Loading...
8231 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LDI NG PROJECT I DENTI FI CATION PERMIT NUMBER AooAEss L a7 ,f ! APPLICATION & PERMIT n - - Itrltlsd BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 8231 31 / OWNER'S f PLAN CHECK VALIDATION / NAME WILL.14"IS QTY /ELECTRIC PERMIT FEE ML2,8.M(25. P-o e2r _ PHONE • -SWITCHES O CONTRACTORS UTLETSSWITCHES-RECEP 10.00/1.00 /UJ LIC.NO. 7 y/�,{./LIGHTING FIXTURES 10.00/1.00 / 3 ' 7�-_ cD ADDRESS, RAPPLIANCES-RESIDENTIAL 4.00 .�� s, 5:13 mol":MRrs? PHOrvE _ PANELS 10,00 DATE OF APPLICATION ARCHI ELT PLAN CHECK FEE P.C.NO. ENGINEER X OR r.C�-NNIS F_A)0,Ih0,,W AIA PANELS (OVER 200 All 20.00 LIC," _41SIGNS TRANS. 3.00 ) AR6H.OR E.16,' PERMIT VALIDATION ADDREss Z 97 SUIN wIrT' IZ.Y�, SPECIAL CIRCUIT 5.00 1 LOS ANT'l en Zip EMP. METER OR POLE INS. 2n Dn 1- ADDRESSTs F 17t=SIN IS 13VYL r2ovJ MOTORS SEE FEE SCH. ADDRESS A Ile- SERVICE CHANGE 20.00 00 LICENSED CON"f RACTORS DECLARATION TEMP.POLE 30.00 �: 1 hereby affirm that 1 ant licensed under provisions of Chapter 9 ISSUANCE DATE m a w (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. D z Professions Code,and my license is in full force and effect. _ z o m - License Class Lie.Nmnber �EFX3 Q DanCGOntral'IDr� �.,t�� Tom✓. ¢ , f -a BUILDING PERMIT ¢ ¢ ¢< OWNER-BUILDER DECLARATION INFORMATION wDi MISC.- REFER TO ORD LL y I hereby affirm that I am exempt front the Contractor's License VALUATION 8/FT. H a04 Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 19„00 � ,�, Code:Any city or county which requires apermit to construct,alreq •-� atom.+ a o improve,demolish,or repair Structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.. qq .1•�. / DLL requires the applicant for such permit to lile o signet(statement Thal TOTAL pA/ V V PERMIT TO A w m he is licensed pursuant to the provisions ol'the Contractor's License Hzi Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe S"/N 4 0 ' Business and Professions Code)or that he is erempt therefrom and DTV. PLUMBING PERMIT FEE ¢ F o (he basis for the alleged exemption.Any violation of Section 7031.5 STORIES- TYPE CONSTR.. a ; by any applicant for a Vermit subjee(slhe applicant to a civil penally ALTER-DRAIN (EA.) 5.00 of not more than five hundred dollars(5500).): ,,,) ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 400 OCC,GROUP RES.UNITS their sole compensation,will do the work,and the structure is not . _ intended or olfered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.003 / Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who docs such work FIXTUR ES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTALACREAGE - himself or through his own employees,provided that such improve- mentsarenotimendedorofferedforsale.If.however.thebuilding GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 3 O or improvement is sold within one year of completion,(be owner- GAS EASYSTEM OVER 4(EA.) 200 builder will have the burden of proving flint he did not bu - . - . . ild or im- BUILDING USES' RES IND CON PB Other prove fors owner of life.(. INDUSTRIAL WASTE INTER. 30.00 ❑ d as owner of the property,he exclusively. 