09729 y
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT.PEN ONLY -1,
+ _ .'`BU I LDING PROJECT I DENTI FICATI ' PERMITNUMBER.
ADE -7 ,. APPLICATION & PERF
DR '.' 09729
ADDRESS ss
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
Eq' !(/7//�T �/j/�p�[jl•- /*/ n t t. PLAN CHEC VALIDATION -
NAME Jit�PH0AL/'4e_Q.f! V VC.. � ..
1 2 DTV: ELECTRIC PERMIT FEEr
/ y
CONTRACTORS ^^ J
.NAME._ vO�[, CONSf RUCT/O/�/.-� OUTLETS-SWITCHES-RECEP 10.00/100 �O' ��� F _
uc.rvo3/ - �.>3. LIGHTI NG FIXTURES 10.00/1.00 !(J7J � 9Ia�0S'
ro.TRacroR's Mtom ER Nosh k11-7Y APPLIANCES-RESIDENTIAL -
' ADOREss (oOJ.
�� +' � _ -5�2 _21PANELS '` +- " ' 10.00 DATE OF APPLICATION
ARCHITECT �Q.R/Y",l'.�r.., s/A/`�O A/ PANELS (OVER 200 AMP) 20.00 " PLAN CHECK FEE P.C.NO.
OR
ENGINEER '
uc.No s, SIGNSTRANS., 3.00
- aARCH,OR DDREES ENG.�0"Uor /G57 '- -, ,z•� SPECIAL CIRCUIT. .5.00 PERMIT VALIDATION
1710 '/71--0 ' 69, zip _2 n ?AID
.EMP.METER OR POLE INS. 20.00
APPLICANT'S !o S'S 1 'C!.?MpS9 y/RY MOTORS ` SI�PCH. S'
ADDRESS ^c�
RY B4J SERVICE CHANGE 20.00
�oo LICIlNS1iDCON'CRACTORSD6CLAIjAT10N_. TEMP.POLE 30,`AOh - �S�-
Q � or I he eby affirm that I am licensed under provisions of Chapter 9 - " -
y ¢ N = ( dmmencing with Section 7000)of Division 3 of the Business and .f p BLDG. ELE T. ECH.
r N z P etas-ons Code, my license hs m full for an e t C VI Cupenl D I�
Zo� Gcena as lNumber - - ®�. (®- y�
9 vi r D Lic.
- �' D Contmctor_ R
a x E
BUILDINGPERMIT -
¢ OWNER-BUILDER DECLARATION "INFORMATION, `.
oaU MISC.- REFER,TO ORD
w 3 1 hereby affirm that I am exem pt from Ilse Contractor's License VALUATION $/FT.
,FLL0< Law for the following ressum(Sec.7031.5',Bisinessand Professions 'pERMIT ISSUANCE - 10.00 O
Code',Any city or county which requires a permit to construct,alter,
an2 ¢ improve,demolish,or repair any structure,prior to its issuance,also ELEC,CONTR.) LIC.NO. ELEC.
ac
O ¢ requires the applicant for such permit to file a signed statement that ' TOTAL P PERMIT TO
w m" he is licensed pursuant to the provisions of the Contractor's License
rii._ Law(Chapter 9(commencing with Section 7000)ofDivision 3 at the
e Business and Professions Code)or that he is exempt therefrom and CITY. .PLUMBING PERMIT FEE' WW
rcro the basis for the alleged exemption.Any violation of Section 703 t.5 k STORIES TYPE CONSTR.
a- by any applicant for a permit subjects ole applicant too civil penalty ALTER-DRAIN IEA.) 5.00 S
of not more than five hundred dollars(S500):)'.
