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03090230 CITY OFCUPER'1'INOs*'°"'+" '' �.�R BUILDING DIVISION PERMIT CON,T,RACTOR INFORMATION `f BDa°wcADDRESS: CALIFORNIA POWER AND LIGHTPERMIT"°03090230 ETTE DR OWNER'S NAME: 8887 LILLY AVE PERMIT ISSUE DATE NE' 4088470520 SANITARY NO. CONIAOL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO HLOG ELECT PLUMB MECH +00 LICENSED CONTRACTOR'S DECLARATION ;dF l literary eMrm that 1 Am licensed under previsions of chapter 9(commencing Job Description :z§ wiNSecdon7fp)DfDiGision3ofth BusincssµIdf.fossamtCarmsuitlmyliemseis w. in full torte an err«t �— l( ELECT SERVICE UPGRADE �1.V ` ..® 'Lj i Llcenac Clua —5 Lic.N 'a� A, Da Contrecm l ARCHITECT! DEQLA OCT J. i l understand my plans shall W used a him, ds L8003 )y 'off Liecosea Professional s OWNER-BUILDER DECLARATION Y 1 hereby affirm that 1 am exempt from the Contractors License Law for the � f1w .00 fallowing mason.(Section 7131.5,Business and Pro@ss �'LD1� ions Code:Anycity nr county C3 SS� which require a permit to cnutrucl,alter,improve,dcmalim.or repair say structure -Za prior to its issuance,alsortluires the applicant for uch Permit to file a signed statement that he is licensed pursuant in the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation - j S (commencing with Section 7(1(10)of Division 3 of the Business and Profcasions Coda)or Nere . 00 at he is Attempt therefrom And the basis for the a11a,od exemption.Any volarlon of 37531043 Section 7031.5 by any applicant for a permit subjoclathe appncanttoacivil Penalty of APN Number Occupancy Type not more than firs hundred dollars(5500). ❑I,u owner of the pmpcny,or my employed with wagesu their sole compcnution, will do Nc work,end Neawmumis nptintendcd oroRcrad fonalc(Sec.7064,Business3U4 — ROUGHsF!LF!/-`TD Tj'jg,T. and Professors Code:The Cnnusctofs License Law dad not apply to in owner of 1eeZtvsrC9 77tstm'~10 as property who builds or improwes thereon,and who doessuch work himsedfor through his 501 - FINAL ELECTRICAL ENERGY ovnemployed.Pmvided calmer imponernmum,an,intended mafreredforsale.If. 505 — FINAL ELECTRICAL however,the building or improvement is sold within one year oreumPletion,the owner. builder will have the burden of proving Nat he did not build or improve for purpose of ole.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construm the project(Sec.7844.Business and Professions Code:)The Contractors Li. case La doe not apply to an owner of pneperty who Wilds or improm Neuron,and, hoc Incta for such pmjecu wiNaeonoactor(q Bcensed pursuant mNe Conmctor's Lite se Law. I am exempt under Sec. ,BkPCfor this muco Owner Dale WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penally of perjury ons of the fallowing declarations: I haw and will maintain a Certificate of Consent m self-insure for Workers Comtism. cation,u pmvidtetl for by Section 3700 of Ne labor Code,for the performance of the work for which Ibis Permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,u requited by Section 311 of the labor Code,for the Performance or the work for which Nis permit is issued. My Worker's gnution Insu carrier and Policy number art: a 'er. Policy No.;G Eftf1�CATEOF EXEMPf10�J-Pf WORKERS' COMPENSATION I CE Tbls rmtion need not W completed If Lha Iermit Isforone hundred dollaa($IBB) nr ksa.) 1 certify that in the perro enyy�work for wry his armor is issued,I ahull not employany nine nth nWcon SI he Wo r�Co tens Ian s laws of Califovo APPIic t NOT APPLICANT:IL e0cr eking Nis Cenifinte of Exemption,you should beeom biter ID he WO,kcrk Com amu ion provisions of the Labor Code,you must D O forthwm ith comply with such provnns or Nmi is pert shall rte deemed rewhad. Z^ CONSTRUCTION LENDING AGENCY I hereby 4Rom that there is consuuctinn lending agency for the Performance of Y. Ne work for which this permit is issued(Sec.3097,Civ,C.) z1 Lendcr's Name 3. 3 z Lender's Address j 0 1 certify Nat I hale mad Nis Application and sum Nal the above information is S.f" correct.I grte to comply with all city and county ordinmces and sum laws mladirl to DU Wilding construction,and hereby auNOrim representatives of Nis city to enmr upon Nc a ahovc(We)agree Property for inspection fy An keep o. (We)gree tG taw,and expenses And keep hay in an she y ac accrue Cupertino against r r/) judgment,granting uind eepcnusmiwhich theytoanywayaccme egalnsuoid City J,7j m wase ANT of UNDERSTANDS of this D WILL APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONP IN Issued by: Dale SOUR /?/// CE ONS,/n� /� v p Re-roofs 'r..of rcanucffiuw, DALY HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or rui b ilding Occupant or handle haarduus material As defined by the Cupertino Munic' al Cade.Chapter 9.11.and the Health and Safety Cuda,section 25532(e)?Yon All roofs shall be inspected prior to any roofing material being installed. Will the applicant or f�N. Gilding beceplot use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hvardnus air contaminants by NA Bay Ama Air Quality Management all new materials for inspection. iwic" ❑Yes I have mad the hon nIous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cale,Secdou 25505,25533 end 25534.1 understand that if the huilding does not currently have a tenam,Nat it is my responsibility w notify Ore occupant of the myuiremcnu whit useMm ormissuance ofa Ce roam or Oaaupanay. Signature of Applicant .Date - �` 0 ter tape,6rized agent Dom All roof coverings to be Class nBn or better 4 J ' CITY OF CUPERTINO ( AOF PERMIT APPLICATION FORM CUPERTINO 41 APN# Date: l - 7it.-�3 Building Address: 11 � j O'1 co r\ i vlele__ ID 'r. Owner's Name: . Phone #: 83v , -7 z ,i Contractor: License#: F rrl;A �au� er q.. � � Contact: t, Cupertino Business License#: Building Permit Info. Bl Elect ?f,� Plumb ❑ Mech ❑ J Descript_iryt: Residential �lw / �Cercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: / Occupancy Group: Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER OtherAppliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERl Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M 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 BELE 200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING X2331 �- I of 3 Z33/L, CITY OF CUPERTINO CITY - PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTINM hispection 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 Fumace> I 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 2of3 ambCITY OF CUPERTINO CITYOF PERMIT APPLICATION FORM CUPER,TINO Quantity Fee ID Fee Description Fee Group 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 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 PlanBUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimn-dng 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 MPERMITF'EE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee s foot PLUMBING ZADDCHG Address Chane BUILDING .1 3 of 3