6992 APPLICANT TO FILL IN INFORMATION WITHIN•RED LINES - USE BALL POINT PEN ONLY
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BUILDING PROJECT PERMIT NUMBER IDENTI FICATION APPLICATION &-PERMIT
BUILDING, Aurora S P.nan r �1('1/'1/�
ADD"EsS t BUILDING-ELECTRICAL-PLUMBING-MECHANICAL F6 `9992
20300 Stevens Creek Blvd.
OWNER'S .}' r4 ky ,y"y `.r'`/:'; " PLAN CHECK VALIDATION
NAME Cupertino City Center ' ' OTYB.� r 5 `tB'd )_ I - � w P P 'MS .
1] , ELECTRIC PERMIT '�'�� x FEE.;;
toAssociates B PHONE
CONTRACTOR'S
NAME . 18798 35 UTLETS-SWITCHES-RECEP 5.00/100
Pim Electric Inc. LIC.NG, 323080 50 ILIGHTING FIXTURES 5.00•/4.0000
CONTRACTOR SPO.BX ZESID-
Alameda Cal.94501 PHONE522-5335 PANELS 5.00 GATE OF APPLICATION
I ARCHITECT SIGNSNOV 6QQ PLAN CHECK FEE P.C.NO.
OR .
ENGINEER
LIC.NO. SIGNS TRANS. 3.00
ADDRESS ENO. SPECIAL CIRCUI_IUItY ot Cupertino 5.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 15.00 n
ASo[\J
ADDREDDRESSS MOTORS SEE FEE SCH.P.O.Box 23$O -
Alameda Calif. 94501 ' . SERVICE CHANGE RAI&) 10.00
w O O LICENSED CONTRACTORS DECLARATION
< u U I hereby al fi IS that I am licensed under provisions or Chapter 9 14UV -�, 10r., r; ISSUANCE DATE
A Z a (commencing with Section 7000)of Division 3 of the Business rad
A Q BLDG. ELECT. PLG. MECH.
(- 0 z Professions Coda,a _ cense is in full force ❑
i vi W Linens¢Cla�srs Con Numb Q�__ El
9 Ihdc JS+/1 / Contractor' .111L:_. I o upertino
w r
T m¢¢ OWNER-BUILDER DECLARATION ..'BUILDING+P,ERMIT
K o a v INFORMATIONS
X
ig u I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORDAq
F LL o j Luw for the following reason.(Sec.]O31.5,Business end l'rofessiuns PERMIT ISSUANCE 6.00 VALUATION $/FT.
Code:Any city or county which requirus a permit to c"nslruch ulteq
¢ ¢ p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTH. LIC.N0. ELEC.
To
wD¢ requires the applicant for such permit In file a signed statement that Pim Elec.Inc. 323080 TOTAL PERMIT TO
ce m he is licensed pursuant to the provisions of the Contractor's License
rzr
Low(Chapter 9(cotimenciagwitIt Section 7000)of Division 3 of the - - -
i o Business and Professions Code)or that he isexempl therefrom and OTY. PLUMBING PERMIT FEE
¢ F$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES 0 TYPE CONSTR.
a 3 .- by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN -WATER (EA.) 4.00
of not more than five hundred dollars(55001.):
❑ I,as owner of the property or my engdoyces with wages as BACK FLOW PROTECT. DEVICE 200
their sole compensation,will do The work,and the structure I .
s not OCC GROUP RES.UNITS
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 of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP - 4.00 SO.FT.FLOOR AREA TOTALACREAGE
• himself or through his own employees,provided that such improve.
rents are not intended or offered 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 proving that h . . .
e did not hold or iia- RES IND CON PB Other
prove for purpose cfsale.). INDUSTRIAL WASTE INTER. 20.OD
Cl 1,as owner.1 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 Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contract's for such projects with a contractors)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ l am exempt wider Sec. ,B.&P.C.for this WATER HEATER W/VENT 4.00
reason
Owner Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that I have a certificate Of a ..ent'ta self-b,urc, ZONING ENG.SITE N0.
or a certificate S�oqf gW8oprpk,ers Compensation Insurance,or a certified
copy UWre,9f,{Ag1l {. b.C.). p,��7.,� -r,,,
1'alicY M1I1L-JULb FFslpany±-j1G1.L_111$'.
O ❑ Certified ropy is hereby furnished. FIRE SPRINK ENERGY T 24
Z_ Z X Cerli"•d 1 flyd� nl t oty inspection division. MISC. REFER TO ORD.
O Applicantot m° 1ecrX1 _.�`nd-. Y N 0 Y N
CC rn PERMIT ISSUANCE 16.00
LU - CF.R'I'I PICA'I'MPE SAiWN'INS FROM WORKERS' FLOOD ZONE A.L.u.c.
' W > COMPENSATION INSURANCE PLG.CONTH. LIC NO. PLG.
CL Z (]'his section need not be completed if tire'pernl it is for one TOTAL Y E] NEI Y ED NEI
hundred dollars(SIOB)or less,)
U O I certify that in the performance of the work for which this per OTEV i",.;max .MECHANICAL'P.ERMITa-' s.. FEE F,EE(SUMMARY
LL E- mit is issued.I shall not employ any person in any manner so as to a" ",4* '
O L) m
becoe subject to the Workers'Compensation Laws of California.
CL Uutc APPIIca"t ' ALTER OR ADD TO MECH. 4.00 BUILDING
} W NOTICE TO APPLICANT:'If,after making(his Certificate of Ex-
2 emotion,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK
Provisions of the Labor Cade, you must forthwith comply with FEE
C1 such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10MCLF.M) 3.00
CONSTRUCTION LENDING AGENCY ' AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00 SEISMIC FEE
1 hereby affirm iha(there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work loo which this permit is issued(Sec. - MICROFILM
3091,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.P.50
Lender's Address - ELECTRIC
1 certify ([,at 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
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00
hereby authorize representatives of this city to enter.upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes,
.(We) agree to save, indem y nd keep hurudcss the City of MISC.- 'REFER TO ORD.
Cupertino against liabilities Idg •nts, costs and expenses which CONST.TAX
may 's an way ac see sins id City in consequence of the PERMIT ISSUANCE 3.00
gra ng of L MECH.CONT. LIC.NO. MECH.
1 10/15/85 TOTAL TOTAL
IN nature of AppLml /Contractor - Datc
OFFICE COPY