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07020152CITY OF CUPERTINO BUILDING DIVISION PERMIT C 1N'I' 1LG 'QR ZN RMATII�N BUILDING ADDRESS: PERMIT NO. 10300 TORRE AVE. AES ELE—"TRIC 07020152 OWNER'S NAME: PERMIT ISSUE DATE CITY OF CUPERTINO 3310 BA3SETT SREFT 02/28/2007 iNE: SANITARY NO. CONTROL NO. (408)985-1320 ARCHITECT/ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job DOSCTIptIOn I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division3oftheBusinessandProfessionsCodc,andmylicenseis ADDING :'ILECTRICAL OUTLETS in full force and effect. License Class Lic. # Date Contractor ARCHITECTS DECLARATION 1 understand my plans shall he used as public records Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the following reason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to rile a signed statement he is licensed to the of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation that pursuant provisions (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $5000 that he is exempt therefrom and the basis for the alleged exemption. Any violation of MN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than rive hundred dollars (ssoo). 369 31 ❑ I, as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- ccnse Law does not apply to an owner of property who builds or improves thereon, and . who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ 1 am exempt under Sea B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I hsoe and will maintain a Certificate of Consent to self-insure for Worker's Compcn- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for anc hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction. and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. i (We) agree to save, indemnify and keep harmless the City of Cupertino against V liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNPSRUANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE RPOMAPF Re-roofs Type Signazu licanl/Contractor Date HAZARDOUS MATERIALS DISCLOSURE of Rc of Will the applicant or future building occupant store or handle hazardous material as dcfrned by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Cede, Section 25532(a)? All roofs s call be inspected prior to any roofing material being installed. ❑ Ycs o )7. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant building occupant use equipment or devices which Will the applicant emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ���... ❑ Yes r(f /Nu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health& Safety Codc, Sections 25505, 25533 and 25534.1 understand mat if me building does not currently have a tenant, that it is my responsibility to notify the occupant of the req *9" must be met prior to issuance of a certificate of occupancy. Signature c f Applicant Date f All roof coverings to be Class "B" or better orauthorizcd agent Date CITY of CUPEI�TINO CITY OF C UPERTINO Mw -015a PERMIT APPLI=CATION FORM _CPN # S Co - & ` O33 Date: O2- - 2-8'- 41 Building Address- Mailing Address (if different from building address): zo Ail, Owner's Name: Ci��/ Phone #: y°g' 77? 327 2 Contractor:A e ec ` , G J (� - Z2 9 License #Soo) -29 Joo Contact: Phone: / &IW60kiFax: �� b i Cupertino Business License#: Y 70 Building Permit Info: Bldg ❑ Elect(15 lumb ❑ Mech ❑ Job Description:d�CC (i(, Residential ❑ Commercia Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: bo® Occupancy Group: % Type of Construction: Please check this box if the project is a second -story addition: Project Size: standard Large ❑ Maj Dr ❑ BBOILER5 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 Boilor > 500K to 1M Btu MECHANICAL BBOILER4 Boile - > 1 M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX IncJOff/Comm/Quasi BUILDING BCONSTAXBQ Cosi. Tax for BQ Zone BUILDING BCONSTAXH hotel and Motel BUILDING BCONSTAXR Constax - Resi/Mobile BUILDING BELEC 1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD E nergy Add Multi BUILDING BINVESTIGA :investigation fee BUILDING 1 of 3 1 CITY OF CUPEkT(NO CITY OF C'UPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Yee urou BMISCELL Miscellaneous Fee BUILDING BMITIGATC Corr m. Housing Mit. Fee BUILDING BNUCOMME N:w Comm Electric ELECTRICAL BNUCOMMM Nev7 Comm Mechanical MECHANICAL BNUCOMMP T ew Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE B1dg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS G&; Piping System Fee PLUMBING BPINTERCEP Intl Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Phrr Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRI K Lawn Sprinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT A It of Drain & Vent PLUMBING BPWATER. -Install/Alter Water Pie PLUMBING BPWHEATER _ Neater Heater[Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/'�- 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 Rclocation of Furnace MECHANICAL BREMFURNOV Re] o 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 Po" er Device/Apparatus ELECTRICAL BREMRECEPT Rc itl, Switch & Outlets ELECTRICAL BREMRELOCA I:elocation of Hood MECHANICAL BREMREPALT R epair/Alter Heating MECHANICAL BREMRESAPP Re nodel Res Appliance ELECTRICAL of 3 CITY OF CUPEkTI(NO CITY OF C'UPERTINO PERMIT APPLICATION FORM ' Quantity Fee ID :Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remz)del Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD c cb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE .seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM ;iwimming 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 Ele .- Permit Issuance ELECTRICAL MPERMFEE M -,chanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plunibing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG j�ddress Change BUILDING 3 oi3