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07100135�Op ;auP 1UU i<c .�z )Wr a� .p� ,% 200C C 0 V^v �=C yFa Ll R'. CITY OF CUPERTINO 6UILDINGDIV1S10N PERMIT11TIZAGOIMIf�N: BUILq,ING,41�p�t ORRE AVE l (J jj U �J ROSENDIN ELECTRIC INC. PERMIT NO. 07100135 IER'S NAME: PERMIT 155UE DATE CITY OF CUPERTINO 880 MPBURY RD 10/18/2007 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: A BUILDING PERMIT INFO REPLACING OLD LIGHT FIXTURE BLDG ELECT PLUMB MECH o a a 0 LICENSED CONTRACTOR'S DECLARATION lob Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Pr fcssivas Code, and my license is in full force and effect �2� License CI Lic. # pare— Contractor ARCHITECTS DECLA ATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure �' q. Ft. Floor Area Valuation prior to its issuance, also requires the applicant for such permit to file a signed statement License Law 9 that he is licensed pursuant to the provisions of the Contractor's (Chapter (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars ($500). 0 I, as owner of the property, or my employees with wages as their sole compensation, Required Inspections q p will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors 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.). 0 1, 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 docs 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 Contractors License Law. 0 1 am exempt under See. B & P C for this reason er Date _ WORKER'S COMPENSATION DECLARATION eclarations:0 I hereby affirm under penalty of perjury one of the following declarations.- 01 have and will maintain a Certificate of Consent to self-insum for Worker's Compen- 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 Workers Compensation Insurance, as required by Section 3 of the Labor Code, for the performance of the work for which this permit is issued. ...y Workers Compensation Insurance carrier and Policy number are: —t erU2J Carrier. Policy No.: k - /T CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($101) or less.) I certify that in the performance of the work for which this permit is issued. 1 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 Lenders Address 1 certify that 1 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. (We) agree to save, indemnify and keep harmless the City of Cupertino against n liabilities, judgments, costs and expenses which may in any way accrue against said City 7 in consequence of the granting of this permit. APPLICANT UNDERSTANDS A D ILL COMPLY WITH ALL NON -POINT Issued by: SO4WX REGU NS. �' �g" 0 • Re -roofs S' u ApplicanUContiador Dare MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material 4cfuned by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes If a roof is installed without first obtaining an inspection, I agree to remove , Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new m.Iterials for inspection. District? 11, 0 Yes W41- 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- Health & Safcty Code. Sections 25505, 25533 and 25534.1 understand that if the building ..oes not currently have a tenant, that it is my responsibility to notify the occupant of the Occupancy. Date reyuiremc hich must be m prior to i u a Cc �� Signature AApplicant "B" All roof coverings to be Class or better Owner or tho ' d agent Date CITY OF CUPERTINO 0-7 tool PERMIT APPLICATION FORM II40q Date: Building Address: :Mailing Address (if different from building address): 162C�O wt"a� r e a. �� Owner's Name: Phone #: _ 32*9 T-er(, e- Contractor: License #: Contact:t Phone: 9168 ?q.3- 028 Cupertino Business License#:I � goy o o Fax: 'iib 8 2ci 3 --023 Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Reel tr-N wo Q l L�S�, -`,-x4� m w' L '� 1V -w 00C-5 Afft-aXJ4,a4aly Residential ❑ V Commercial Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupan y Group: MECHANICAL BCONSTAX Type of Construction: Please check this box if the project is a ❑ _— second -story addition: I Project Size: Standard ❑ Large ❑ Ma or ❑ BCONSTAXBQ BCONSTAXH Qi�a_ntity Fee ID BAPPLOTHER Fee Description ether Appliances Fee Group MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boilcr > 1M to 1.75 M Btu MECHANICAL BBOILER5 E oiler > 1.75M Btu MECHANICAL BCONSTAX -onstruction Tax BUILDING BCONSTAX In i/Off/Comm/Quasi BUILDING BCONSTAXBQ BCONSTAXH Ccn. Tax for BQ Zone Hotel and Motel BUILDING BUILDING BCONSTAXR Constax - Resi/Mobile BUILDING BELEC 1000 El ec 600V <= l OOOA ELECTRICAL BELEC1001 F lec 600V > 1000A ELECTRICAL BELEC200 Elec. Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD energy Add Multi BUILDING onXTATUCTT(;A TnvPctivation fee BUILDING of 3 3., C TY r CUPEkTINO CITY OF C'UPERTINO PERMIT APPLICATION FORM .?uantity Fee ID Fee Description Fee Group BREMSIGNAD Rmc_l Signs Add Branch ELECTRICAL BREMSIGNS Rem Adel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD S cb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE ',►eismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM 3wimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Tem,3orary Bldg Permit BUILDING BTEMPSVCS 'remp Dist Svcs ELECTRICAL BUSLIC E,usiness License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Phmbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING 3 A3 -' CITY OF �UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # OT7 too ' 3 ca ao o�-re__ o.v-e__ �--•-- ----- --- — BUSINESS NAME OWNER'S NAME: �= v PHONE # - 3 GENERAL CONTRACTOR:' FAX # I am not using any subcontractors/0-/,R- 07 Signature Date and rmmnlete fhP following information: 1 1CQDC l.1LCl.1� a iaaa.r►a- 7ua.��..vi«a..a�..v=... SUBCONTRACTOR �--•-- ----- --- — BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical R 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 4qw �)- A"At--— /0- / ol>- 0 7 / / Owner/ Contractor Signature Date