4709 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDING PROJECT I OENTI FI CATION PERMIT NUMBER
BO:r-DING APPLICATION & PERMIT
ADORE
r0o,:� B (LDING —ELECTRICAL—PLUMBING —MECHANICAL 470
PAID
X OWNERS l
NAM �PfJ PLq VALIDATION
Z tri V ELECTRIC PERMIT FEE DEC C - 1983 ; -
CONTRACTOR
NAM,r UTLETS-SWITCHES-RECEP 5.00/1.00
[/—JJ1 ua no, LIGHTING FIXTURES 5.00/1.00 city Of Cupertino
CONTRACTOR'S PPLIANCES-RESIDENTIAL 4.00
AODREss f y 9/`C / PHONE/'%IST PANELS - 5.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.NO.
OR 'O� SIGNS 6.00
IN
ENGEER
SIGNS TRANS. 3.00 ' •
ARCH OR ENG SPECIALCIRCUIT 5.00 PERMIT VALIDATION
. ZIP TEMP.METER OR POLE INS. 15.00
APPLICANTS
ADDRESS MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
o
IS
i ----
r00
LICENSED CONTRACTORS DECUIRATION t
G v I hereby afliru that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
P, vWai (commencing with Seclinn 7000)of Division 3 of the Business and G. ELECT. I NPIA. MECH.
H y z Professions Code,and my license Is in full for I d e'JJ"'}'yyf ,)
z o License ClassLie Number Sds !/
9 H o Dutc Contractor-� ;
Qyf 3 ` Zo
BUILDING PERMIT
m 6 - OWNER-BUILDER U, smn r Rap RATION INFORMATION
wH 1 hereby ufYirm thw 1 am exempt from the Cuntrucmr's License MISC.— REFER TO ORD
H u o j Ula for the following mason.(Sec]031.5,tlminess and Proltssions PERMIT ISSUANCE VALUATION S/FL
la
Code:Any'cityor county whichrequiresapennil to construct,alter.
6.00 n
2 Q O improve,demolish,or repair any structure,prior to its isztmnce,also ELEC.CONTR. LIC.NQ ELEC. /
L O C, requires the applicant for such per-mit to Glc a signed statement that TOTAL
A w he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
13
Hai Law(Chapter9(commencing with Section 7000)of Division 3 of the
4 0 Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
w r $ the basis for the alleged exemption.Any violation of Section 7031.5T RI S TYPE CONSTR.
d �
by any applicant for a permit subiects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 4.00
or not more than five hundred dollen(5500).1'.
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00
their sole compensation,will do the work,and the structure is not OccARouP q UNITS y
��}�;
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 4.00
Code:The Contractur's License Law dots not apply to an owner of IT
property who builds or improves demon,and who docs such work FIXTURES-PER TRAP 4.00 so.PT FLOOR AREA Tprq`ACREAGE
himself or or ugh intends ownemployees,for
Pani.however,d that the
improve- GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00
mems are not intended or offered for sale.If.however,the builJing
or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 1,00 BUILDING USE
builder will have the burden of proving that he did not build or tin- E IN
prove for purpose of saleD CON PB Omnr
.). INDUSTRIAL WASTE INTER. 20.00 E] CO 1:1❑ I,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 Coll rhe Contractor's License Law does not apply
to an owner of prolstrly who builds or imprmes thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1,00
contracts for such protects with a cumraduelsl licensed pursuant to
the C'ontractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO, PARCEL NO.
real❑ I um exempt Ruder Sea ,B.&RC.for this WATER HEATER W/V ENT 4,00
son
Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILENO.
WORK 17RS'COMPE:NSA f ION D1:CLA RATION WATER TREATING EQUIP. 4.00
1 hereby affirm that I have a cerlifmalc ofconscat to self-insure.
or a cenificate of Workers'Compcmatim, nsur'dnce,or a cert ifed ZONING ENG.SITE NO.
ICopy tilery'qJy'� 3 Lab C,). / !
'ol cY Dl6Ke4 . 1 ny O O 7 -F ,
Q ❑ Certilied eo.155KKK55 Wiled. FIRE SPRINK ENERGY L�<
Z 2 ❑ Certified copy is Citteeddwiwith the city inspection division.
F" O Applicant MISC.- REFER TO ORD. y E) N❑ .Y ❑ N[_]
= CGRTIFICATE Of EXEMPTION'FRO.tt WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L,U,C,
LU > COMPENSATION INSURANC17 PLG.CONTR, TIC.NO, PLG.
d O 1 This section need not be,completed if the permit is for one TOTAL Y❑ NY❑ IN
Z hundred dollars IS 100)or hszj '
U O 1 certify that in the performance of the work tor which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued, 1 shall not employ any parson in any manner so as to
V become subject to the Workers'Compensation Laws of California t
0 i Dale Applicant ALTER OR ADD TO MECH. q,BB BUILDING - �D
} N NOTICE TO APPLICANT: If,arbor making this Certificate of Ex- _
Z mnption,you should bueomosobject v,the Workers'Com punsab ion APPLIANCE 4.00 PLAN CHECK
provisions of the Libor Code, you must Turd with conptly with FEE
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=CF.M.) 3.00
CONSTRUCTION LENDING AGI?N'CY - AIR HANDLING UNIT(OVER 10pODC.EM.) 5.00 SEISMIC FEE
I hereby affirm that Orme is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Cay.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name
Lender;Address HEATING UN IT(OVER 100,000 B.T.U.)7.50 ELECTRIC.
l certify filar l have read this application and state that the above VENTILATION FAN (SINGLE) 3A0
inlormaf ion is correct. I agree to comply with all city and county BOILER-COhiP(3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING
ordinances and state laws relating to building construction. and
hereby eon s rc rcpresntatnes ur (his city m creat Rpm the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH.
above-mentioned propcny lormsncaion purposes. MECHANICAL
(We) agree to save, indemnify and keep In nnless the City d MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE CONST.TAX
may in any way accrue xgaimt said City in comaquence of the 3.00 -
gorming of this permit MECH.CONT. LIC.NO. MECH.
�I TOTAL TOTAL 00
/ SlgnORNIT Applican ILommctor Date
OFFICE COPY
o HERE
February 3, 1984 u� FEB 2 1984
BLDG. INSPECTION DEPARTMERT,
CITY OF CUPERTINO
City of Cupertino
Qjilding Permits
10300 Torre Avenue
Cupertino, Calif. 95014
Mr. Joe Antonucci
I am writting you in response to a request from Dee's-- —
roofing. As,-you know-they -recently completed a re-roof of
our home at 10539 Farallone Drive in Cupertino. The
treatment of the patios cover has been called into
question. From my viewpoint, the solution applied is
satisfactory.
s
Sincerely,
V;�
Ken Foot
10539 Farallone Drive
Cupertino, Ca. 95014
cc: Dee's Roofing