C5862i
TO FILL,1N.!4
TION WITHIN RED LINES - USE BALL POINT PEN ONLY 10.491 •
BUI LONG PROJECTzI DENTI,F,ICATION
APPLICATION &PERMIT
BUILDING - ELECTRICAL- PLUMBING -MECHANICAL
PERMIT NUMBER
f ���b n�
r
-
IWILIN.55
ADDRESS
10600
10600 Rid evieliCt.
OWNER'S
"AME
Energy, Center PHONE
QTY. ELECTRIC PERMIT FEE
PCAN.CHECK VALIDATION
CONTRACTORS
NAME
NAME
UTLETS-SWITCHES, RECEP 5.00/1.00
Viking Fire Protec. Uc.No. 187293C-
'
6 LIGHTING FIXTURES 5.00/1.00
CONTRACTORS-
ADDRESS 3880 Bay Center Place
PPLIANCES-RESIDENTIAL 4.00
PANELS 5.00
PHONE 415-785-
DATE OF APPLICATION
ARC OEcr3571
OR
ENGINEER
LIC. No.
SIGNS' 6.00
IPLAN CHECK FEE P.C. NO.
SIGNS TRANS... 3.00
ADDR. 0.SS ENG:
ADDRESS ✓"
SPECIALCIRCUIT -5.00
PERMIT VALIDATION
VALIDATION
EMP. METER OR POLE INS. 15.00
' ZIP
)APR 2 61925
APPLICANT
ADDRESS
MOTORS SEE FEE SCH.
SERVICE CHANGE 10.00
City of Cupertino
LICENSEDCON'IRACIURS DECLARATION
7
- r k
I hereby affirm that 1 am licensed under provisions o(Chaprer)
(bmmeocng mhS t n7000) fDIlslon13 offhe Busineyss and
l f 'ns ClldL a nwJnccnse s li lullfuc' f•c
LI m' • ClykV.�-D- L Numbe�
Dam-4alJ- jConimcmr
ISSUANCE DATE
_•„� ��-....-�.. ., - ,.._...- _
f.� "
-'BLDG' ELECT:
r
PLG: MECH.
❑ 1 11
-\
BUILDING PERMIT
INFORMATION
pp**����yy
OWNER -BUILDER DECLA?A1;q •CA
I hereby affirm that 1 am exee.7 fm.5 the Cmilminessa and professions License
Law forAny the
countywhing reason. Sec.7irres permit tocnstruct, mons
Code: Any city or county my which requires a permit to construct, alter,
improve, demolish, or repair any structure, prior to its issuance, also
requires the applicant fur such revisit to file a signed actor's i use
he is licensed pursuant the provisions of the Contractor's License
_
MISC.- REFER TO ORD
VALUATION
SIFT.
PERMIT ISSUANCE 6.00
ELEC. CONTR. - 'LIC.NO.
-
TOTAL •,
TOTAL '
ERMIT TO
QTY. PLUMBING PERMIT FEE
Law (Chang 9(commencingwith Section is7000)
en 3
Division 3ofnd
Code) or that he is exempt therefrom and
Business and exempt
the basis for the alleged exemption. Any violation of Sectio" 7031.5
he alleged
r
IE i
by any applicant for a permit subjects the applicant you civil penally
of nut more than five hundred dollars(S500).1:
ALTER-DRAIN&VENT-WATER (EA.) 4.00
❑ Las owner of the property, or my employees with wages as
their stile compensation, will,do the work, and the structure is not
BACK FLOW PROTECT. DEVICE 2.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AREA, COND. 4.00
intended or offered for sale (Sec. 7044, Business and Professions
Code: 1'he Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work
himself orthrough his own employees, provided that such improve-
me"is are Nor intended or Offered for sale If, however, the building
-
FIXTURES- PER 'TRAP' 4:00
-� ~�'•-
SO. FT. FLOOR AREA
TOTALACREAGE
GAS-EA-SYSTEM-1'INC-40UTLETS•4'00
or improvement is Sold within one year of completion, the owner-
builder will have the burden. of proving that Ile did not build or iIF-
prove filo purpose of sale. ).
