The URL can be used to link to this page

030700960z z 0 P>_ LLA az UO OU U F� �z ITY OF CUPERTINO +', F 'I-• BUILDING DIVISION PERMIT,CONTR CTOMNFORMAMNO F"ILDING . L, e *41 1 saga t n', bF ' " %'C(. ADDRESS: PURE ELECTRIC PERMIT No 03070096 OWNER'S NAME: 27,365 INDUSTRIAL BLV PERMIT ISSUE DATE ONE: (800)246-9998 SANITARY NO, CONTR OL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Jb Description o hereby Orions I am li=ed under provisions of Chapter 9 (mencing I hereaffim Wmcom with Spedoo 7") of Division 3 of Ne Business and Professions CMeand my license Is in full fare,Lic,.Ctt nderran. ELECT. OUTLET FOR COMPUTER �TE�19•g.»�� U..# Dam ConlraTu , ARCHITECTS DECLARATION I understand my plans shall W used se public meardt JUL 2 5 2003 Liccncd Pmrcad.nal OWNER—BUILDER DECLARATION 1 hereby .(fere that I exempt from the Gaalraoleo Anse law for the BUILDING e: I.S. and Code: Any city orcounty acquire; 703Lruct. whftillich a Permit cons, her. are, demolish, or repair any which requires a pcmltt alter Improve, On statement prior Illsl its Iensedp rcr rcgnl to lhovisio sof far Nollpermit le IIIce, Law Chapter l ra each h Perlia that wit.SectionNc the Contnner's License Law (s Sq. Ft. Floor Area Valuation of Divisions (commencing with Section71100) of Divisions of the Businessand Canis) or (cobeescing on. An ACsde)or that Ile b exempt therefrom and Um bub Tor the dlcgcd exemption. Any vloladon of 37536023,00 APN Number Occupancy Type Section 7031.5 by any applicant fon Fennh subjects the applicant o a 601 penalty of not mom Nu five hundred dollen (5500). with the lbs propany, m my.t mmpem,nas ❑ I, =she 103 - UFER Required Inspections q P inm.cu will de w,ok a emdfor (Sm. tooan nt Code: Code: 's toyinbnded lesion. Law does Ld who Law ems not apply lf ,t owner of and Pmfmsiom no Connector's apply. owner Toe Co thuniu propenywha builtlsorlmproves Oareon,,nd who daes,uch work bimselforthrough his 304 - ROUGH ELECTRICAL own amployme, provided that such improvements an not intended crortued for sale. If. 505 — FINAL ELECTRICAL however, the building or improvement Is sold within one year of completion, Ne owner. Wilder will have the burden of proving that ho did not build or improve fur purpose of este.). s h as owner or the property, am exclusively cmnraning with liaised mairmtors to onswn the project (Sec. 7044, Business and Profusions Code:) The Contnetors Li. mewlaw date not apply m an owner of properly who builds ver improves themon, and who contracts for such projects with a contnctor(s) li=ned Pursuant to the Comment's License Law. ❑ I esempl de Sec. B& P C f r This mason D �1 WORKER'S G MP N ATION DECLARATI 1 hereby �on under pc ,lyy of perjury one of the following dedmtionc I have and will reeimain a Cemficab of Consent la self-Insum for Worker, Camper. ssyion, u provided for by S=tion 3700 of the labor Code. (n dts performan= of the work for which this permit is issued. ❑ 1 ban and will maintain Warker's Compensation loon=, u required by Section 37M or the labor Code, far the perrmmance of the work for which this permit is issued, My Worker's Compensation Insurance carrier and Policy numbenm: Cartier, Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Toho section need not lecomplebd lithe permit is for enc hundrod dallan(Slrp) or less.) 1 certify that in the performance of the work for which this permit is issued, 1 that not employ any pcomn in any meaner an u to mcc ma subject to um Workers' Compensation Laws of California. Data - Applicant , NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the lahm Code, you must rnthwi to comply with such provisions or this Permit shall Ae deemed revoked, CONSTRUCTION LENDING AGENCY 1 hereby effort Nat then Is a construction lending agency for the performance or the work for which this remit is issued (Sec. 3097, Civ, C.) Lenders Name Lender's Address I have read this application and dina Out the ,hove information is I ttime, building I agree o c with city and county ordinances and rete laws relating building upot e construction, hereby sulhonp ¢presemotives of this city to ewer upon the y (/�////y/��-�� entioned aientl above-mentioned properly for inspection purposes V (We) agree to outs indemnify end keep harmless the City of Cupertino ,dainty a, Hall and may in any way creme against said City t s ofexpenses in of pewhich in ennsequcnce of Ne gaming of This permit APPLICANT UNDERSTAND WILL COMPLY WITH ALL NONPOINT Issued by: Date SO CER U IONS. 7 Re -roofs � 'gnu. of ApplicanOContn o Dab HAZA OUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant stare or handle hauardous matior d as defined by the Cupertino Municipal Code. chapter 9.12, and the Health and Safety Code. Section 35533(.)? ❑ Yea 116. All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment at devices which It hnrsrdaus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. l=aid? ❑Yes )(Nu I have mad the humming materials requirements under Chapter &95 or the C,lifor• nts Health d Sdcry Crdc.S=timts 35505,35533 and 35534.1 undersand that irds building does not currently haw a ant m it is my responsihiliry m nn'f the tacuput of the re tots hen 1 met .pangy ( Signature of Applicant Date Signature All roof coverings to be Class B" or better ' Own ter tulhorizcde I Daa CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM (r3 07 v O � 0 1 of3 PN # Z Date: Building Address M /D ^� v 'G Vl y fling Address (if diff fr bui di ddress): Owner's Name' S P Contractor:L � � ^ems cense #: � Contact: a� Phone:$/O, Cupertino Business License#: Fax: i ding it Info: Bld Elec Plumb ❑ MecW ❑ Jo es ption: % ential ElZ'"' _ f �� "' fp*uCoon c a1LL9- Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: a,Occupancy / Group: Type of Construction: Please check this b if t e second -story addition: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING. BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM 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 > I OOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 0 1 of3 CITY o CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM AdEkk Ouantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING MIXTURE . 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 IMF 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 cf n MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFDCT 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 2 of 3 aclor CUPEII;TINO CITY OF CUPERTINO PERMIT APPLICATION FORM uant' Fee ID Fee Description Fee Group 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 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 R9C.RT.VD Scb Snecific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM T6mporary 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3