this box if the project is a 4h Lii secon d-story addition:' El Project Size: Standard ❑ Large ❑ Ma'or ❑ - Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> IOOK 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING _BENERGYADD Energy Add Multi BUILDING B19VESTIGA Investigation fee BUILDING I of 3 MAI O CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEIZ,TINO 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 BOVERTMIE 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 BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK - Plan Cbeck 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 HeaterNent 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 2 of 3 a�_fflffl� 9ITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM ' CUPERTINO Quantity 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 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 Change -- . BUILDING 3 of 3 CITY OF CUPERTINO — ;,r. g ..a —sr ,u'3:;r' ati �s:'.a ?a``xau BUILDING DIVISION PERMIT CONTRACTORINFORMATION BUILDING ADDRESS: THERMA CORP PERMITNO0412 O 15 10240 BUBB RD OWNER'S NAME: PERMIT ISSUE DATE DURCET CORP 1601 LAS PLUMAS AVE 12 /21 /2004 E. SANITARY NO. CONTROL NO. (408) 347-3400 ARCHITECT/ENGINEER: - BUILDING PERMIT INFO BLDG •- 'ELECT PLT MECH 0 0 0 _Op LICENSED CONTRACTOR'S DECLARATION .. _- _ __•_ _ __ :ad w I hemhy&from Net I on licensed ander v am of chapter 9(aa momma g Job Description i do )nf Division Softhc Businruand scnde.atdmyliconseis - "— 'nod imm�r ante e1. r p1 27a6nJ8 REVISION-ADD NEW CHLLLER/PUMP j�� Lice los F Dow Contrala /IlA F ARCHITECT'S DECLARA m< 1 urWersand my plans shall be used as pis nods 11 Dau ;oG Licensed Professional 3 OWNER-BUILDER DECLARATION C 1 hereby affirm Nm 1 am exempt fru.the Cammcmrs License Law for the 0 00 following mason.(Section 71131.5,Business and Profession Code:Any city or county V w z m(L which mquioes a permit to cnmwct alar,improve.demdksh,in minor any summit v80 m—m prior to its issuance,also inquires the applicant for such permit to rile a signed as¢mem that he is licensed pursuant to the provisions of the Conducmf's License Law(Chapter 9 Sq.Ft.Floor Area �Ho (commencing with Section 7")of Divimon3 of the Businemand Professions Code)or y Nat he u exempt therefrom and to,basis far Ne alleged exemption.Any violation of - Section 7031.5 by any applicant for a permh subjects the applicant to a civil penalty of et0 O Occupancy Type not mom Can five hundred dollars n50o). ❑1,ss owner of the property,or my employes with walla u their auto compensadon, will do the work,end the swctum is not mounted or offered larsal.(See.7W.Business Required Inspections - and Profnutions Code:The Convector'sC License law does not apply in owner of q P property who builds or improves themon,and who doessuchwork himselfor through his Own employees.provided Nat such improvements see maturational oraRered forsale.If, -- however,the building or improvement is sold within mw year of eompledon,the owma- builder will hoe the burden of proving that he did not build O improve for puryow of ,, - ssle.). 1,as Owner of the property,am exclusively conducting with licensed conductors to. Construct the project(Sec.7664.Business and Professions Code:)The Common's Li- - .- nst taw does net apply in an owner of psopany who builds or improves themen,and. -- who conuacu for such projects with a conmetur(s)Instead pursuant in the Conmdors List.law. p 1 am exempt under Sec. .B@ P C far this round Owner Date WORKER'S COMPENSATION DECLARATION -'—" 1 hereby atom,under parody of perjury arc of the following decimations: U I haw and will milnain a Certificate of Consent to self-mium for Waheh Compcm nation,as provided for by Section 3780 of the IabO Code,for the part.mawo of the - - work far which this promit is issued. have and will mountain Workers Compensation Insurance,u required by Section 1 o(the labor Cadc,for Ne performance.!Ne wart forwhich Nupermit is issued. - MyW a Co nsauon Insunrrce aortico and Policy number an: L t Polt'p'No.: -730000.7 ,.A__ uE CE IFICA'EOFEXEMPnolq ORKERS' ���^/�I COMPENSATION INSu ANCE (Thu duction nttd not he completed iftle formit is faronc hundred dollars DIM) or less.) 1 certify Not in the performance of the..,it for which this cand,is issued,I shall nut .- employ any person in any mannerm a to become subject to the Workers'Compcn onion Laws of Califnmia.Dew Applicant NOTICE TO APPLICANT:If,after making this Cenibca c of Exemption.you should become subject in the Worker's Compensation previsions of the Labor Cade,you mum .J,Z forthwith comply with such provision or this per.itxball be deemed revoked. Z O CONSTRUCTION LENDING AGENCY Thereby affirm that them is a construction lending agency for the performance of G' Ne work fm which this permit is camcd(Sec.3 .Civ.C.) fc]Q lender's Name G lender's Address U C) 1 certify that 1 have mad this application and nam Nat Nc above termination is U.f-' conmeL 1 agree to comply with all city and county ordinances and saw laws mating to !� J DU building Construction.and hereby authOac representatives of this city w enter upon the above mentioned property for inspection purideas. 4. (We)agree to saw,indemnify and temp harmless the City of Cuportina against Hto liabilities,judgmcna.custs and expenses which may in any way ac no,against said City U Z in consequence of the granting of this Permit. APPLICANT UNDE STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCEREGUL Re-roofs rc a PP rano✓ o nor Daw HAZARDOUS MATERIALS DISCLOS Type of Roof ill tho.,Pliant ser fume building oceupant sore or handle havardous material as do recd by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety Code.Seedan 25532(.)° All roofs shall be inspected prior to any roofing material being installed. El Y. lis Will the applicant or future building acupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove .sin hamrdous air contaminants as defined by thc Bay Area Air Quality Management all new materials for inspection. District? ❑Yes 8th. 1 have mM Ne Wardnus materials mquimments under Chapwr6.95 of Ne Califor- niaHcalNKSafctyCodc.Sa6ons25505,25533end25534.1undcrsandt ,ri cbuilding dommicurtennly ha tenant,Nor it is my respamibility t al the-to ant of the mquirtmcnts which t me ' rwissuanco ofa Ccnirc�awm upancy. Z z�4y Signature of Applicant Date 0w ri,ed.&at Dam All roof coverings to be Class "B"or better