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06060095ioa d ��w a�2 C�6 yes rLL �O �s 3° _I EF s z F Z) Z) U Cr. F U Ct B VC, 0N�RACTORM0RMATI0N -, . . BUILDING U i,..,.. m ^. &:;; x:a:. k: :?.A:�k,_...9.., _.. G.:, zs. ..t - «xY✓x .5.", BUILDINGADDRESS: E EVER SHINE P PFRMITN0'06060095 19770 STEVENS CREE OWNER'S NAME: P PERMIT LiSUEDATE EVERSHINE NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGWEER: B BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION J Job Description I hereby affirm Net 1 am licensed under provisions of Chapter 9 (commencing P P with Section 7") of Division 3 ofthc Burma lM Professions Cade, am my license u in roll faros and efrCCL R REVISION TO 03100011: ADDED FRAMING TO EXISTING Dole, s Comgractor T TRELLIS, MODIFICATION ARCHITECTS DECLARATION I understand my plans shall bo used as public records ciry "oF CUPEkTINO J2e CITY OF CUPERTIN( - N PERMIT APPLICATION FORM I (d kl 4 de D$ 16001 ,PN # ��•o� -oo�ao Date: 6 � U6 Buildi g n Add r ss• Mailing Address (if different from building address): Fee Group Owner's Name: hone #: A1, -,) 6, L � f ; YAV3 Y3 -lD Contractor: License #: ow eft- Xe.4 1'- 0 2 MECHANICAL Contact: Phone: Ybak /3� /day Cupertino Business License #: 04 dl 6 ;4, Zi-4i Y Fax: �-/039 MECHANICAL Building Pe it Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Job Description: 1�z SUP rly1W,& k Xf�q7f✓ Residential ❑ Commercial � t Sq.Ft. Floor Area: Sq.Ft.: Boiler > 1M to 1.75 M Btu MECHANICAL Cost of Project: Occupancy Group: Boiler > 1.75M Btu MECHANICAL Type of Construction: ) Please check this box if the project is a G✓�- o,�.�,, ,./ second-story addition: ❑ BCONSTAX roject Size: Standard _0 Large ❑ Major ❑ BUILDING 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 1 M 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY of CUPERTINO OTY OF CUPERTINO PERMIT APPLICATION FORM z w 2of3 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 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 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 Furnace > l 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 1KZ r00 U UeZw -mow 7 v�Z Zaa 7yU C F- �O <� `00r� Smt+. u ^vi a YFOm 0z z° F� W t]. Q �z U V, F 0 Fa r-t Vi U .r ARCHITECT /ENGINEER: LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. k Date Contractor ARCHITECT'S DECLARATION I 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, imprnvc, demolish, or repair any structure prior tar its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (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 not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work. and the structure is not intended or offered forsalc (Sec. 7044, Business and Professions Code: The Contractor's 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 arc not intended or offered for sale. IL 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.). ❑ 1, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (See. 7044. Business and Professions Code:) The Contractor's Li- cense law does 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 Contractor's License law. ❑ 1 am exempt under Sec , B & P C for this reason Owner i ��% /�✓%�.�% Date WORZERS- OMP SATTON DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Workers 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 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 0-his section need not be completed if the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California. D /f Applicant /✓' .E,'�E' -'�1 NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 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.) Lenders Name Lender's Address 1 certify that I 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 consuuction, 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 liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATION S. Sighature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑ Yeso 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 District? ❑ Yes ,-"u I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safciy Cade, Sections 25505.25533 and 25534. I understand that if the building does not currently have a tenam- that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certificate of Occupancy. r; Owner or authorized apcm Dam PERMIT N0.06060095 PERMIT ISSUE DATE SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description REVISION TO 03100011: ADDED FRAMING TO EXISTING TRELLIS, MODIFICATION Ft. Floor Area M 36009.00 Required Inspections Issued by: Re -roofs Type of Roof Valuation Occupancy Date S� Z All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better