744contracting with ❑ ❑ ❑ ❑ licensed colons od to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law Joos not apply to allcontracts owner of property who builds tr improves ensed p, aJa who LAWN SPRINKLERS-OVER 5(EA.) 1.00 ? the Co is Contractor's h cenj e L with a contrae(oHs)licrnu•A purvmnt kt J T the Confranor's License Law. SEWER-SAN ITAR V-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. ❑ I am exempt order Set.-,B.&P.C.for fills WATER HEATER W/VENT 6.00 / ) reason V 3 Owner Dale WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORKERS'COMPF-NSATION UECLARA'I'ION WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to self-insure, ZONING ENG.SITE N0. 1 or a certificate of Worker,'Com,co,mion Insurance,m a certificJ h copy thereof(Sec.3800,Lab.C.). �f Policy No. Company J. Q ❑ certificJ ropy is Ileml).y.fu lied FIRE SPRINK ENERGY T 24: Z Z IyCertif copy is I'ed ith the i -inspectiondivision. O/ Applicant MISC.- REFER TO ORD. Y❑ N❑ Y ❑ -N❑ M N Cl R IPICATE OI'EXEMPTION 17RONI WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C. LU > // CONIPENSAI'ION INSURANCE PLG.CONTR. LIC.NO. PLG. v❑ N❑ ,Y ❑ N❑ CL Z L IThis section need not be completed if the permit is for one TOTA hundred dollars IS 100)or less.) :U O 1 certify that in the performance of the work for which this per- DTV. MECHANICAL PERMIT FEE FEE SUMMARY LL F mil is issued,1 shall not employ any person in any Inwmer so as 10 U become subject to the Workers'Contpensal ion Lawsof California. n Dale ApplicantALTER OR ADD TO MECH. 5.00 BUILDING } rn NOTICE TO APPLICANT: If,after making this Certificate of Fs- trunnion,you should become subject to the Workers'Compensation APPLIANCE 5.00 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.) 4.00 CONSTRUCT ION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 1 hereby affirm than there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097.Civ.CA HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lander',Name HEATING UNIT(OV ER 100,000 B.T.U:F9.50 Lender's Address ELECTRIC 1 certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00 ' �`. information is correct, I agree to comply with all city and county BOILER H.P.Dr 100,000 B.T.U.1 6.00 PLUMBING ordinances and stale laws relating to suiting consloortion, and hereby aullmri a ripresen(atives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. _ _ (we) agree to save, indemnify and keep harmless the City of It- REFER TO ORD. , Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX a�(p may in any way acer a agni said Cit pin Consequence of the / 7 grant ofthu,Pettit, MECH.CONT. LIC.NO. MECH. TOTAL I TOTAL `4 \I�, "gn o App m / riaclor a /0�S• N INSPECTOR COPY POST THIS CARD NEAR FRONT OF BUILDING I ERNnT puMBeR CITY , OF CUPERTINO /� QQl INSPECTION DIVISION ' "' k 82x31 JOB INSPECTION RECORD , - PERM IT..EXP,I RATIO ia`z��Dn 11 �eW'�r. JOB ADDRESS o UNIT# LOT# l �( . .c - - PERMIT E9CP.IRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYS OFPERMITISSU- FOUNDATION C ANCE OR ABO DAYS FROM -.���Y �'� U / �u• V' LAS,CALLED INSPECTION; UFER, PREGUNITE •// b) K a }PEaMrt IAL onnoN • :>: rl POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ? '. •%L•. UNDERGROUND /SLAB PLUMBING ELECTRICAL .. - ISSUANCE DATE MECHANICAL - - - BLDG. ELECT P G. