6435 1274 Eklaff
APPLICANT TO'F'I?M'*INPWF I A 1ION-WITHIN-RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
APPLICATION & PERMIT
nunmNG 10700 s. De Anza Blvd. 6435
ADDRESS
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER' PLAN CHECK VALIDATION
name aU.G JD S,0' acc�cctt� QTY. ELECTRIC PERMIT FEE
• Cohn Sabrato) PH �46r0700
N°MER"cTORs UTLETS-SWITCHES-RECEP 5.00/1.00
Cal-Air, TM. G.NO, 137195 LIGHTING FIXTURES 5.00/1.00
CONTRACTORS PPLIANCES-RESIDENTIAL 4.00
Aoo LESS
1775 S. 1st St. PRONE M-8204 PANELS 5.00 DATE OF APPLICATION
ARCHITECTSIGN$ 6DD PLAN CHECK FEE P.C.NO.
On .
rMIEn stenfort LIC.NO, 15,884 SIGNS TRANS. 3.00
ADDRRi°SS ENc' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
1775 S. 1St St. S.J. z,P95112 EMP.METER OR POLE INS. 15.00 �
APPLICANT
ADDRESS
MOTORS SEE FEE SCH.
A
1775. s. 1st St., S.J. 95112 SERVICE CHANGE 10.00 6/��S
o¢ i
F
00 LICENSED CONTRACTORS DECLARA'HON
¢ vI hereby ufflon that I am licensed under provieinns of Chupler 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business antl BLDG. ELECT. PLG. MECH.
rsc i 1'ro fesslons Code.a n1yI' nse is in full fors,an-d effect.
z o m - Licemm ClussL /11 Lin.-ContrNumbact., �,�,/
0 O Datc__fi� `�-Cmuructor C'41 A -1El 11 1
¢ u s -a BUILDING PERMIT
¢ ¢ w a OWNER-BUILDER DECLARATION
_ INFORMATION
Aoa MISC.- REFER TO ORD
w LL r hereby:follow ing I am exempt from the Contractors is License VALUATION $/FT.
H u D Q Law for the following rcuson.(Sec.7031.5.Business and Professions PERMIT ISSUANCE 6.00
,A i Code Any city or county which requires permit toconstruct'alteq j
Sea O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. j
O ¢ sequins the applicant for such permit to file a signed statement that TOTAL PERMIT TO
a F m w he is Ii rnicd pursuant to the provisions of the Contractors License - s', "r �� ( -�
z>
Law(Chapter 9(commenchngwith Section 7000)of Divislon3nfthe l
a Business and Professions Code)or that he isexempt therefrom and QTY. PLUMBING PERMIT FEE
at f p the basis for the alleged exemption.Any violation of Section?031,5 1 STORIES TYPE CONSTR.
a3w by any.applicant for it permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00
.feet more than hive hundred dollars(S500y):
❑ I,as owner of the property.m my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.uNlis
Iheir.sole emopensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Profession', DRAINS-FLOOR,ROOF,AREA,COND. 4.00
Code:The Contractor's License Law does not apply to an owner o _
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 7 4.00 SOFT.FI-OORAREA TOTALACREAGE
• himself or Ih rough his own employees,provided that such improve-
entsarenotintendedurofferedforsale.If,however.the building GAS
m -11NC.40UTLETS 4.00
or improvement is sold within one year of completion.the owner- GAS-EASYSTEM-OVER 4 IEA.) 1.00 BUILDING USE
builder will have Ute burden of proving that he did not build or im- . RES IND CON PD Omer
prove for pmrpose c,"sal°.). INDUSTRIAL WASTE INTER. 20.00
❑ I,as owner of the properly,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:'I'he Contractors License Law dues not apply
to un owner of p,,)Perry who builds ur improves[hereon,.,,it who LAWN SPRINKLERS-OVER 5(EA.) 1-00
contracts forsueh projects with a condructods)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ lamexetnptunder Sec. ,B.&P.C.for this WATER HEATER W/VENT 4.00
ren,a
Owner / A Dme WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby alfirm that I have a certificate of consent 10 selGinsure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,of a certified
copy IhereuflS.ee.3300.Lab.C-.).
Policy No._�+11L_Cruipnny�Tqy,,
O ❑ Cc filled copy ix hereby furnisidd! FIRE SPRINK ENERGY T 24
z C2,15. d -opo 's fded with t hTe city m: e'i n gvision.
p A4 cant ca 9�fileQdq (1�•• MISC.- REFER TO ORD. Y❑ N❑ Y ❑ N❑
cc L '1' 'I: tf'(:X VIA EION ROM wORK1iRs' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.u.C.
LU > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL ('Phis uClum need not be conhplocd if the permit is for one TOTAL Y❑ N❑ Y❑ N
Z ❑
hundred dollars IS MIDI nr Icss.)
U O - 1 certify(hal in the performance of the work for which this per. OTY MECHANICAL PERMIT FEE FEE SUMMARY
LL 1- mi(is issued-I shall not employ any person in any manner so as to
O U become subject to tire Workers'Compensation Laws of California. BUILDING
a Dme applicant ALTER OR ADD TO MECH. 4.00
} or NOl'ICE TO APPLICANT: If,after mak iN tlh�s(Arlificale of Ex
F Z enhption,you should become subject(o the ' rkers Compensation APPLIANCE 4.00 PLAN CHECK
provisions of [he Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10JO66C.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CF.M.) 5.00 SEISMIC FEE
I hereby affirm that there 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;Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name HEATING UNIT'(OV ER 100,000 B.T.U.P.50
Lender's Address ELECTRIC
I certify that I have read this application and slate that[K above VENTILATION FAN (SINGLE) 3.00
inl'onmanon is correct. I agree(o comply with all city and county PLUMBING
ordinances and state laws relating to building construclion, and BOILER-COMP(3 H.P.or400,0008.T.U,) 4.00
homey authorise representatives ec this city to enter upon the BOILER-COMP love,100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purpous.
t (We) agree to save, indemnify,and keep harmless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses whichCONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 3:00 /Q
' gr' ht. MECH.CONT. LIG NO. MECH.
-<J7,
6/5/85 TOTAL
/ TOTAL
Signature of Apdfl UConlraTlo� fate coo -a
INSPECTOR COPY