3887 APPLICANT TO FILL IN INFORMATION.WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING'PROJECT IDENTIFICATION - _ . " PERMIT NUMBER
- APPLICATION & PERMIT
BUILDING- -
ADDRESS _
( TQN BUILDING - ELECTRICAL-PLUMBING -MECHANICAL
3887
OWNER'S ` -PLAN CHECK VALIDATION
Nm AME - ' TY. ELECTRIC PERMIT'
� , - FEE -
� ; �► +
Iron's
NAME OUTLETS-SWITCHES-RECEP 5.00/.1.00 -
NAME
13 ge
L .No. - 9D LIGHTING'FIXTURES 5.00/1.00 '
- ro rnncrons
AGGRESS - APPLIANCES'-RESIDENTIAL 4.00
- •f
Lt p e oNE PANELS 5.00 DATE OF APPLICATION
ARCHITECT . SIGNS - 6.DB . PLANCHECK FEE P.C.NO.
on'
ENGINEER
LIC.No. SIGNS TRANS. 3.00 --
AARCRDGREOR SR ENG. SPECIAL CIRCUIT,•, 'S.DD PERMIT VALIDATION -
'xIP rrEMP. METER OR POLE INS. 15.00
APPLICANT'S qa6l/ADDnEss MOTORS - SEE FEE SCH. SS\/• SERVICE CHANGE 10.0000LICENSEDCONFRACTORS DCCLARATION ��`•�-
,Q U u I herehy affirm that I um licensed under provisions of Chapter 9 �� dGC1 ISSUANCE DATE
N a "' (commencing still Section 7000)of Division 3 of the Business and e BL G. ELECT]' PLG. MECH.
H y i Professions Co a y license is ih full for a elf u (� O0. ❑ ❑ ❑
z o m - License CI Lic.Kumber
o A r to D_alu Cn..Intern
'- 11 Vd�, �-Q N➢d
¢ BE f - BUILDING PERMIT
¢ ¢ ¢ ¢' OW NE WBUILDIiR DECLARATION-
w U INFORMATION
wig u I hereby affirm did I ant exempt from rte Cnntrnmur's License MISC.- - - REFER TO ORD t VALUATION -
HacOa Law for the following reason.(See.7031.5,Business and Profession, ;PERMIT ISSUANCE - 6.00 $/FT.,
�,m Code'.Any city orcounty which requiresa permit mconstUcLalter, - _ o/, OQ
ac rc<o improve,demolish,or repair any structure,prior to itS issuance,also ELEC.CONTR.'., LIC.NO. ELEC. ) 70 P
, inquires lite applicant for such permit to file a signed statement that TOTAL , PER MIT.TO
d w m he is licensed pursuant to the provisions of the Contractor's License _ '
Hzi
Law(Chapter 9(commencing with Section 7000)of Division 3 of tte�
a limbless and Professions Code)or first he is exempt thmehom and-QTY'. PLUMBING PERMIT, FEE. fe.-eouP. '
¢ r O file basis for the alleged exemplion.Any violation of Section 7031.5 STORIES TYPE CONSTR:
AFby any applicant lora permit subjects the applicant toacindpenalty ALTER-DRAIN -WATER (EA.) 4.00 .F
ofnolntore than five hen dreddollars(5500p.): - u.-
❑ I,as owner of tie property,or my employees whit wages as BACK F LOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the st recture is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4,00
Code:T'he 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 PLOOR AREA TOTAL ACREAGE
himscDents are not
hde own emred fors,provid ho ever,such improve-
Dents
mf!rovr - GAS-EA.SYSTEM-.1 INC.4 OUTLETS 4,00
hints an:not omitted or offered for sale.IL however,s the budding
.Iran movement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA) 1.00 BUILDING USE
builder will have the burden of proving that h .
e did not build or im- -
"loveforpurposeofsale.). INDUSTRIAL WASTE INTER. 20.00 "" R IND . CON PR Omer
C, I,as owner ol';the property,am exclusively contracting with El 0 . El 11Iieensed'contractors to construct the project(See. 7044,Business LAWN SPRINKLERS-1INC 5 V.B. 5.00 vi ASSESSOHS PARCEL NO.
.:md Professions Code:The Contractor's License Law does not apply ,
to an owner of property who buil&or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 '
contracts for such projects with a contractons)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑' 1 am exempt under Sec. ,11.&I',C.kono's WATER HEATER W/VENT 4.00 `
reason
Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
- WORK 1iRS'CON1I'ENSA`NON DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that I have'a certificate of avuent to sel Finsurc,
or a certificate of Workerti Ccumpensation Inewvnce,'or a cert lied ZONING ENG.SITE NO.
copy there S.,,��3 .ab.C.). C�-�
Policy NnWd�AP-any_STA-TS-_F&n10 -
Q ❑ Certified copy ishereby furnished." FIRESPRINK ENERGY T-24
W��Cert(j'�d y fikd wilt ci im)reH, d'x'SimT MISC- REFER TO ORD.Z 0 AP�rI¢em RpwO-FIJ. s-/fLLL/- - Y❑ N❑ Y ❑ N❑
'~ rn PERMIT ISSUANCE 6.00
CC Cl;RT1171CA*rF OF iXEMPTION 'ROM WORKI!RS' _FLOOD ZONE A.L.UC.,
LU CONI PENSATION INSURANCE PLG,CONTR. u0.No. PLG.
,CL CL CITis mesion need not be'comple ed if the permit is for one TOTAL Y ElN❑ 0❑ 'N❑
Z
hundred dollars IS 100)or less.(
U O 1 certiiy that in the performance of the work for which this per- TY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued,I shall not employ any Person man'manner sdas to -
U Iiecome subject to the Workers'Coinpensuli6n l.,iws of Californill.'
LU Date Apphcunt ALTER OR ADD TO-MECH.' 4.00 BUILDING 's5O
} W NOTICE 'f0 APPLICANT':-If,after making this Certificate of fixJq
-
F Z emption,you should become subject m the Workers'Commensal ion APPLIANCE 4.00 PLAN CHECK -
provisions of the Labor Code, you Bond fo lli,volh comply with
(� such provisions or this permit sha11 be deemed revoked. AIR HANDLING UNIT(TO 10p00C.F.M.) 3.00 FEE ITO
CONs'fRUCTION LENDING'AGIINCY AIR HANDLING UNIT(OVER 10=C.EM.) 5.00 SEISMIC.FEE
I hereby affirm that there is a construction lending agency lot EXHAUST'HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec MICROFILM
• 3097,Civ.C.). - HEATING UNIT ITO 100,000 B.T.U.) 4.00
Lender's Name
Lender's Address HEATI NG UN IT(OVER 100,000 B.T.U.)7.50 ELECTRIC
I certify first I haveRed this appliculion and Swte Thin tile above VENTILATION FAN (SINGLE) 3.00
inforinformation it correct. I agree li comply with all oily and county' BOILER-COMP 13 H.P.or 100,000 B.T.U.) 4.00 - PLUMBING „
m do cis correc lows relining to building c city an ion,•a county
-
Ilemby aulhorire represcounces 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, indemmil'y and keep harmless the City of MISC.- - REFER TO ORD.
Cupertino aFaind liabilities,-judgments, ensu and expenses which - - CONST.TAX
may in any way accrue against said City in•conscqucnce'of the PERMIT ISSUANCE' 3.00 '
granting of this permit. n I MECH.CONT... LIC.NO. MECH.
y,.(_/ 491��1U :6-20 �� TOTAL TOTAL T1� QD
Slgnalureof Applicant/Contractor Date 'i _ZF?
. .:OFFICE COPY .