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07100141 CIT�' OF CUPERTINO ' BUILDING DIV1S10N PERMIT ��'�� ' ,; ......:. .... . PERMIT NO. Bu ��4�� ES �TEVENS CREEK BLVD EMCOR/MF;SA ENERGY SYSTEM 07100141 � PERMIT LSSUE DATE ER'S NAME: CALIFORNIA BANK & TRUST 5 VANDEF.BILT 10/18/2007 SANITARY NO. CONTROL NO. PHONE: (510)67U-1690 BUILDING PERMiT MFO ARCHITECT/ENGINEER: BLDG ELECT PLUMH MECH � � � 0 � p o LICENSED CON7RACTOR'S DECLARATION JOb DBSCTlpt10❑ � v� I hcrcby aftirm that I am licenscd undcr provisions oC Chapicr 9(commcncing ;Z� w ithScction7000)ofDivision3ofihcBusincssandPrafcssiunsCadc.andmyliccnscis REPLACE TWO 8 1/2 TON HEAT PLTMPS AT GROLJND LEVEL ;� y in full Corce and etfec� 6"`/ ��' � v� Z Licensc Class �1 •�..}��ic. if ± F i p Datc %OT L i 7 Conuactor �� ARCHCIECI'S DECLARATION S r Gwf �C ; W U I undcrs�and my plans shali Ac uscd u public rccords ' u. y LKCnsed Pn�fcssional � � � OW NER-BUII.DER DECLARATION 1 hcrcby alTirm th�t 1 am ezcmpt Crom thc Contractors Liccnsc Law far �hc � p o Collowing reason. (Sccuon 7(131.5, Eusiness and Profccsions Codc: Any city or county �,° � which rcquires a pcimit to conswct, altcr, improvc, dcmolieh, or repair any sWMUrc °" y prioc ui i1s issuancc, alsa rcquires �hc applicant for such permit io filc a signcd statemcn� i, Valuation - Z < that hc is liccnsed pursuant to thc provisions oC thc Contrxwr's Liccnsc Law (Chaptcr 9 ,�q. Ft. Floor Area $ 310 4 3 Y F� (commcncing wiih Scction 7000) of Division 3 of Ihc Busincss and Profcssions Codc) or ' y�� that 6e is ezempt Nercfrom and Ihe basis for the allcgcd ezempdon. Any violauon ot Occupancy Type Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of 3 2 6 3 4 0 6 � � �'E�� Number n o t m o rc U � a n f i v e h u n d re d d a l l ar s ( 5 5 0 0� ❑ I, az owner o[ ttie pmpercy. a my cmployces with wages u the'v solc compensation, wi!! da �he work and the swcture is not intended or of[ered for sale (Sec. 7044. Business Required Inspections and Professions Code: The Conuactor's License Law does not apply ta sn owner of propeny who 6uilds or impraves thereon, and who daes such wort himself or �hrough hu own employces, prov3dcd that such improvements are not imended or oQered [or sale. IC, however, the building or improvement is sold within one year oC wmplcuon, die ownu- builder will have the burden o[ proving �hat he did no� build or improvc [or purpose of salc.). ❑ I, as owner of the property, am ezclusively conuacting wi�h liansed conuutors to conswct the projen (Sec. 7044. Business and ProCessions Code:) The Cootncwrs Li- ccnse Law docs not apply �o an owner of property who builds or improves thneon, and . who con�racts for sucd projec�s with a comractor(s) Iicensed pursusnt to �he Convacror's License Law. f [ am uempt under Sec , B& P C for this rcason �er Date _ . . WORKER'S COMPENSATION DECLARA170N I hercby atfirm under penalty of pe�jury onc a( the following declaraGons: ❑ I hsoe and will maintain a Certificate o( Conscnt to self-insure for Workcrs Compen- sation, as provided for by Sec[ion 3700 of the Labor Code. Cor the performance o[ ihe woric for which Ihis pertnit is issucd. ❑ I havc and will maintain Workcr's Compensation Insurana, as �cquircd by Scction , 3700 oC Ure Labor Code, for the performance of the work for which this peimit is issued. My Warkers Compensauon Insurance carticr and Policy nu�mbc ar�c: c, ��/' Cartier. � '�/'tA/ � Pol'�ty Noi'�S�.s?`�� d -�La / /� CERTI ATE OF EXEMPI'[ON FROM WORKERS' COMPENSAT[ON INSURANCE (This section nccd not hc complcted i( the permit is for onc hundred dollazs (5100) , or Icss.) I cenify th.e in the perfortnance of ihe work for which �his pertni� is issucd, 1 shall not arnploy any person in any manner so ts ta become su6ject io �he Workers' Compensation Laws of Califomia. Datc Applicant NOTICE TO APPLICANT: If, aftcr making this Ccrtiticatc of ExcmpGon, you shoulJ become subjcct to thc Worker's Compcnsation provisions of Wc Lalwr Codc, you must �,Z forthwi�h eomply with such pravisions or this pccmit shall hc decmcd revakcd. z O CONSTRUCCION LENDWG AGENCY F � 1 hcrcby afiirm that thcre is a conswction Icnding agenry [ar thc performancc u( p�., � thc work for which ihis permit is iuucd (Sec. 3097. Civ. C.) , W A Lcndcr's Namc � z Lsnder's Address U � 1 certify ihat I have rcad this application and statc that thc abovc informatiun is w � correct. I agrce to comply with all ci�y and county ordinances and sute laws eclating lo � U building conswction, and hcicby authorim reprcsenutivcs of ihis ciry to cntcr upon �hc � W above-menlioned properry for inspecUOn