O I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE ,4.00 ' .Dec.GROOP RES.UNITS
inter sole compensation,sale(S the work,Business
structuress not
intended or offered for sale(Sec. does Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 6.00
Codr The Contractor's License Lew does not apply to an owner of
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 S so.Fr.FLooR aREA TOTAL ACREAGE
'himself or through his own employees,provided that such improve-
•. l ments are-non intended or offered for sale.If,however,lite building GAS-EA.SYSTEM-11NC.40UTLETS 8.00 v210'.�2-
t or improvement is sold within one year of completion,the owner- GAS-EA:SYSTEM-"OVER 4 (EA.) 2.00 BUILDING usE
builder will have the burden of proving that he did not build or am- - RES IND ' CON PB Other
prove for purpose of sale.).^ - INDUSTRIAL WASTE INTER. 30.00 /►`fll '�
❑, L as owner of the property,am exclusively contracting with 0 El
. , licensed contractors to construct the project(Sec. 7044,Business. LAWN SPRINKLERS-1 INC 6.00 s. ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply 1 .
to an owner of property who builds or improves thereon,:end who 1 LAWN SPRINKLER
-OV ER'5 IEA.1 , 1.00 `
contracts for such projects with a contractors)licensed pursuant to -
' theContractor'sLicenseLaw. "v :SEWER-SANITARY-ST A ttVtLO.00 TRACT NO. PARCEL NO.
❑ I:un exempt under,Sea ,B.&P.C.tentless I WATERH_A W/VE 6.00 .� '76
_ reason �'- ' q�
F Owner Date' i WATER SYSTEM ffi S ACC.OATE ACC.FILE NO.
r WORK ERS'COMPENSATION DECLARATION WATERTREATING EQU , 5:00
hereby affirm that I have a certificate of consent to sal Ginsure, / -
or a certificate of Workers'Compensation Insumucc,or a certified HYDko�+ / ZONING ENG.SITE NO.
ccmYthere ( c�1�Q0 Lah.C.)
Policy NO �'1C upan)
'r. ❑ ,Cerlil7ed copy is hereby furnished: „ FIRE SPRINK ENERGY T-24
- _Z Z j� Certifie��copy is filed with the'city inspection division ,
p Applicant F72'Aff �innl - '' - MISC, , REFER TO ORD. y �' N� Y ❑ N1-1
CCrO - PERMIT ISSUANCE. 10.00
CC _ 1, CERTIFICATE OF F:XEMI'TION PROMWORKERS' �. O ~ FLOOD ZONEA.L.u.C.
W > COMPENSATION INSURANCE' PLG.CONTR. - LC.NO. PLG. - � �
CLI0 .(This section need not be completed'If the pe nut a to,one TOTAL b y NY N
Ihundred dollars IS 100)or less). I ,
V O'" l certify that in the performance of the work for which this per, pTY. F MECHANICALPERMIT FEE ''§ FEE SUMMARY
m '
LL 1-- mit Is issued,I shall not employ any person in any manner so as to .y '
O W become subject to the Workers'Compensa[ion Laws of Caiifonua. BUILDING S�d
(L Data Applicant '" - . 5.00
}'N -NOTICE TO APPLICANT: If,after making this Certificate of Ex ALTER OR ADD TO MECH.
F 2„ 'emption,you should become subject to the Workers'Compeivaoon APPLIANCE' 5.00 = PLAN CHECK
'i provisions of the Labor Code, you must forthwith comply with ,FEE
f U such provisions or this permit shall deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING.AOENCY` AIR HANDLING UNIT(OVER .M.) 6.00 SEISMIC FEE
I hereby affirm that there FIT construction lending ugeii.y him. EXHAUST HOOD(WITH DUCT) 00
the performance oft the work for which this permit Is issued(Sec. MICROFILM
3097,Civ.C.). i1EATING.UNIT ITO 0 L -:'8, 0
Lender's Ntmc GL e0 r/oHEATING UNIT(OVE .100,000B.T.U.)0.50 G
Lender's Address ELECTRIC, ��0 y
ICertify that Hu,c read this application a it state that the above VENTILATION FAN (S �ppe 0 / W
information is correct. I agree to comply with roll city and.county. PLUMBING f O� ✓
ordinances and state laws relating to building construction;and - BOILER-COMP(3 H.P.ort Q,000 B.T.U,) 6.00
hereby authorize representatives of this city to enter upon the 801 LER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL 3.2
above-mentioned property for inspection purposes. :
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, Costs and oxpemscs which , PERMIT ISSUANCE'' 10.00 CONST.TAX, 44
maytin
accrue agmnst SI Ply in nsequenCe of the Q
gmnlmhL' - MECH.CONT LIC.N0. MECH.lTOTAL iyv_ TOTALh+ cant/Contractor Dale
-"OFF,ICE COPY ,