5724 (2) I. APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT lDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT
ADDRESS Cupertino CityCenter/ pV8INg-ELECTRICAL-PLUM6ING-MECHANICAL .2R1vEI4 Stevens 57
OWNERS PLAN CHECK VALIDATION
NAME OTY. ELECTRIC PERMIT FEE
Cupertino City Center A e
CONTRACTOR
NAME UTLETS-SWITCHES-RECEP 5.00/1.00
RVIN ENGINE E RINGLIG.ND. 15075 LIGHTING FIXTURES 5.00/1.00
AroFs
CODNTRASDRESS Fremont CA 94538 APPLIANCES-RESIDENTIAL 4.00 t
077 Pestana P1 . 4H1,.ry65 PANELS 5-00 DATE OF APPLICATION
ARCHITECTSIGN$ BOD PLAN CHECK FEE Y.C.NO.
OT
RNGINEET
LIC NO. SIGNS TRANS. 3.00
ARC"Orr ENG. PERMIT VALIDATION
ADDRESS SPECIALCIRCUIT '5,00
ZIP EMP.METER OR POLE INS. 15.00 ^ /�
AMOTORS SEE FEE SCH.
ADDRESS DREss
SERVICE CHANGE 10.00
wo o LICENSED CONTRACTORS DECLARATION / O
a U I hereby affirm that 1 am licensed under provisions of Ch.p(C,9 ISSUANCE DATE
m a m (commencing with Suction 7000)of Division 3 of the Rusin...and BLDG. ELECT. PLG. MECH..
F w z 1'rufessions Cody,ap I license is in full force and effect.
z O m - License Class 1'f n Lie.Number C l�-16 I❑
D - D ratc D e racor
e-.-i 1-9 ttSRV-I-N-F'NL'I JEERING BUILDING PERMIT
¢ ¢ w ¢ OWNIi R-BUILDER DECLARATION INFORMATION
od " MISC.- REFER TO ORD
w 3 LL H I herr by atrium that I so exempt Imre ❑m C'essiai oars Licca... VALUATION $/FT.
FLLOj Lowlirny hollowing ntyw.(Seroussa,crmin town Prul'ccsiom' PERMIT ISSUANCE 6.00
sh Cole:Any city or county which requiros a punnit m corutruul,:dleq
Qta40 improve,denmlish,ar repair any structure,prior to its'issuance,aHo ELEC.CONTR_ LIG NO. ELEC. 2 9SRInn '
-O¢ requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO
lee is licensed pursuant to(be provisions of the Contractor's License
Fzi
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe FARC S,Dk infKGC
a Business;and Professions Code)or that he is exempt therefnnn and QTY. PLUMBING PERMIT FEE
¢ F Oo the basis for lire alleged exemption.Any violation of ScCtion 7031.5 STORIES TYPE CONSTR.
n „- by any applicant for a permit subjects the applicant toaclvll penalty ALTER-DRAIN& VENT-WATER (EA.) 4.00
of not more than five hundred dollars(5500).):
Cl 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2-00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
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 docs such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
mentsare not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 4.00
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 im-
,roveR,rpurposeofsalr.). INDUSTRIAL WASTE INTER. 20.00 RES HID cory PB areae
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
r licensed contractors v, construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Profexsimu Code:'Tire Contractors License Law docs not apply
to un owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00 '
contracts lir such projects with a contractoR0 licensed pursuant to
lire Contractor License Luw. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ I:un exempt under Sec. ,B.&ItC.for this WATER HEATER W/VENT 4.00
reason
Owner Date WATER SYSTEM 4.00 ACC.DATE ACC FILE NO.
WORK ERS'COMPENSATION DLCLARAI'ION WATER TREATING EQUIP. 4.00
I hereby atfinn that I have a certificate of consent to self-insure, ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a ce,lified
copy IhC{ya�($y, j8p0�sAb.C� ��ITN-
Colicy a (2 AS?0yapdrl�
O ❑ CCRifie)Copy is hereby fumishe FIRE SPRINK ENERGY T 24
Z2 7fT.�Ccrlifis6RrVq't frhtd gd11tluuitvRi¢sticclion di vision. MISC.- REFER TO ORD. v ❑ N❑ v ❑ N❑
O A',,A 1.0 ba 1�1 kL6i 11 1pVf cC
CC CERI'IIICA'IIi OF FXEMI'TION FROM WORK ERS' PERMIT ISSUANCE 6.00 FLOODZONE A.L.U.C..
Lu >_ COMIPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
EL 0 11 In, section need not be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
� Z hundred Anllors l$100)or loss]
U O 1 reality that in the performance of lira:work tar which this per- OTY MECHANICAL PERMIT FEE FLEE SUMMARY
mit is Rsamd, 1 shall not employ any parson in any manner su as m
LL O Ir
uconm subject to Bre Workers Compensation Laws ol'Colihrrnio.
O w Date, Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
>- vii NO'1'ICIi 10 APPLICANT: If,after making this Certificate of Ez- 38.50
Z eruption,you should become subject to the Workers'Compensation APPLIANCE + /"4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO.10=C.F,M,) 3.00 25 ,03 .
( CONSI'RUCt10N LENDING AGENCY .'AIR HANDLING UNIT(OVER 101JOOC.F.M.),5.00 SEISMIC FEE .
Thereby afODn that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00
[lie performance of the work for which this permit is issued(Sec. MICROFILM
3097,CIv.C,)' BankOf AMe rice NTBIS HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name EATI N G UNIT(O V E R 100,000 B.T.U.)7.50
• ' Lender's AJdrr- y . O Alt ELECTRIC
I wrlity Rut I have read this application and stale that the above VENTILATION FAN (SINGLE) 3,00
ink......Ran is correct.I agree to comply with all city and county PLUMBING
oRCriares, and state laws relating to building construction, and BOILER-OOMP(3 H.P.Or,100,000 B.T.U.) 4.00
hereby authorize representatives of this city to carter upon the
/ uboyrmentiuned pn,p<rly fur inspeni BOILER-COMP IOver 100.000 BTU)SEE FEE SCH. MECHANICAL
I poses.
(W4 age. to sae- country r p harmless the City of MISC.- REFER TO ORD.
+I Clhvfrli against abilities,judgn n , sts and rzpcnecs which CONST.TAX
I"; any way aCAme against ai ty in consequence of the PERMIT ISSUANCE 3.00
n,/I his sur 'L MECH.CONT. LIC.NO, MECH.
12/7/84 TOTAL TOTAL 64.03
i
Wore, WILin
ntmcl r )
/; INSPECTOR COPY