purposes. � (Wc) agree to save, indcmni(y and kecp harmlcss ihc Ci�y of Cupcnino against H � liabiliues, judgmcnts, costs and expenscs wAich may in any way accruc against said City , V z in consequencc af lhc granting o( Ihis pertnit. Date (� (�' '� � APPLICAM UNDERSTANDS AND WILL C PLY WITH ALL NON-POINT Issued by SOURCE REGULATI . ' Re-roofs /j/� s� �� ar �� o��o. �am TYPe of R oof ' HAZARDOUS MATERIALS DISCLOSURE �11 ihc applicant or futwc building accupant storc or handlc ha�ardous ma�crial dcfincd by the Cupenino Municipal Codc. Chaptcr 9.12. and [he HcalUi and Safety :�. Scction 25532(a)? All roofs shall be inspecied prior to any roofing material being installed. �Ycs �No . Wi11 thc applicant or futurc building occupant usc cyuipmcnt or dcvices which If a roof i� installed without first obtaining an inspection, I agree to remove cmi� harardous air contaminanls u dcfincd by the Bay Arca Air Qualiry Managcmcn� all new rr aterials for inspeciion. asu�� ❑ Ycs �N� I havc rcaJ the hvardous ma�crials requircmcn�t undcr Chaptcr6.95 a(Ihc Califac- nia Hcalth & Safcry Codc. Sectio�s 25505, 25533 and 25534. I undcrsrand thaz iC ihc buildinB does not curten�ly have a tenan4 uat it is my responsibili notify the occupant of the rcyuircmc , ich rior ' af camofOcc �r. SignatureofApplicant Date �j �l � All roof coverings to be Class "B" or better Owncr or au�hori agcnt Datc — � � � oo � �-f-- i � CITY OF CUPERTIl�TO �� `_ � � �`��.I��/�.� UPE�TIN� PERMIT APPLICATION FORM APN # Date: .� � O � • 0� G�� .zl Building Address: i i Eyc c �� Z v�0 Owner's Name: Phone #: � ---�r�_c,��N �— � �� %/ZV� � �d `G - Contractor: Phone: License ##: ��►C.�2 �v � /'�i � �12G � ;c� 1:✓ �S)D ( -/6 ��cS Contact: hone: Cupertino Business License #: i T i/tJ�f I U�' 7� -D�� — Building Permit Info: Bldg ❑ Elect LL�� Plumb C�� Mech � Job Description• C_. - l Z,�4 rw l v.�u4 '' �- Residential ❑ Commercial J� For Residential Installations: Attic � 1 St floor � 2 floor � Adhere to min set back requirement ❑ or Commercial Installations: Replacement same weight �' Additional weight (structural calcs) � Structural Calculations required for new installation �� New installation Planning A proval Required ❑ Cost of Pro�ct: Type of Construc:ion: Occupanc group: �> Dy3,vo � Strapped ❑ On Platform ❑ Bonded Sq.Ft. Floor Area: New Location � Replacement '�` Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Er�ergy BUILDING ' BREMFURN Ft rnace MECHANICAL BREMACOVER A� C Unit > 10,000 cfin MECHANICAL B�M,e,I�� A, C Units <= 10, 000 cfin MECHANICAL BREMRECEPT R�;c tl, Switch & Outlets ELECTRICAL BSEISMICRE Sf:ismic Fee Res BUILDING BSEISMICOM Sf:ismic Commercial BUILIDNG /' EPERMITFEE EJ ec Permit Issuance ELECTRICAL ( MPERMITFEE Mech Permit Issuance MECHANICAL / PPERMTTFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Pernut Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC B �siness License BUILDING CITY OF CUPERTINO 6 ITEMS OF 6 PERMIZ RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN ......... 32E34067.00 DATE ISSUED.......: 10/18/2007 RECEIPT #.........: BSC00003029 REFERENCE ID # ...: 07]00141 SITE ADDRESS .....: 20`_41 STEVENS CREEK BLVD SUBDIVISION ....... CITY .............. CU�'ERTINO IMPACT AREA ....... OWNER ............: CAI,IFORNIA BANK & TRUST ADDRESS ........... CITY/STATE/ZIP ...: SAt1 FRANCISCO CA, 94118 RECEIVED FROM ....: ME;3A ENERGY SYS INC CONTRACTOR .......: R0�3ERT LAKE LIC # 26058 COMPANY ..........: EM('OR/MESA ENERGY SYSTEM ADDRESS ..........: 5 �TANDERBILT CITY/STATE/ZIP ...: IR��INE, CA 92618 TELEPHONE ........: (5:_0)670-1690 FEE ID UNIT QUANTITY ��MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BREMAIRHAN NO.UNITS 2.00 20.52 0.00 20.52 0.00 BSEISMICOM VALUATION 31,043.00 6.72 0.00 6.72 0.00 EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 184.47 0.00 184.47 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 184.47 #060043 --------------- TOTAL RECEIPT : 184.47 � , Community Development �t�, ' 10300 Torre Avenue �". ' 3 �" ` Cupertino CA 95014 Telephone (408) ?77-3228 C1TY OF Fax (408) 777-3333 �UPEf�TINO Buildi:n De artment JOB ADDRESS: PERMIT # � �� ` 20S`y/ - c �1 �� OWNER'S NAME: �' u,� - �z TiL v,; T PHONE # D-�' - -�G9U GENERAL CONTRACTOR: �� , _ ,z, ,. F� # S/ � --/ 9 I am not using any subcontractors: � �� Si�;nature Date Please check a licable subcontractors and com �lete the followin information: SUBCONTRACTOR BUSIr�ESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Fini.shing IIectrical 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 � 1!� zi ai Owner/ ontractor Signature ate