6451 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
81-IL°ING APPLICATION & PERMIT
ADDRESS 6 4 51
BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER a PLAN CHECK VALIDATION
i"AME CITY. ELECTRIC PERMIT FEE
a. ` /✓V/✓ PHONE Q
CONTRACT N$
"AME ? S _ UTLETS-SWITCHES-RECEP 5.00/1.00
462iye _77#,O
W46w/ c.N ILIGHTING FIXTURES 5.00/1.00
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
ADDRESS CHITECT �J
ZzW4,e, HoNE,2a 2 PANELS 5.00 DATE OF APPLICATION
on
SIGNS 6.00 PLAN CHECK FEE P.C.NO.
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.OR ENG. PE T ODATION
ADDRESS -� SPECIAL CIRCUIT 5.00 J
APPucANrs ZIP TEMP.METER OR POLE INS. 15.00 ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
0 SE r-'
r w o LICENSED CONTIIACI'ORS DECLARATION TVD .1-
a o I hereby affirm that 1 ons licensed under provisions of Chapter 9 ISSUANCE DATE
H z h (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H y z Professions Cydyy1 1 � se is in full fnr{{{,,,'��� d c(., ❑ ❑ ❑ ❑
z o w- License Cla$1!3 s Lic.Nwnhcr. $_(?
o L F w Date_sf/_�.�. Contractor_ 'C+
a m E , BUILDING PERMIT
M ,
¢a OWNER-BUILDER DECLARATION
INFORMATION w ; u y I hereby affirm that 1 urn exempt from the Contractor's License MISC.- REFER TO ORD
F u m J Law for the following reason.(Sec.7031.5,Rusinessand Professions PERMIT ISSUANCE 600 VALUATION S/FT.
Ew> E Code:Any city or county which requiresa permit to constmct,alter, '� y7d
¢ ¢ ¢0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR, LIC.NO. ELEC. /
0 u requires the applicant for such permit to file:)Signed statement that TOTAL PERMIT TO
a w m m he is licensed pursuant to the provisions of the Contractor's License
H z >
Law(Chapter 9(commencing with Section 7000)of Division 3 critic R ,6-j�It- pp/e-4 PTa�
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ o the basis for lire alleged eornlption.Any violation of Sertim 7031.5 SIDRIES TYPE CONSTR.
i;m by any applicant Far permit objects the applicant too civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00 upert=
.fact more than five hundred dollms(S500).):
❑ I,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:'fire Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTALACREAGE
4itself or.through his own employees,provided that such improve-
11 more not intended or offered for sale if,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00
o? provement is Sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 7
builder will have the burden of proving that he did not build or an- BUILDING USE
IND CON Pe Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00
❑ I,as awnur of the propetlY.ala exclusively contracting with C3 El 0 13
licensed contractors to construct the project (Sec.7044,Business LAWN SPRINKLERS-I INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:l'he Contractor's License Law does not apply
to an owner of properly who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCELNO.
❑ lam exempt under Sec. ,li.&P.C.for this.ason WATER HEATER W/VENT 4.00
Owner' Date WATER SYSTEM . 4.00 ACO.DATE ACC.FILE NO.
WORAERS'COMPENSAI'ION DECLARATION I WATER TREATING EQUIP. 4.00
1 hereby affirm that 1 have a certificate of consent to self-insure. TONING ENG.SITE N0.
or a"ttificate of Workers'Compensation Insurance,or a certified
copy themoNSec.3800,LA.C.),
Policy No. Company
O ❑, Ce}lilied copy is hereby furnished. FIRE SPRINK ENERGY T-24
Z Z ❑ Certified copy i, tiled will, the city inspection division. MISC. REFER TO ORD.
O Applicant V N V N
~ �+ PERMIT ISSUANCE 6.00
LU - CfiR'fIpICAT PFNPAFIOl'INS FROMWORKIiRS' FLOOD ZONE A.L.U.C.
W > � C'OMPIiNSATION INSURANCE PLG.CONTR. LIC.N0. PLG.
CL Z (This section need not be completed if the permit is for one - TOTAL V N[ Y C] No
hwsdred dollars(S 1000 of Icss.)
U O 1 certify that in the performance of the work for which this per. TV. MECHANICAL PERMIT .FEE FEE SUMMARY
(L 1- in is issued,I'slldll not employ any person in any mannerso o"Ust
U U becranys 1 t t t o Workers'C ens alifor
Datta Applicant _ BUILDING S'T!
a
} N NOTICIi TOA I LICANI': Her making this Certificate of lix- ALTER OR ADD TO MECH. 4.00
Z emption,you should become subject to the Workers'Compensation AP IANCE 4.00 PLAN CHECK
prcosions-of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=42-F.M.) 3.00
CONSTRUCTION'iENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE
I hereby affirm that them is u construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.f HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50
Leader's Address ELECTRIC
I certify that l have read this application and state that the alma VENTILATION FAN (SINGLE) 3.00
1' .? ' f^enation is correct. I agree to comply with all city and county PLUMBING
Or'+II$no-es and state laws relating to building construction,and BOILER-DOW(3 H.P.or 100,000 B.T.U.) 4.00
hereby authorize representatives of this city to enter upon the 801LER-COMP
above-min Toned properly for inspection purposes. IOver 100,000 STUB SEE FEE SCH. MECHANICAL
(WO agree In save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments,costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way actio g�d City in consequence of the
grant*n of th1. MECH.CONT. LIC.NO. MECH.
� TorAL TOTAL �S7
alum of Applicant/Contractor Data
OFFICE COPY
J & J HOME IMPROVEMENTS
10070 Imperial Avenue
Cupertino, CA 95014
Phone (408) 252-2990
STATE LICENSED FOR
FLOOR COVERING CONCRETE CERAMICTILE .
FENCING
To Whom It May Concern:
" RE:-1157 YORKSHIRE DRIVE, CUPERTINO
This is to .certify that all fungus and dryrot was removed from beneath the
bathtub in the hall bath on 5-23-84 .
All adjacent framing was treated with a registered fungicide to arrest any
possible fungus activity.
If there are any questions regarding this matter, please feel free to call
us at (408) 252-2990.
Regards,
JAMES L. TOWNSEND
JLT/jf
I