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05080078 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRAC"°TOR INFORMATION BUILDING ADDRESS: WILLOW GLEN ELECTRIC INC PERMIT NO,05080078 867 FERNGROVE DR OWNER'S NAME: PERMIT ISSUE DATE MOORE, KATHERINE 1085 WARREN AVE 08/10/2005 NE: SANITARY NO. CONTROL NO. (408) 289-9725 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH O M O O �Oa LICENSED CONTRACTOR'S DECLARATION w I hereby affirm Nat I am licensed under provisions of Chapmr 9(commencing Job Description <� with Section 7(Kgry,f Division SofdW Business and Pr ssintu Cale. nil my license is p mm�f.amandercect 200 AMP POWER UPGRADE (tlHt�(j]�j j,0�, 2 Liccnsc Clan r- Lim. � ��^� F p DaK Continue j f(��. D <nm-i ARCHITECTS DECLARATION N tg�r 11_a1'/IY/Ip1 C c` 1 understand my plans shall W turd as public mcnrda s4.< LicensedPnoresOnnal, a� fa�� `OJ OWNER-BUILDER DECLARATION 10055 <� 1 tummy alfrm that I am eacmpt(m.the Contactor'a License Law for the R p y J Q O following mason.(Sinton 7031.5,Business and Pmf¢siou Cade:Any city or county qq i$ which mulun.it permit m co.1L alter,improve,demolish,or repair my smacmm - +n A 4 9 S i:f l k n _$2980 prior it)its issuance.also tequitu the applicant for such permit to file a signed summent I — y t that he is licensed pursuant to the pmvisiomser the contractor's License Law(Chapter 9 Sq.Ft. Floor Area ate' ;"60##VMdati6n x1--O (commencing with Section 70)0)or Division 3 of the Business and Professions Code)or V 4 5$ that he IS exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of AIN r Occupancy Type not mom Nan five hundred dollars(S500). ' 0 1,as owner of 1M pmpmy,m my employcu with wgo u dteir mit eompemtion, will do the work.and dm structure is not intended or offered forssm(Snc.7044,Business Required Inspections and Professions Code:The Contractor's Licer ense Law does not apply to an owneof q P property who builds or improves thereon,end who does such work himself or through his own employees,provided that such improvements me not intended or offered for sale.If. ha«ever.On building or improvement is said within one your of completion,the owner, builder will have doe bunion of proving that W did not Wild or improve fm purpose of sale.). 0 1,as owner of On propcny,am c.cluaivdy contracting wino licensed contractors to construct 1M project(Sec.7014,Business and Profusions Cade:)The Cantrwtals Li- mnw law does not apply to an owner of property who builds or improv thereon,and who contacts for such pmjmu with o cantrwmr(s)licensed pursuant to th<Conment's License Law. 0 l am exempt under Sm. B k P C for this moon Owner Dam WORKER'S COMPENSATION DECLARATION 1 hereby Orion under pernity of perjury one of the following declarations: 1 have and will maintain a Cenifum of Consent N self-insum for Worker's Compen- sation,an pmvidcd for by Section 370)of the labor Code,for the pefformmce of the work for which this permit is issued. . ❑I have and will maintain Worker's Compensation Iran==,as required by Section 37W of the labor Code,for On performance of the work for which this permit is issued MyWorker' Cnmpensaton lnsum/na� ciniermdpolisi iumm, Caoriee PCj CG N ryl�tjar'lcy No.: WC y7 3 1 CERTIFICATE OF EXEMP ION FROM WORKERS' COMPENSATION INSURANCE (This section wind not W eumplemd If Ole permit is rorone hundred dollars(SIM) or Mss.) 1 cenlfy that in the performance of Ne work for which this permit is issued.I shill not employ any person in any manner m as w income subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If.after making this Ccniftcam,of Exemption,you should become subject to On Workers Compensation pmvisiom of the LahM Code.you mum .J O forthwith comply with such provisions or this permit shall he deemed revoked. Z CONSTRUCTION LENDING AGENCY [-tom IWmby affirm Nat thine is a construction lending agency for Ne performance of fY On work for which this permit is Wood(Sec.3097,Civ.C.) QLeacce,Name Z Lasker's Address V Q 1 certify Nat 1 have mad this application and sum that the shove information u {l.F coma I a&=to comply with all city and county oNinmces and sur n laws relating to O V building constmction,and hereby authorize repruematives of this city 10 enter upon the �I37 shove-mentioned propcny for impaction purpmes (We)agree to rove,indemnify and keep harmless the City of Cupertino against F'rary Iimilidics,judgments.costs and expenses which may in my way wrote against said City C.)z APPLL CANTcof the UNDERSTANDSthis ND WILL COMPV WITH ALL NON-POINT Issued by: Date 6_r SOURCE REGULATIONS. C� �� Dl Re-roofs f SignalurrfAp cantlCon t -- - am HAZA GUS MATERIALS DISCLOSURE ' Type of Roof I theappliantw no Wilding Occupant store or handle hevardoue material u d IV by tM Cupaenian tomp 11 Code.Chapter 9.13,and the Health and Safety cane.Satan zss3zl )7 All roofs shall be inspected prior to any roofing material being installed. ❑res ,- it Will the applicant or furore Willing occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air conumiumis as defin d by the Bay Arca Air Quality Management all new materials for inspection. Diavict7 ❑Ycs I have mal the hvaNnusmamriab requirement under Chapter 6.95 of the Califory nice Health h Safely Code.Swtou 25505,35533 md25534.1 unJcrsund Nw if the building dao not currently ham a mount. tit is my respouinlity to nntly dK cecupam of the ma when t¢tx rtoissum K.Koraetp r' Signature of Applicant Date OwnW.,a hcunnad age& DO IAll roof coverings to be Class "B" or better o5a � c� o� &' clesad 1-t,too-�•u� Q CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM �UPEkTINO _ J% SOL APN# 3 VS a 1 ('� Date: GG O �U 0 S Building Address: g 6� Fen o\Je C.Owner's Name: Phone#: 2S 5 - 5 U`l Contractor: . j License#:Contact: Cupertino Business �se#: �(�cA MM � - / Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Descriptio • I �j Residential AM"� ° Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project /� Occupancy Group: e of Construc on• der ;rv,..,Z_ uanti 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 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> 1O00A 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 X03 . 1 to 1 of 3 d CITY OF CUPERTINO CSN OF PERMIT APPLICATION FORM CUPERTINO -Quantity 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 rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent 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 Fumace MECHANICAL BREMFURNOV Relo Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREN MISC 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 Ak BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Maz uee 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 BSWIM 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 PPERNHTFEE--- —Plumbin"-PermifIssue --PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3