4805 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENT:FICATION PERMIT NUMBER
ADDRESS APPLICATION & PERMIT 4805
ADDRESS
Ct.
BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
10275 Virginia Swan
OWNER'S PLAN CHECK VALIDATION
NAME ` OTY. ELECTRIC PERMIT FEE
Bud Newman PHONE •.
CONTRACTORS
NAME C43SC20 UTLETS-SWITCHES-RECEP 5.00/1.00
Asmac LIC No. 247722 LIGHTING FIXTURES 5.00/1,00
ADDRESS TORS APPLIANCES-RESIDENTIAL 4.00
ADDRESS
Enterprise PHONE 796-8311 PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER Newark, CA. 945§Q
I o. SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP. METER OR POLE INS. 15.00
APPLICANTS MOTORS SEE FEE SCH.
ADDRESS
SERVICE CHANGE 10.00
o o LICENSED CONTRACTORS DECLARATION
ES I., I hereby ul'I'irm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
R a ec (commencing with Section 7000)of Divition 3 ,f the Business xnd BLDG. ELECT. PLG. MECH.
r m i I'In(essions CodyyaaypQQp MMyy��ppse is in full gly)yjfFp. 11 El 1:1Tomm
_ - License Class l.Ys+JCe•V Lic.Nuberr_-2 /-ALL
9 w w Date Contractor
y f BUILDING PERMIT
rc ISw a OWNER-BUILDER DECLARATION
r
oA MISC.- REFER TO ORD INFORMATION
wLL y I hereby ulfinn thus ;un exempt from the Contractor License VALUATION $/FT.
F u_
04 Law for the following mason.(Sec.7031.5,Business and Professions 'PERMIT ISSUANCE 6.00 -
Code:Any city or county which requires n permit tore construct,alter. (�.
Q ¢ 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTE. LIC.N0. ELEC.
w
D a, rcgaircs the applicant fursuch permit to file u signed etatenhent that TOTAL PERMIT TO
n ism he is licensed putsu rl to the provisions ol[he Contrhctor's License
Fzi
Law(Chapter 9(cotronencingwith Section 7000)o1-Divisiort 3 o flhe
a :business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
I o
:business
for the alleged exemption.Any violation tFSc,tmH 7031.5 STORIES' T P CONSTR.
i3E by any applicant for u permit subjects the aPPlicun1103 Civil penally
ALTER-DRAIN -WATER IEA.: 4.00
III not more than Five hundred dollars(5500).L
❑ 1,as owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.caouP RES.UNITS
:heir sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044- Business and Professions DRAINS-FLOOR,ROOF,AR EA,COND. 4.00
Code'fhc Cont...let's Liccnsc L.w docs not apply to tan owocref
property who builds or improves thereon,and who does such work F IXTUR ES-PER TRAP 4.00 So,FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided:hat such improa'e-
mentsare not intended oroffered for saleIf,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 hove the burden of proving that he did not buildurim-
proveforpurposeofsale.). : INDUSTRIAL WASTE INTER. - 20.00 RES IND cOry Ps �00I.,`
•• h. ❑ I,as owner of the property.'xm escluffeb,contracting anti ❑ ❑ [T g13r -t-i-
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. .
:obit Professions Code.'Plat Contractor's License Law does not apply t
town owner of property who builds rr Improves ihcrr>II,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 l
contracts for such projects with a contractor(i)licensed pursuant to -
theContractor'sLicenseLaw. SEWER-SANITARY-STORM EA. 200ft/8.00 TRACT NO. PARCEL NO.
❑ I am Cxempt under Sec. ,B.&BC.for this WATER HEATER W/VENT 4.00
reason
Dam Owner WATER SYSTEM 4.00 ACC.DATE Acts FILE NO.
WORK ERS'COMPENSTPION DECLARATION WATER TREATING EQUIP. 4.00
I herehy affirm that I have a certificale of consent to WlGinsore' ZONIrv6 ENG.SITE NO.
or a certificate of Workers'Colpetoation Insurance,or a certilied
copy coerce 0. .C.1
Pull No. S1=dl'Uny � Unigard Security
-
0 ❑ CcEilied copy is hereby furnished. TTppQpppppp�p1 pp FIRE SPRINK ENERGY T"24
Q� Certified copy is filed will, fhc ;P§,gp2cmCRUi.L MISC.- REFER TO ORD.
� O Applicant _ Y ❑ N❑ Y ❑ N❑
Cc rn CE R IFICAT Ii OP EXEMIt I'ION FROM WORK IiRS. PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
LU5 CO)1pliNSATIONINSURANCIi PLO.CONTE. LIC.IN PLG. Y❑ N❑ Y ❑ N❑
Z frh15 sectidn need blot he completed if the permit is fur one - TOTAL
hundred dollars IS IOU)ur 1,11)
U O 1 certify that in lire per(ormincc of ihework I.,which thisper- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
LL - shit is issued,I shall not enhploy any person in any manner so as to
U become subject to the Workers'Compensation Laws of California.
U a Dntc Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
} m NOI'ICIi 'I'0 APPLICANI If,after making this Cerllfiate of Ex- '
FZ enhption,you should be,ome subject to the Workcri Connpcnmtimh APPLIANCE 4.00 PLAN CHECK
Provisions of the Labor Coda you must forthwith comply with FEE
U such provisions or this permit shall be deerned revoked. AIR HANDLING UNIT(TO 10DWC.F.M.) 3.00
CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10)"C.EM.) 5,00 SEISMIC FEE
1 hereby affirm that there is a censTnheloo lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the perfurnhance of the work for which this Permit is issued(Sec. MICROFILM
3097,Civ.CU. None H EATI NG UN IT(TO 100,000 B.T.U.) 4.00
Lender's Name H EATI NG UNIT IOV ER 100,000 B.T.U.)7.50
Lender;Address ELECTRIC
Icertify that l have read this application and state that the above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city and countsPLUMBING -
urdinances and state laws relating to building construcliun, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00 ',uu'�'�
h ereby.aathonic re Prewntalics el this city to enter upon the BOILER-COMP (Over 100,000 BTU:SEE FEE SCH. U% MECHANICAL VV
above-mehnioncd property for,mpcciiun purposes.
!we) agree 10 save, indemnify and keep harmless the Cil)'of MISC.- REFER TO ORD.
Cupertino against liabilities,Judgments, costs and expenses which PERMIT ISpmp 3.00 CONST.TAX
may in any way accrue against said City in con equence of t,c /� �+-
grunti of this PEG m.L MECH.CONT. LIC.NO. MECH.
7-10-85 TOTAL /-b ` TOTAL
Slgnaturc oG Applicant Cmhtraaor Date
INSPECTOR COPY
i