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05090045yecZ 0C itw p LI u Ydj L00 YppCp Kms+ Uzi EFc` �-5 a3 - I 0C z V U 2 UC OF Fn U2 CITY OF CUPER'I'INO BUILDING DIVISION PERMIT -' CONTRACTOR INFORMATION ,p. BUILDING ADDRESS: '79r rQT.T.TN('.qWQRTR ST UNIQ ELECTRIC INC PERMIT N005090045 OWNER'S NAME: PERMIT ISSUE DATE LADO MUHLSTEIN, JR, 3248 MORRI 8 2005 HE SANITARY N0, CONTROL NO. (650)773-3734 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH _ t� (� 0 LICENSED CONTRACTOR'S DECLARATION Chapter 9 Job Description p 1 beroby affirm that 1 am licensed under provisions of (commencing with Section 70W) of Division 3 of the Busimss and Profe.inns Code, end my license is �� mto0 to..nd affect' INSTALL ELECT. SUB PANEL � D License Clnss Lk.M Dam Contxmr ARCHITECTS DECLARATION I understand my shall W used as raids �.`11 plans public ZODS Licensed Pm(cssioml OWNER -BUILDER DECLARATION 1 hereby affirm Not I am exempt from the ftuxnstafs : Any C law for the 703L5,Business andve. deoli Co d=: Any City nrcounty t� p 1 fl IL('sll whichfollowingremuna(SCCIIaa witch requires a permit re c ohne impmsY, demolish. ri mash any (Ifs $'18a4 d $.5 0 im the, tatucmm sLissuance, alsosego re LateapplicantforsuchPermit mfilensign.(summate Sq. Ft. Floor Area Valuation unitic tenmecing wit pursuaat tnlhcpmvisioiuooftCamrxmr's License Law(CTadlar9 (commencing withSection]OW) of Division 3 mf the B caeand Pmfessiona Circ) ser ed Out he u ..crept therefrom and Lase heti far Late alleged exemption. Any violation of J WlIN NTEFerU Occupancy Type Section ]031.5 by any applicant for a permit subjects the applicant to a civil Penally of not more than five hundred dollars (SSW). ❑ L as owner of the property, or my employees with wages as their sure compensation, Required Inspections will do the work, and the awcmm is not located of offered for sale (Sec. 7061, Business and Profusions Code: The Conmctm's License law doe not apply to an owner of propeny who builds or improve thereon, and who does such work himself or through his own employees, provided that such improvements are nm intended or offered forsala If. however. the building m improwmcnt is sold within one year of completion. Ne owner - builder will have the burden of proving that to did act Wild as improve (a, purpose of sale.). h as owrmr of the progeny, am eelnsiwly communing with licensed contractors m screamer dm project (Sec. 7061. Business and Professions Cade:) The Conuacmrs U. corse Law does not apply m an owner a(pmpeny who Wilds or improver thereon, Ind. who contacts for such projects W N acome,caf fs) licensed pursuant to dm Co muctoes License Law. ' ❑lam axe n Sec. .B& P C for this reason Dat T ER' COMPENSATION I,ARAIO 1 hereby affirm under penalty of perjury me of the following doelarnions: I have and will maintain a CcNOcate of Consent o self-inwm for Worker's Camp.m satien, Is provided for by Section 37M of the labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compemmian Insurance, m required by Saefon 3700 of the labor Code, for Lac performance of the work for which this permit is issued. My Worloo s Compsmation Insurance easier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (phis section nccd not W completer if LK permit is for one hundred dollars (SIM) of less.) 1 card!, that in the performance of the work for which this permit is issued, I shall not m. ( t cmc subjccuo the Wolicts Compcnsadon Laws of Califrnia. nuc LawsCalifornia.ate Applicant 4 A,& Y� NOTICE TO APPLICANT. If, aper making this Certificate of Exemption, you shnulJ become subject to the Wohcr's Compensation provisions of the Ichor Code, you most foMwith comply with such provisions or this permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm Nat there is a construction lending agency for the Performance of On work for which this permit Is issued (Sce. 319]. Civ. C.) lender's Nam. lender's Address ' I ttnify Oat I have mad this application and nam that the show informatium is coracle 1 agree m comply with all city and county ondinmeas and sum laws relating to Wilding construction, and hereby authodm represemm iWa of this city Lo enter upon the about -mo rduxd pmpeny for inspenlon purpmes (We) agree m saw, indemnify and kap harmless the City or Cupertino against liabilities, judgment, Boss and expnws which may in any way attic against said City6i in canxqucncca(thcgrSTANDfNisDWiL. APPLICANT ERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date 50 C AT S Re -roofs k Type of Roof ignair plica onuumr - arc HAZARDOUS MATERIALS DISCLOSURE Will Ne applicant ser return building occupant store or handle hamdous material as defined by the Cupertino Municipal Code. Chapter 9.11, and the Health and Safety C.radon sssu(ar' - All roofs shall be inspected to any roofing material being installed. ❑Yes ,'RNs prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building Occupant use equipment or devises wrote Lhanardous sir contaminant as defined by the Bay Ams Air Quality Management all new materials for inspection. outlet? ❑Yes �No I haus reel dre lueardmus materialsrcquimments under Chapter 6.95 of the Califor- . riaHwbh&SafeLYChoc, Sections 25505, 25533 and 25536.1 undcrsuM two if the Wilding Joos mac. • ¢nam. Nat it t my responsibility ro madly the occupant or the a�tt my 'm meas ,i eni0aate or a=trp Signature of Applicant Date All roof coverings to be Class "B" or better Owner or awM1ari ed agent pm e Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: ( /,{/ PHONE # GENERAL CONTRACTOR W/ D FAX # D 573 --le I am not using any subcontractors'i%x' t r Signature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature Date 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 Owner/ Contractor Signature Date 4 Y - DO CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM �� N # Fee Description Date: , B 5- O Buildi Mailing Address (if different from building address): LAddress: BBOILERI Boiler <= 100,000 Btu .,ZOwne BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3. Phone #: MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu Contractor: BBOILER5 License #: ti 65 BCONSTAX Construction Tax Contact: Phone: Cupertino Business License#: BUILDING Fax: Con. Tax for BQ Zone Building Permit Info: BCONSTAXH Hotel and Motel Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: BELEC1000 Elec 600V <= 1000A Residential BELEC1001 Commercial ❑ Sq.Ft. Floor Area: BELEC200 q.Ft.: Cost of Project: 850, — / BENERGY Occupancy Group: Type of Construction: j—%.7, /91W, BENERGYADD Please check this box if the project is a BUILDING BINVESTIGA second -story addition: ❑ ro'ect Size: Standard ❑ Laze ❑ 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> 1.75MBtu 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 BELEC200 Elec Svcs 600V <= 200A ELECTRICAL / BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 I 4 �F 1 CITY OF CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM uanti 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 Atmos beric 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 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 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 cfln MECHANICAL BRENUMIAN 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 > l 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 BREMYOWER Power Device/Apparatus ELECTRICAL BREMItECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP 'Remodel Res Appliance ELECTRICAL 2 of 3 `.t CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM 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 PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change I BUILDING 3 of 3 7 0