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05100017 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT LRONTPUkICTOR INFORMATION .r nk•=-iw` ,..,.� �.�.. P-�'�si nAf, 3._xc_£fix' BUILDING ADDRESS: WILLOW GLEN ELECTRIC INC PERMITNO.05100017 10330 MANN D OWNER'S NAME: PERMIT ISSUE DATE TERRENCE GARRITY 1085 WARREN AVE10/05/2005 ONE: SANITARY NO. CONTROL NO. (408) 289-9725 ARCHITEC iENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 :00—LICENSED CONTRACITIR'S DECLAR fChap S5 iWalby )of that IamRcemteicoact ssndPrsionaofChapter9(rommenseis Job Description -� wish llfareSection 7deffecDivisirn 3o the Business and Profcuiom Cade,and mylicenscu inmufaLiters effect. UPGRADE ELECT. SERVICE 200AMP Ca�,.Z Datanrc Clesa Contractor `;t 1 ARCHITECT'S DECLARATION understand my plans slaullW ss public record; ` bcad Licensed Poor..ional OWNER-BUILDER DECLARATION Conimem i I hereby affirm that 1 I.S.exempt from Jto fmiont Co License Law for tite D O allowing muona.(Jectian En 1. Business,altarand P ,dicat as Code:Any city Or county $� which requires a permit m cnalwcC alcor,impmw,dcmolkh,,repair any structure prior In its istoom,ee.also reclaims the applicant for such permit In file a signed sctemenl < that he Islicensed pursuant u tW prevision of the Contractees License Law(Chapte,9 Sq.F[. Floor Area Valuation x (commencing with Sation7000)of Divuin3of Ne Bushesand Profeuiom Cnde)ur .. that he is escort thererman and tie basis for Na alleged osmium.Any violarlon of Section 7031.5 by any applicant for a Permit subjects due applicant as a civil PerWry of rU U Occupancy Type not roam Nan five huMmd dollars($500). . C 1,as owner of the property,m my employees with wage$u their sale compensation, will do the wart and the swmum is Out intended orafremd far side(Sm.7011,Business Required Inspections and Proofread...Code: e neu The Communes License Law dot apply an Ownere of 9 P property who boildaarimprom thereon.andwhe daasuc tw,kbimaNf orduonugh his own employees.provided Nn such improvements are not intended aroRered for sale.If. however,the building or impeavemnt Is sold within one year of nmplation,the Owner. Wilder will have time burden of proving thea he did nt Wild ar improve f,Formosa of "I.I. n"L as Owner of the property,am exclusively contracting with Restated contractors to construct tW project(Sec.7014.Business and Professional Code:)The Commons LL mesa Law deal not apply an an owner of property who Wilds or Improves themon,and. who convects for such projects with a connwctoKs)Iicensae pursuant to the Curvatures License law. Clamex(eJ�ppI der See. y .B&PC far this reason Owner lel Xxys°KI lin f4 Dau bckwc WORK M SA ON DEC ATON 1 hereby elfin under penalty of Perjury one of the following declaradou: 1 have and will maintain a Certificato ofConaenl In self-iasum for WargeM1Compen- 10371(d) on,u provided for by Section 3700 of the labor Code,far the performance,of the rt for which this permit is immul. 1 have and will maintain WorkeWorker'sCompensation Insurance,u required by Section of the Lab, ce Cade,(n the performanof the wort forwhich this permit u Issued. My Wortc's Compewtion Inwnrxe carrier and Policy number me: Carrier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This$cede need notbecomplemd If the Permit is f,onehundreddnllan(SIIX) or less.) 1 certify Chet in the performance of the wort for which this Permit is issue,l$hall not employ any person in any con crnubbmomucauubjecun the wortcrs'Campeamtion Laws of Callfo u.Dam A�sr•_a- c a5 Appliram \.. n��4s^d.t NOTICE TO APPLICANT:X.after mating leu Ceninau of Ere mpGon,you Mould become subject to site Worker's Compensation proviuons or the Leh,Conde,you must ,JO forthwith comply with such provisions or this permit abet be dcemed raveled. wZr� CONSTRUCTION LENDING AGENCY I—t IWmby affirm thou Nem Iso eansuuctin loading agency for she perfmommecuf mi> the wort for which this permit is issued(Sec.3097,Civ.C.1 aQ Lea eYs Nurse =2 Lender's Addmer U p 1 certify that 1 haw read this application and sato Nu the aura information is car comm I agme to comply with all city and county onminuwes and ruts lave milling m O building cralwctian,and hcmby nthoris representatives of Nis city m enter open the W aWw-menwneA property fm inspection purposes. (Wei agree to saes.indemnify and keep harmless the City of Cupertino against Iisbilitiu.ludLmw and which may In my way gimme against raid City O 4 In consequence of the granting of ths permiL / APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date (� U SOUPhSREGULATIONS. O A� C a— Re-roofs t Shure of A,lin onuacmr Dau AZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or rum.Wilding occupant Tom,hatble hatasdous motorial as ecnned by the Cupertino Municipal Code.Charm,9.13,and the Hcalth and Safety [:]Yu adasetuar35533fa)+ All roofs shall be inspected prior to any roofing material being installed. Will the applicant or found building Occupant ase cu apmnt,devices which If a roof is installed without first obtaining an inspection,I agree to remove It harardoua air cnnuminants as defined by the Bay Ama Air Quality Management all new materials for inspection. 7District?❑YetI have mW the huardous materials mqulmmem under Chapter 6.95 ofthe Califor. Rcolth&SfetyCode,Sumi,u 25305,25533 nd 35534.1 undomand thm lime Wildingal not Curromly how a anus,Nu it it my responsibility m notify the nempnt of Ne cnlswhichmuslix I ' suisavncea( ctnneemaramp.,y. i Signature of Applicant Date wner or amhrrwsde t Dow All roof coverings to be Class��B��or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Cl OF Fax(408)777-3333 �1JPEkjIN0 Building Department JOB ADDRESS: , �, PERMIT # (03 1,y 3D v % LCN � b� , v� 6-T,160,0 /? OWNER'SNAME: PHONE # Lt 0!;) 2S3 2011 GENERAL CONTRACTOR &ZFAX # I am not using any subcontractors: . �r Signature Date Please check applicable subcontractors and complete the following information: 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 or— Tile Owner/Contractor Signature Date CITY OF CUPERTINO ��0--v V/ CUPE TING aR PERMIT APPLICATION FORM APN# Date: 3 a LA � o 0 3 8c� s , o s Building Address: Mailing Address (if different from building address): (0330 WXatnvi Owner's Name: Phone#: .L( O$ Contractor: / 11 �� License#: Wl��ooi G,l� C``�&,4'rL L Contact: _ Phone: Cupertino Business License#: pj � W\,l�.n/�/L Fax: Building Permit Info: S2t^V-ce Uf54 -)-00 . Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential �25— Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Project: 1 t So Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ ro'ect Size: Standard ❑ _Lare ❑ 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 End/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 F 3 � ��'� / 1 of ` UUU CITY OF CUPERTINO CUPEf�TINO PERMIT APPLICATION FORM uantiFee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 13NUCOMNM New Comm Electric• ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTINIE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING MIXTURE 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 Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREI LUUTAN A/C Units<= 10,000 din MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFDCT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Mise Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREN20LE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rept], Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT R air/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO CUP PERMIT APPLICATION FORM EkTINO 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 BSEISAUCRE Seismic Fee Res BUELDING 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 PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Commet Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3 of 3