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05080235 CITY OF CUPERTINOf ra,�rg�,dw "3aa.: � '� ''" " •" BUILDING DIVISION PERMIT -ONTRAC'TORINFORMATION BUILDING ADDRESS: COLOA CONSTRUCTION, INC ""'05080235 OWNER'S NAME: PERMM MUE DATE JAMES LIN IF;71 CANYON vTFw ng OAL2SI/20053 NE: SANITARY NO. CONTROL NO. (408) 891-2449 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH e 0 0 0 JOo LICENSED CONTRACTOR'S DECLARATION JobDescflpfign I hereby affirm eget 1 am licensed under provisions of Chapmr 9(commencing 77 with Section 7M)of Dlvialon 3af iho Busincatnd Professions Code,end my license Is n=1rr In r0 some and effm UPGRADE ELECT. PANEL ,JZ Done. Clw Cntramor •�� IN� ey V ARCHITECTS DECLORIATrOhl I undersand my plans Jell be used a public records 366660"""" Licensed Pmfesstoml ,•� /� 1//Q(v OWNER-BUILDER exempt DEC t ConnaON ,,BBt N gJ 0 F I hmose affirm Net 1 1. exempt Imre Ne ConuanC d :Any c Lew for the M S fallowing reomn.(Sectun 703 1.5.Busimss end Rofes.dons Code:Any city m county ��yBB�''++ S y JT.y;j q which requires a Permit m construeL alter.harrow.demolish,or repair my Structure w b ed q 18 0 0 y,si~n prior it)its issuance,also requires to applicant for such permit to ale a signed su¢ment i < Nat he is licensed pursuant in dte provisions of the Contractor's Ixanm Law(Chapter 9 Sq.Ft.Floor Area 474 VV. aluation of (commencing with Section 70D0)of Division 3 of Nc Business and Profeaions Code)or — that he a eranpt therefrom and the hosts fa the alleged assumption.Any violation of Smdon 7031.5 by my applicant for a permit subjects the applicant to a civil penalty of OQQU �I not more than Rve hundred dolls r(M). Occupancy •7 Pe ❑L as owner of the property,or my employees with wagesas their mle compensation, will do the work,and the smcmre Is not intended or offered Puristic(Sec.7044,Business Required Inspections and Profession;Code:The Grammes License Law does out apply N an Owner of q P property who build,a IMmo ,thereon,andwho dosrahwork himmlfor through his Own employees,Provided that Such Improvements me contended aoRered for We.If. however.Ne building or Improvement is Sold within o0 year of completion.the Owner. builder will have th burden of proving tat he did nes build or improve for purpose of ule.). ❑1,u Owner or she Property,me uelWvely..meeting with licensed contreetars in construct the pmject(Sec.7044,Business and Professions Code:)The CanuanaM1 LI- ceve Law does not apply ro an mover of prop,my who builds or Improves thereon,and, who conuacu roraah projects with a cotrmunro licensed pursuant in the Contractor's License Law, ❑1 am exemPunder Syec. ,B&P C for Nisj�mon 1307,00 wner ��VW"/'-"7�"��- WORKER'S COMPENSATION DECLARATIOl4" I hereby affirm under penalty of penjtay,one of the following declarations: 1 haw and wil meinain aCeNncate of Conserv I.self-inure for WarkeYsCooper. ton,as provided for by Section 3700 of the Labor Code.for the perfarmence or the rk for which this permit is Issued. I have and will maintain Workst's Compensation Insurance,ss required by Section of the labor Cade,for Ne performance of tite went far which this permit u issued. Workef,Compensation Insuame artier nd Policy number are: rtier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This Section Stood not he completed lithe Penult I,two=hundreddolisn(SIM) of less.) 1 certify Net In the perroreaneo of the work for which this permit is issued,I,hall not employ anyperaon in my maned.as in me subject the Worhrs'Compensation Law;or CalifsoU Date t Applicant , p(^w NOTICE TO APPLICANT.If",aver mating this Certificate of Exemption,you should became Subject he the Worker's Comp mstdon provision,of the Labor Coda you most forthwith comply with such provisions or this permit Mail he deemnd revoked. z" CONSTRUCTION LENDING AGENCY 14[-+ Ifor by whicffironh thatchorelesro (Sm.3 lending agenry for the performance,of Le work for whim Nis permit h issued(gee.309],Civ.C.) ' II] Q Len Name a2 Lendces Add. V Q I Unity that 1 haw read this application and Nm Nn the above MrOmeatin U Iy F once.I Sino to comply with all city and county ordini moa and sate laws relating Is Q V building consnotion,and hereby autharire mpreaenudwa of this city mcenter upon the [i7 ,ban-mandood Property for Inspection purposes. �"gL (We)is.te an.Indemnify and keep harmless the City of Cupertino against Ilabllitics,judgment,costs and expenses which may In my way accrue against said City V in consequence of the trending of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. SAA X�tL 11 i ENr & Re-roofs sigma a ph HAZARDOUS MATERIALS DISCLOSURE ate Type of Roof Will She applicant or future building acupmt am or handle heard=material as dented by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety eerie, on 4. ❑res ❑Nm All roofs shall be inspected prior to any roofing material being Installed. Will the applicant or future building Occupant use equipment or dcvicce which If a roof is installed without first obtaining an inspection,I agree to remove It hewafdous air contaminates as dcMcd by the Bay Area Air Quality Management all new materials for inspection. lurid? ❑Yes ❑Nu (havered mehvardwn aterials 25305,2553mal25M.Iu Chapter G95afine Califor- / �^ ��,_1 nice Halm nemly,haadc,Scmiau mita myresWx5531.1 udcnwdethout if mcup banding i/\f11.7v1•'�S boa not curtenty,have•teams.mu ides my mvpoosinility a notify the occupmt of dte a requiremcntswhichmun1bemedpdormissuancoofacertinc000roccup Signature of Applicant Date o> ,sena e��/ k T>� All roof coverings to be Class"B" or better Community Development 0 Torre Avenue CupOertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPEkTINO Building Department JQJ3 ADDRESS: PERMIT# 4-3-2- lu /27ZG'Woa Dig . CKS-a 8-0 3 OWNER'S NAME: IV ;*mfx, Cis/_ PHONE # GENERAL CONTRACTOR 0 /TS FAX # I am not using any subcontractors: —1_ 2Z-- 04 Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets &Millwork Cement Finishing Electrical 60(0Co yys^ . ZS� 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 �_-- 2—o- Owner/Contractor Signature Date �M-P CITY OF CUPERTINO 2, CUPEI�TI PERMIT APPLICATION FORM °3 APN# Date: Building Address: Mailing Address if diff rent from building address): 32 MV1 12• bEW000 ox - Cv wqJ1NO C Owper's Name: Phone#: &4 . Contractor: S License #: .7 Con act, ` Phone:64_A7 Cupertino Business License#: Con wr4 ylQ' Fax: Building Permit Info: Bldg ❑ Elect 90 Plumb ❑ Mech ❑ Job Description: �^_ dv� UpCOA'60E . Residential 9 Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project. Occupancy Group: Type of Constti n: Please check this box if the project is a second-story addition: ❑ Pro'ect Size: Standard ❑ Lar e ❑ Ma'or ❑ 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 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILERS 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING Z 1 of 3 i CITY OF CUPERTINO CUPERjIN0 PERMIT APPLICATION FORM QuantityFee 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 BOVERTIIvIE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g 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 Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREN AIRHAN A/C Units<= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace 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 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 2of3 CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Insection 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 PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3of3