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05020113ITY OF CUPERTINO '"S¢ii6r .� t +•' �`"� BUILDING DIVISION PER i CONTItAC'1'OR IN ORIVIA.TION Flu A LDING,ADDRESS: PERMIT NO05020113 10371 SCENIC BLVD OWNER'S NAME; PERMITISSUHDATE FRANK NABAVI 02/16/2005 ONE: SANITARY NO. CONTROL N0. ARCHITECT/ENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH t� Q LICENSED CONTRACTOR'S DECLARATION lob Description 1 hereby Nn 1 em under of Chapter Y (rommense P d Preuns with Section )(K0) of OivlAlon ] of the Business anti Prufcssiom Code. and my license is ) ar offt Bu is instil forte, rce �-�e��� b a0LL4� UPGRADE ELECT. PANEL (200AMP) List. a., cuwactor KkA5 iinA CONTRACTOR: TETON ELECT. ARCHITECTS DECLARATION 1 understand my plana shall W used as public records Licensed Pmressional OWNER -BUILDER DECLARATION I hereby affirm that 1 em exempt from the Contractors License Lew for the following reason. (Section 7031.5, Business and Professions Code: Any city at county which requires a Permit to construct, Alter, Impasse, demolish. m repair my suction, prior to its isavancitalso requires the applicant fareach permit in fde a signed statement that he is licensedpunuart m the provialas.f the C.Airmm', License Lew (Chats, 9 Sq. FL Floor Area Valuatjb6 0 0 (eommeaai.S.Ith Sectio 7100) of Division 3 of the 13minen and Profcssiom Code) tar Nat Is u exempt therefrem and the basis for the alleges exemption. Any violation of APN Number Occupancy Type Section 70315 by arty Applicant rot a Permit subjects the applicant to a civil penalty of cont mase Nan floc hundred delta. (5500). 35702011.00 ❑ I, As owner of the property, or my employees with wages u Heir sale compensation, Required Inspections wasdO the work, .adthuwnum is an, intended .,offered f ... le(Sec.70N.Buvrcam And Profession. Cade: The Convactnes Lt. Law data cwt apply M an .1 or q P propeny who builds or hare ed thereon,and who doessuchworkhimselfor through his Own romenuam rmL earoedoraRcrW formic. If. eent however, thens,ping or I provur however, the building or Improvement is sold dein mu year or comolvOf the owncf is Wilder will ban Ne burden of proving Net he did not build., improve for puryose or a r sale ❑ 1, as Owner of the property, am exclusively contracting with licensed contractors to contract the cram .sanwnerossand ProfessionsCode:)or.)Themthomor's La mxnoa(See cease Law data oat Apply rce an owner of properly who sed a thereon, and, d at whocontractsLatta for such proJeeu with a cohvmtoKU licensed punwm to the CantnaaM1 rs to the 'tea V Licence Lew. " 0 I Am exempt under Sec. . B dr P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby efts, under Penalty of perjury one of the following declarations: 1 ham and will maintain A Ceniftwtn of Consent mlGiusure for WorkersCompets- Attila, m provided for by Section 37W of the ISWr Code, for the performance or the work for which Nis Permit is issued. ❑ 1 have and will maintain Workers Compensation Imurance, as required by Section 3700aftee LAWfCade, for Ne performsnceofthe work forwhich this permit tai d. My Wohcn ComPen Insunn ad numbs 7, m Po No.: CE ATEO • XEMPTION ROM WO ERS' COMPENSATION INSURANCE (Dissection need at becomplewd if the permit isfura c hundred alias ($1001 MICA..) 1 certify Not in the performance of On work for which this Permit Is issued, l Nell not cc subject to the Workcri Compensation employ my Noma in say ,annrso es b bcom SI'.1nc LAW. of Celira Ia.D Applicant NOTICE TO APPLICANT: if. i9ftanRAging this CUIMCSm of Exemption, you should become subject to the Worker's Compensation previsions of the Ulan Code. you must forthwith comply with such previsions or this permit list] W deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm Nat then its conslroctlon lending agency for the performance of the work for which this permit Is issued (Sec. 3097, Civ. C.) Lender's Name Lender'sAdemss 1 canify NM I have read this application and sum that the show information is COMCL. l agree to comply with all city and county ordinances end state laws misting to Wilding construction, and hereby sudtodae IsPreMMILMS of Nis city to enter upon the 1 Won-menttaned pmperty for imPCcdaa Pugonsea (We) agree to save, indemnify end keep humlw the City of Cupenino against liabilities, judgments. costs and expenses which may in anyway accrue against mid City In consegwnce of the localing of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOU CEREGULAT�O� , Re -roofs Type of Roof Go w"t R�1'A Jhe- )a5 Sigwam oItkarlickIdUncracor HAZARDOUS MATERIALS DISCLOSURE Will IheApplicant or future building occupant store or handle loommow mtlmisl As defmcd by the CupArda Municipal Coca. Chapter 9.12. and d¢ Health and Safely code. Secti.n us32(.)1 All roofs shall be inspected to any roofing material being installed. ❑Yes No prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building acupanl use equipment or devices which It hamrdow air contaminants As O fnctl by the Bay Area Air Quality Management all new materials for inspection. t iet7 Dyes �4u I have mad the humrdousmarorlah requirements under Chapter6,95 orthc Califor. , Hml h & Safely Cade, Sections 25505.25533 and 25534,1 undersand thaif the Wilding not currouly how a remit, Nat It is my responsibility m notify Ne occupant of the 4boocnu which mu tete Lpdor to isswnw of. Centipede of Occupancy. Signature of Applicant Date d All roof coverings to be Class +'B" or better Owner d or euihoria ajsI Dak D Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: , ,03� ► ,C- �l �� PERMIT # r�ro Z ©//-3 OWNER'S NAME: -E-6,4 A aJl PHONE # �0-) (o95-CpcezL-Z GENERAL CONTRACTOR: FAX # I am not using any subcontractors�"��� a t2 b t tare Date Please check applicable subcontractors and complete the following information Owner/ Contractor Signature Date RI SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical 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 Owner/ Contractor Signature Date c. ,� alo CUPERTINO r L CITY OF CUPERTINO 5S'�a U 11� PERMIT APPLICATION FORM WLPN # l Fee Description Date: a BAPPLOTHER Building Address: p C--, (p Mailing Address Cif different from building address): Owner's Name: Boiler <= 100,000 Btu Phone #: ova- Contractor_� Boiler > 100K to 500K Btu License #:����0 Contact: Phone:tlrA QA �S� eO-ALJ. 'JPE� Fax: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: l,�pG� `i�aNEC Residential o`1C1'� A Commercial ❑ Sq.Ft. Floor AreA: BCONSTAX $/Sq.Ft.: Cost of Project: `°% r BCONSTAX Occupancy Group: Type of Construction: BCONSTAXBQ Please check this box if the project is a second -story addition: i ❑ ro'ect Size: Standard IS Large ❑ Ma'or. ❑ Hotel and Motel Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL 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 BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING LJ 1 of 3 rS 4� (t CUPEkTINO 14 CITY OF CUPERTINO PERMIT APPLICATION FORM 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 nnkler/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 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 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMrgSC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliande ELECTRICAL BREWOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rcpt], Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 t CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM r 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 Inspection BUILDING BSWIM Swimming Pool BUILDING BTENT Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING. BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License I BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance L MECHANICAL PPERMMEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Feeafoot foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3