8297 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU I LDING PROJECT IDENTIFICATION APPLICATION 81 PERMIT PERMIT NUMBER
BUILDING A A^
7/ ADDRESS , BUILDING-ELECTRICAL-PLUMBING-MECHANICAL uJ L�[f�
20740 Valle Green Drive _
OWNER'S - PLAN CHECK VALIDATION
NAME. Apple Com uterHONE QTY. ELECTRIC PERMIT FEE
Ocrony
NOME
ME UTLETS-SWITCHES-RECEP 10.00/1.00
NAME
A. . Assoc, LIC.No B424096LIGHTING FIXTURES 10.00/1.00
CONTRACTORS APPLIANCES-RESIDENTIAL 4.00
,1;•
ADDRESS 4966 El Camino #225
NEll;01 PANELS 10,00 DATE OF APPLICATION
A
o PLAN CHECK FEE P.C.NO.
I OR . PANELS (OVER 200 AMP)Alt20.00 -
CNGINEER
Llc.No. SIGNS TRANS. 3.00
ARCH,OR ENG. PERMIT VALIDATION
ADDRESS SPECIALCIRCUIT 5.00
ZIP TEMP.METER OR POLE INS. 20.00
ADDRESS r$ MOTORS .SEE FEE SCF'41
x SERVICE CHANGE 20.00
/f w-o o ! - LICENSED CONTRACTORS DECLARATION TEMPIPOLE 30.00
G u U I hereby affirm float I am licensed under provisions of Chaptcr 9 ISSUANCE DATE II
2 w (commencing wilt,Section 7000)of Division 3.1 the Business and BLDG. ELECT. I PLG. MECH.
iProl'eselonS Code.and my license is in full forceand effect. ❑ •❑ ❑ ❑
/ License Class Lie.Nurnber
0-Z 0' Dare _B Contractor -42'4��j6
'a'•y E �/ 3-21.�F'da' & Assoc BUILDING PERMIT
BE w u O IiR-BUILDfiR D[CL A N --
MISC.- REFER TO ORD INFORMATION
E
3 ¢ w 1 hereby affirm that 1 am exempt from the Contractors License VALUATION $/FT.
Cr Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE ,].OAO
m Code Any city or county which requires permit to comlrucL alter, r
EE ¢ Q p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. . LIG N0. TEL
- G
BE
requires the applicant for such permit to file a signed statement that TOTAL 3 PERMIT TO
a
to m m he is licensed pursuant to the provisions of the Contractor's License
ri >
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
¢ Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
BE r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
n ; m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00
of not score than five hundred dollars(SS00).1:
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS sole connpensation,will do the work,and the structure is not
intended ar offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Cade:The Contractor's License Law don'not apply to Be ownerof
- property who builds or improves the con,and who does such work FIXTURES-PER TRAP 5.00 So.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such....poet
rnrnls are not intended or offered for sale.IL however,the budding GAS-EA.SYSTEM
Of
6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build OTim-
Proveforpurposeofsale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Orhei
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(See.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO..
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds ar improves thereof.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractons)licensed pursuant to SEWER-SANITAR V-STORM EA.200ft/10.00
the Contractor s License Law. TRACT NO. PARCEL NO.
❑ l am exempt under Sec.-,BAKC,for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSA'I ION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have c cenificaoc ul'consmd to s,HGinsarc. ZONING
or a cerlificate'of Workers'Compeasulioa Insurance,or a leltified ENG.SITE NO.
copy Thereof(Sec,3800,Lab.CJ.
N
I'olicy(r�QZ5�,'j{I.�ElmD ny--(tA-nPm$n-l-B-i�'ifnf�
❑ Cenilmd copy is`hmeh}'IurnuTi,tt FIRESPRINK ENERGY T-24
Z 2 j�Certified copy is filed with the city inspection division.
Q„ A#cant - MISC.- REFER TO ORD. Y❑ N❑ Y❑ N❑
jr w l PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
LU CI: 7' A FPE COMPENSATION
INSEROh1 N'ORKI:RS'
W � COMPENSATION INSURr\NCE PLG.CONTR. LOC.N0. PLG. �
CL ❑ 1'1'his section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
Z) Z hundred dollars(S 100)or less.)
0 O I certify that in the performance of lt,e work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued, 1 shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
0 y Dam ApplicantALTER OR ADD TO MECH. 5.00 BUILDING
Do NOTICE TO APPLICANTr. If,after making this Certifene of Ex-
Z cmou
pii...0,you shld bcrome Subm
Object to the Workers'Copcosalion APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you nwsl forthwith conal ly with FEE
CJ Such provisions or this permit shall be deemed revoke(l. AIR HANDLING UNIT(TO 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIRHANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this scrinit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Leader's Name
Lenders AddreHEATI NG UNIT[OVER 100,000 B.T.U.)9.50 ELECTRIC 3
ss
1 certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
. information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construclion, and BOILER-COMP(3 H.P.o-100,000B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs :and expenses which CONST.TAX
..nay in any way accrue against said City in annseyLiece of the PERMIT ISSUANCE 10.00
granting of thifl Verntit. MECH.CONT, LIC.NO. MECH.
} RiO _A�� TOTAL TOTAL
• 9ignutllttTl Ap rein ra Uatc
INSPECTOR COPY
I