5862 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY 10,491
BUILDING PROJECT IDENTIFICATION -PE IT NUMBE
BUILDING APPLICATION & PERMIT ^ ^
ADDREs5 10600 RidgevieW Ct. BUILDING-ELECTRICAL-PLUMBING-MECHANICAL bG
i OWNER'SP VALIDATION
Energy Center
NAME QTY. ELECTRIC PERMIT FEE
,BONE '
NAMEeAc.Dvs OUTLETS-SWITCHES--RECEP 5.00/1.00
Viking Fire Protec. LID,NG, 187293C-16 LIGHTING FIXTURES 5.00/1.00
CONTRACTORS
.DDRESS 3880 Bay Center Place -APPLIANCES-RESIDENTIAL 4.00
CONTRA
PROrvE 415-785- PANELS
ondp CA 94545- 5.00 DATE OF APPLICATION
nC uTECT 357 1 SIGNS 6.00 PLAN CNECK FEE P.C.NO.
O
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ARCH,OR ENO. SPECIALCIRCUIT 5.00 PERMIT Vgp�DAr�q,1p
ZIP EMP.METER OR POLE INS. 15.00 l�l��lsH
APPucANTs MOTORS SEE FEE SCH. IAPR 2 6 1985
AOOREaa'
SERVICE CHANGE 10.00
° 0 = City of Cupertino
FOO LI(:RNSIiU C0N'IRACfORS DIiCLARATION _
Q v I hereby affirm that I am licensed under porwismax ot'CIIDpte,9 ISSUANCE DATE
w,aa_ (cmnnlnncing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F w z I'rolcssions COJc, _na1yy hu is in lull f�reyy'�yhJ,afb- ❑ ❑ ❑ ❑
a i too Liccnsy CP _ �V Contra,,.,
t.
,A t- Dutc 4=1.7-5 Contrucmr Q111KSS1Ilg; N.7 rt.
F m s " rptN2.C. BUILDING PERMIT'•`"„
m re OWNER-ISUILDIiR UIiCLA Al U
m I hereby affirm that I am exempt Irom the Contractor's License
MISC.- REFER TO ORD INFORIV'IATIONi
LLoj Law ler tirefolluwiny reason.ISec.7031.5,BusinessanJ Professions pERM1T ISSUANCE VALUATION S/FT.
� - Code:Any cityoreoumy which requires a permit to construct,alter,
6'�
p p. y ELEC.CONTR. LIC.NO. ELEC. 10,491
rt ¢ ¢ o im rove,Jemolixh,or re air an structure,prior to i[s issuance,alsl
°u
restrikes the applicant for such permit to file a signed statement that TOTAL PERMIT TO
u
at m he is licensed pursuant to the provisions of the Contractor's License
i
Law(Chapter 9(commencingwith Section 7000)of Division 3 of the
a Business and Prolissicas Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE Fire S rinklers
H p lire basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant In a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00
of not more than five hundred dollars(S500k):
ID Las owner of the property,m my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractor's License Law does not apply to an owner el'
properly who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsarenot intended orOffired for sale.If,however,the building GAS-EA.SYSTEM-1INC.4 OUTLETS 4.00
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 (EA) 100 BUILDING USE
builder will have the burden of proBear . . .
ving thhe did not build or im- 'RES IND CON Pe Omer
prove for purpose Of sale.). INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑ ❑ ❑
❑ 1,as owner of the property,am exclusively contracting with
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:The Con urrun's License Law does nm apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 '
contracts fora Such Projects with it contractor(s)license(]pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO, PARCELNO.
O I ani exempt under Sec.-,B.&P.C.for this WATER HEATER W/VENT 4.00
reason
Owner Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPP.NSAT ION DECLARATION WATER TREATING EQUIP. 4.00
' I hereby infio1 that I have a certificate ofconsent ill selfirsure. ZONING ENG.SITE NO.
Or a certificate of Werkc,,Compensation Insurance,or a certified
copy thereJJ��(
Policy Nn.y.�(Jy.h.l'�hfplMy_AmeT Intal. Adj.
O fl Cctilicd copy sbmcby(urnisbud. FIRE SPRINK ENERGY T 24
Z Z IX Certifwfl ippy is fhlSd Will, the ily inspection division. MISC.- REFER TO ORD.
Q Appheam-V-,long-Else-P-rotectbon-Cor Y❑ N Y ❑ No
m CBR1'll'ICA1 I*OF I!XEMPfION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.0 C.
LU > CCI IPl'NSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL O (This acclidn need net be completed if the permit is In,one TOTAL Y[:] Is E] V ❑ N
Z) Z It idre0 doll...IS 100)or less.) I Y9
U O I certify that in the performance of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SUMMARK�,;,,
LL F mil is issued,I shall not employ any per-am in any manner w as to
U becolne subject to the Workers'Compensation Laws of California.
0.0. Date Applicant ALTER OR ADD TO MECH. 4.00 BUILDING 86.50
} on NOTICE '1-0 APPLICANT: If,after making this Certificate of[is-
2 emption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Libor Code• you must forthwith comply with FEE •56.23
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 3.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER IOAOOC.F.M.) 5.00 SEISMIC FEE .77
1 hu«by al'I'irm that there is a innstum,tion lauding agency I'll EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM
3097.Civ.CJ.
l'ender's Name
Lenders Address HEATI NG UNIT(OV ER 100,000 B.T.U.P.50 ELECTRIC
I Certify than I have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city and county PLUMBING
erdiemecs and slate laws relating to building construction, ad BOILER-CONIP(3 H.P.or 100,000 B.T.U.) 4.00
hereby uuthoricc representatives of this city to L.
in thc BOILER-COMP (Can 10000OBTU)SEEFEESCH. MECHANICAL
abuvemrentioned property for inspection purposes.
(Wc) agree to save, indemnify anti keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, casts and expenses which PERMIT ISSUANCE 3.00 CONST.TAX
may in any way accrue against mid City in consequence of the
gm Ung of lhi mn1iL MECH.CONT. LIC.NO. MECH.
gmn - 4�_ TOTAL TOTAL 143.50
Sign' ppIt ant/Con ter Late- -
A.L. Tol ert. OFFICE COPY r