❑ I, as owner of the property. am exclusively contracting with
GAS - EA. SYSTEM - OVER 4 (EA.) IAX)
BUILDING USE
RES IND CON PO OIM1er
❑ ❑ ❑ ❑ ❑
INDUSTRIAL WASTE INTER. 20.00
LAWN SPRINKLERS - 1 INC 5 V.B. 5.00
LAWN SPRINKLERS - OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
licensed contractors to construct the project (Sec. 7044, Business
and Professions Code: "[be Contractor's License Law does not apply
In an owner of property who builds or improves thereon, and who
contracts for Such projects with a cootreclons) licensed pursuant to
the Contractor's License law. '"
SEWER -SANITARY -STORM EA. 200ft/8.00
TRACT NO,
PARCEL NO.
❑ I um cxcmla muter tics. ,B.&I'.C. fur This
reason
WATER HEATER W/VENT 4,00
Owner Dale
WATER SYSTEM 4.00
ACC. DATE
ACC. FILE NO,
WATER TREATING EQUIP. 4.00
WORK ERS'COM PENSA'I'ION DECLARA'T'ION
1 hereby affirm that I have a certificate of consent to self-inNlre.
or a certificate of Workers Compensation Insurance, or a certified
ZONING
ENG. SITE NO.
copy thereOff 381 CJ.
:I'ohCY'NoS7Pl3E7-'1'�I Y,QAmnr- Tntl.-Adi.•
❑p Cctldictt copy I.s 1 ereby fern shed...
W Certified Copy 4 fled Willi the flay In�)t'e11Va d1V ItIV11.
Applicant VJ king-FUe ocectli n__CA'r
- -
FIR E'SPRINK
Y ❑ N❑
ENERGY T24
Y ❑ N❑
MISC. - REFER TO ORD.
PERMIT ISSUANCE 6.00
FLOOD ZONE
A.L.U.C.
❑'.R1'IFICATEOF EXEMI'I'I ON FROM WORKERS'
PLG.CONTR. LIC. NO.
PLG.
TOTAL
' COMPENSATION INSURANCE'S
CI his Wetton:need not he completed if the permit is for one
V El N
Y 1:1 N
QTY MECHANICAL PERMIT FEE
FEE SUMMARY
hundred dollars IS 100) or h1S.)
I certify that in the pei,formare, of the work for which this per-
mil is issuedsl shall not employ any persam in any munnerso as to
BUILDING
bocome subject to Ole Workers' Compensation Laws of California.
Date Applicant ' "
'FWAPPLICAN'
ALTER OR ADD TO MECH. 4.00
-
NOTICE 1': If, after nmking this Certificate of Ex86
emption, you should become subject to the Workers' Compensation
APPLIANCE 4.00
PLAN CHECK
50
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shall be deemed revoked.
,iCONSTRUC'DON LENDING AGENCYAIR
FEE
56 93
AIR HANDLING UNIT (TO 10SMC.F.M) 3.00
HANDLING UNIT (OVER 10=C.F.M.) 5.00
SEISMIC FEE
EXHAUST HOOD (WITH DUCT)77
,
I hereby'aflirm that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec.
3099, Civ,G,),
MICROFILM
HEATING UNIT (TO 100,000 B.T.U.) '4.00
HEATING UNIT (OVER 100,000 B.T.U.)7.50
ELECTRIC
Lender's Name
Lender's Addrexs
I certify that l have read lhisepplifation.md state that the above
infornlalion is correct. I agree to comply with all city and county
ordinances and stale laws relating to building construction, and,
VENTILATION FAN (SINGLE) 3.00
-
PLUMBING
BOILER-CDMP(3 H.P. or 100,0006.T.U.) 4,00
BOILER -COMP (Over 100000 BTU)SEE FEE. SCH.
MECHANICAL
INNN, auilcoriee replese"tatives of this city to error upon file
above mcnli)med property for inspection purposes.
(We) agl' to cove, indcmnify,and keep harmless the City of
MISC. - REFER TO ORD.
Cupertino against liabilities, judgments, costs and -,sense, which
man
ay in y way accrue against said City in consequence of Ole
CONST. TAX
PERMIT ISSUANCE 3.00
gra ling o{f]lhi:LIDnniL
• "\I A 1� G -15 -RS
MECH. CONT. LIC. NO. MECH.
TOTAL
TOTAL
1143150
Sq,f urV ant/Cnn E.Clor r Dam
'I; I, A.L.. 'roLbert INSPECTOR COPY