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05040005CITY OF CUPERTINO"u^�e5�sg.�ws.t},vtR+"X:3i' BUILDING DIVISION PERMIT ON: ,�§NT.RX6,TORzaNB:4O,.RMAT iy BUILDING ADDRESS: ALTERNATIVE POWER & ELECTR tgMIT 1105040005 OWNER'S NAME: PERMIT ISSUE DATE VICTO ONE: SANITARY NO. CONTROL NO. (831)338-4887 ARCHI]ECGENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Descrition P 1 Mreby affirm But I atm licenved under previa mer of Chapter 9 (mmmemcing with Section 7W0) of Division Sof the Business and Professions Code, and my license is I. fell rcaamdercec` ELECT SERVICE 200AMP License ClLie. e. X Date Contractor ARCHITECTS DECLARATION " I understood my plans "I be used as Public ¢ands ' A � AA � �® 1 `V Licensed Professional OWNER -BUILDER DECLARATION I hereby nae law for IM arclw onn 1 em exempt from the ConwstCo l/ / e: A so (Section ]ID 1.; Business and ns Code: Any city or manly _ ,v� whichreason foo, demolish. repair key awcum which requires a ectmu to conswcL alar, w. dem I / nt fl Pour m its issuance, rive requires the applicant for such Permit b file ea LAW( mnpon 9 thuheulice nuumr'stdxnaclaw(CMPur9 $q. FL FIOOrA - Valuation Semon7000) of Division3 n(theegedco and Profesa vi Code) or withSeeuansothepmviaions 3Ofthe that W u ¢¢cops thmefrom ecru 0e Wsts for the silegd eumptim. MY viohtion of ft, Is exempt i Nm Eve anyappllicantred or as permit objects the applicant m a civil penalty of 3 2WS Tkoi2ftro 0 Occupancy Type not more 0 I. u owner or the property, m my employees with wages u their mle compensation, Required Inspections el .111 do the work. and the mrunum istswintended proffered formi.0m.7044,11usinesa and Proranalans code: The Conuacut's Liam LAW does mapply a an owner of q P property who builds at impo s, thermn,and whodoessuch work hinuelfmthrough his own employers, provided thm meh improwmenu art mt inended mofremd fmaaln If, however, Ne Wilding or Improvement is mid within aro yea of mmplcdm. the moner- Wilder. will haw the Wrden of proving that he did not build or improve for purpose of .1.1 ❑ 1, u mvner of the property, am exclusively conumling with licensed cmuecmra to comma the project (Sec. 7016, Business and Profea tions Code:) The Cmuactm's Li- cense Law dace not apply to an owner of property who Wilde or improves demon, and, who contracts for such projects with a cmu icur(a) licensed pursuant in the Ommuc pr'¢ License Law. 0 lamese tundde, Sm. Bg: P C farthiswon Owner-- n) C Dau " AI—Q'�) WORKER'S COMPENSATION DECLSRATION . I hereby aMm under Knalty of perjury am of the following decimations: ofConsent m xlf-Imam fm Worksr'aCampen- have end will msimu amM andort,I (Pe by Section 370D of tee IaWr Code, fm the per(ormma of tee 37(x .,itf rprovided ooh for which this p<mtit Is issuM. 0 1 base and will maintain Wmkch Compensation Insurance, as required by Sedan 37W of tee Labor Code, for the ped'owmce of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS ' COMPENSATION INSURANCE (Thu section need not be cmm plemd if the permit is far enc hundred dollen (5100) or leas.) 1 cenify that in the performance of the work for which this Pewit is Issued, I shall not employ any person in my moo ler�m satin necoDe nbjecI to the Worked'Compensation Laws or Califamin. Date 1 R Applicmt / NOTICE TO APPLICAk%D If. after making this CeniEau of Exemption. you should become subject to the Worker's Compensation provisions or the labor Cody, you mm ' forthwith comply with ¢tech povisions Or thin Iamb( dull W decmod cooked. CONSTRUCTION LENDING AGENCY I thereby at Irm that them its comuuminn lending agency for the Perimmance of the work for which this permit is inuml (Sec. 3097, Ch. C.) Undoes Name - 1<Mer's Add. 1 certify that I hove mad thin application and sum that the nWw informmm is cows. I agree to comply with all city and county ordinances and sok law relating to building convection, and hereby authorise representatives of this city to enter upon the above-mentioned properly for WPeman purposes (We) agree in save, indemnify and keep hamlets the City of Cupertino against Ilabilidenjudgmenta, coats and expenses which may in my way accrue agsimt said City In eonsegmme of the gmmng of this pewit. APPLICANT UNDERSTAND ND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULA /' M -0e0 iK t' Re -roofs Type of Roof SI wore of ApplicantlConumur Dau HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future Wilding accupmtuore orhan ile hannlous material n deMN by the CuKrdno Municipal Code. Chapter 9.13, and the Health and Safety Commen , sezss3z(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yn �kla building If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future occupant use equipment or devices which It havardous air conuminma m dm xul by the Bay Area Air Quality Management all new materials for inspection, inrict7 0Yesw u I have read the harardousmaterialsrequiremena under Chapter 6.93afde Collins. nuHealth hSafrayCodc,Sanions25505.25533 and255M. l understood use lithe Wilding dat curmmly new • temut the it' my bespondminy m ramify the occupant nr ue te no requimmcnuw lch mus nuance or a cMifuam rOcmpanry. Signature of Applicant Date ✓ I All roof coverings to be Class "B" or better Owner or Ifitharir=d agent D,m I� u 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 ._ 1 r, CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORMas— N # 3, j 3 v ZJ Datl FBuildingAddress: Mailing Address (if different from building address): b C(AIEner' Name: V rc o r . Pere -o Phone #: Contract : n License #: C 10 -634 & Conta Phone: Cupertino Business License#: �Qi '� `T Fax: MECHANICAL Building Permit Info: Bldg ❑ Elect 1� Plumb ❑ Mech ❑ Job Description:,�p , t� Residential S �r ,N(el CIA t4w�2`(2 'i 0 ;omfinerci 1 0 Sq.Ft. Floor Area: $/Sq.Ft.: Costo roject: Occupancy Group: ,VP�OD I MECHANICAL Type of Construction: Sf-P Please check this box if the project is a ❑ I second -story addition: Project Size: Standard ❑ Large ❑ Major ❑ BUILDING 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> IM 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 BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING I of 2 1 � CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Ouantltv I 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 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 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 > 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 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 CUPEI,TINO CITY OF CUPERTINO 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 Inspection BUILDING BSWfM 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 -Faro PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3 of 3 J •