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APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION
APPLICATION & PERMIT
BUILDING -ELECTRICAL- PLUMBING -MECHANICAL
PERMIT NUMBER
6958
BUILDING
ADDRESS 20525 Mariani Ave.
OWNER'S
NAME
Apple Computer ,HONE
CITY. ELECTRIC PERMIT FEE.
PLAN CHECK VALIDATION
DATE OF APPLICATION
CONTRACTORS
Q
ME ASM
T IIIc. ND IIJ��
UTLETS - SWITCHES -RECEP 5.00/1.00
LIGHTING FIXTURES 5.00(7.00
e,ONTRA TORS pASl nwllY
AOOHESS�
7�E7 PHONE 5j-01
PPLIANCES- RESIDENTIAL 4.00
PANELS 5.00
ARCHITECT
OR
ENGINEER
LIC. NO.
SIGNS 6.00
PLAN CNECK FEE P.C. NO.
SIGNS TRANS. 3.00
ARCH. OR END.
ADDRESS
ZIP
SPECIALCIRCUIT 5,00
PERMIT VALIDATION
TEMP. METER OR POLE INS. 15.00
ADDRESS
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
! U
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9
ISSUANCE DATE
(comn.criemg with Section 7000) of Division 3 of the Business and
1 rol'essions Code I t�{v licenu is in full farce.. n e e
License Class_l�.=l�Q-Lie. Number_
BLOC. ELECT.
❑ ❑
PLG. MECH.
❑ ❑
Contractor
OWNIi R-BUILDIiR DECLARATION
I hereby affirm that I am exempt from the Contractor's License
Lawfmthefollowingrecon.f5«.Thea, BusinessanEPro1'Cssions
permit Incronsuance, also
Cuda: Any city orcounty my whiny structure, prior to its issuance, also
int demolish, or repair any
BUILDING PERMIT •ku"
INFORMATION S: -
MISC. - REFER TO ORD
PERMIT ISSUANCE 6.00
VALUATION S/FT.
10,400
ELEC. CONTR. LIC. NO.
rm it to
requires ns applicant Iitr such permit to file a signed actor's i that
sires
he is licensed pursuanten the provisions of Contractor's License
TOTAL
TOTAL
PERMIT TO MOdif }r
QTY. PLUMBING PERMIT FEE
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
00
Business and Professions Code) or that he is exempt therefrom and
the basis For the alleged exemption. Any violation of Section 7031.5
Fire Sp tinkle TS
STORIES
TYPE CONSTR.
ALTER -DRAIN & VENT -WATER (EA.) 4.00
by any applicant m. u permit subjects the applicant w a eivilpenulty
of not amm than five hundred dollars (5500).):
❑ 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 for sale (Sec. 7044, Business and Professions
BACK FLOW PROTECT. DEVICE 2.00
occ. GROUP
REB. UNITS
DRAINS -FLOOR, ROOF, AREA,COND. 4.00
Code: The Contractor's License Law floes not apply to an owner of
property who builds or nlprovc%Thereon, and who does Such work
FIXTURES - PER TRAP 4.00
SO. AT. FLOOR AREA
TOTAL ACREAGE
himself or through his own employees, provided that such improve-
mentsarcnet intendedOroffered for Salt. If, however, the building'
GAS-EA.SVSTEM-11NC.4OUTLETS 4.00
or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or im-
prove for purpose of sale.).
u I, as owner of the property, am exdusivuly contracting with
IicmiseA contractors to construct the project (Sen. 7044, Business
GAS - EA. SYSTEM - OVER 4 (EA.) 1.00
BUILDING USE
RES IND CON PB Other
INDUSTRIAL WASTE INTER. 20.00
LAWN SPRINKLERS - 1 INC 5 V.B. 5.00ASSESSORS
PARCEL NO.
and Professions Code. fie Contractor's License Law does not apply
to an owner of property who builds or improves (hereon, and who
- LAWN SPRINKLERS - OVER 5 (EA.) 1.00
wroacts for such projects with a emuncomf o licensed pursuum to
the Contractor's License Law.
SEWER -SANITARY -STORM EA. 200ft/8.00
TRACT NO.
PARCEL NO.
WATER HEATER W/VENT 4.00
O I:un exempt under SC,,-, B.&P.C. I'.. this
rcmnn
Owner Date
WATER SYSTEM 4.00
ACC.DATE
ACC.FILENO.
WORK P-RS'COMPENSATION DECLARATION
WATER TREATING EQUIP. 4-00
I hereby ulfrm that I have a certificate of consent to self -insure.
or a certificate of Workers' Conine cation Insumneu, or a mrtilicd
utpy Ihco, (C OQ Lnh,C /'_ /�
Policy No. �Cumpany C6td L
ZONING
ENG. SITE NO.
FIRE SPR INK
ENERHT24,❑
❑ Ce,Rned copy Is hemby f sI d
Cenife p s f uh le city inspection division.
V 0 N❑
yAppbcuntCIiR'I'IPICA'fl::OP
MISC. - REFER TO ORD.
ISSUANCE 6.00
FLOOD ZONE
A.LCOMPENSATION
li II'I'ION('ROMWURKfiRS'PERMIT
PLG. CONTR. LIQ N0.
PLG.
TOTAL
INSURANCI!
1'I'his section need not be completed if (he permit is for one
y E) N❑Y
QTY MECHANICAL PERMIT FEE
'-��r�}
FEE :SUMMARY6; , ua"6i'
hundred dollars(5100)orinss.)
I certify that in the performance of the work for which this per-
mit is issued, I shall nal employ any person in any manner so as to
beconm subject to the Workeri Compensation Laws Of California.
'Doc Applicant
NTbi
O ICE TO APPLICANT: If, after making Is Certif,ale of Ex-
emption, YOU should become subject to the Workeri Comperettion
provisions of the Labor Code, you must forthwith Comply with
such provisions or this permit shall be deemed revoked.
BUILDING
86.50
ALTER OR ADD TO MECH. 4.00
APPLIANCE 4.00
PLAN CHECK
FEE
56.23
AIR HANDLING UNIT (TO 10p00QFJA) 3.00
AIR HANDLING UNIT (OVER IOJJOOC.F.M.) 5.00
SEISMIC FEE
,77
CONS'T'RUCTION LENDING AGENCY
EXHAUST HOOD (WITH DUCT) 2.00
MICROFILM
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.).
HEATING UNIT (TO 100,000 B.T.U.) 4.00
HEATING UNIT (OVER 100,000 B.T.U.P.50
ELECTRIC
Lenders Name
Lender's Address
1 certify that I have read this application and state that the above
information is currecl. I agree to comply with all City and county
ordinances and state laws relating to building construction, and
VENTILATION FAN (SINGLE) 3.00
PLUMBING
BOILER-COMP(3 H.P. or 100,000 B.T.U.) 4.00
BOILER -COMP (Over 110,000 BTU) SEE FEE SCH.
MECHANICAL
hereby authorize representatives of this city to enter upon (he
above-mentioned properly for inspection purposes.
MISC. - REFER TO ORD.
CONST. TAX
(WC) agree to save, indemnify and keep harmless the City of
Cupertino against liabilities, 'udgments, costs and expenses which
may in a way aceto• St City in Corse cote f the
grand Thi m
�J ,� �� 17 �,
PERMIT ISSUANCE 3.00
Ti -T. LIC. NO. To
TOTAL
TOTAL
143.5 0
Signalure of Appbcan onl FF ate
V OFFICECOPY