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUI ING RMIT WOOD FL00 IN ORMA_ION • It PLUMBING ( - yAwnnoN - ( /FT. 1 tip- MECHANICAL ELECTRICAL .r, - PERMITTO - FRAMING S INSULATION STORIES,i �•• TYPE CONSTR. ' ' � � _ � ... - *�� - OCC.GROUP RES.UNITS' PLACE'NO SUBFLOOR UNTIL ABOVE HAS BEEN,SIGNED ti • •ROOF ,,_ I I SO,FT.FLOOR AREA TOTAL ACREAGE, DIAPHRAGM" BUILDING USE - RES IND CON 'Ps 00 , APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ . ❑' ❑ ❑ . El ROU ASSESSORS PARCEL NO. GH ' - PLUMBING T. !'1..,--=i GAS-TESTTRACT NO, PARCEL NO. ` MECHANICAL _ � ;;;. ACC.DATE ACC.FILE NO. . - ELECTRICAL J/.�-�-5' .FINALS - - - DATE INSP' - � FRAMING _ _ SAN 0 - - ZONING ENG,SITE.NO., INSULATION . . - PLUMBING - GAS .� MECHANICAL - FIRE SPRINK - ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ NO FLOOD ZONE A.L.U.C., !' LATH-INTERIOR ELECTRICAL S s • LATH-EfERIOR / FIRE-DEPT. - Y.❑ ."❑ °❑ "❑ SHEE KIjL d h GRADE FEE SUMMARY SHEAR I ERIO BUILDING a -( SHEAR EXTERIOR T - TEMPOR RY APPROVALS BUILDING '.�, ./ :•�; FIREWALLS ELECTRIC .PLAN CHECK _ GAS. NO TAPE OR PLASTER UNTIL ABOVE HAS B IGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM - ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRICLU - ONE.WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBINGO� PLEASE GIVE JOB ADDRESS WHEN PHONING. z II - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL' ; l 1 ' OFFICE COPY , - , APPLICANT TO;FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY • ` BU LDING PROJECT I DENTI FICATION -'' _ PERMIT NUMBER DING ADDRESS APPLICATION & PERMIT R /S�1 ' O-z • .V 1 . 'BUILDING=ELECTRICAL—PLUMBING—'MECHANICAL � ' 8231 V Z ' NAME Eq'S��//�� 'I' /rW( PLAN CHECK VALIDATION NI1IERr� 1-iIW. •{JrrlVY� Wtt-UQ/I PJ. OTV., PNrE -5436 ELECTRIC PERMIT '`FEE • ` CONTRACTOR'S NAM E- ' � UTLETS-SWITCHES-RECEP 10.00/1.00 /OOy— uCNO, LIGHTING FIXTURES 10.00/1.00 . /' 3 rorvrnScioR'sp ...moi ADDREssL , APPLIANCES-RESIDENTIAL 4.00 I al MIINr "r`e AL PHorvE s�J�y PANELS 10.00 . ARCHrtECT DATE OF APPLICATION DR C�eDL=NNJb PJUD+I170W AIA PANELS (OVER 200 AMP)' 20.00 - • PLAN CHECK FEEP.C.NO. ENGINEER _ uc.NO.G w SIGNS TRANS.' ARCH.OR ENG. ADDq ESs 23895'3Jnont�y"' 12D, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION r, LOS, CO S '.Cfq zIP - $p3p EMP.METER OR POLE INS. APPLICANT'S J�El.$M IS QV�✓ZOw MOTORS P ADDRESS EE SGH, SERVICE CHANGE ' -- - D.00 ,'/a,.�p" D to/1`�q?r4 198 FOO' LICENSED CONTRACTORS DECLARATION TEMP.POLE �j `.) OO a Z0 W I hereby affirm that I am licensed under provisions of Chapter 91 • - ' Z (commencing with Section 7000)of Division 3 of the Business and p ISSUA F w Z Professions Coda and my license is in full fore d ffac - 't ,oI JJp BLDG. ELECT. PL . z O License Class Lie.Nwuber O w I- Dale 7, 2 Conlmetor r - 01 ❑ Q y J E ¢ w OWNER DER DECLARATION - r' BUILDING PERMIT 'xa ;'1- I hereby affirm(hat 1'am exempt from the Contractor's License MISC.— REFER TO ORD INFORMATION H u.00 Law for the following reason.(Sec.7031.5,Business and Professions 'PERMIT ISSUANCE VALUATION - SIFT, f wff Code:Any city or county whichrequimsapermit toconstrucgalter, 19x00 /q Z ¢ el 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. L_IC.NO. ELEC. �` i a, 0, requires the applicant for such pertni Dto file a signed statement that / w S m he is licensed pursuant to the provision's of the Contractor's License TOTAL C4 .PERMIT TO z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe ° s/N� 4 m c Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT - FEE ' $ the basis for the alleged exemption:Any violation of Section 7031.5 II I' E .- by anyapplicant fora permit subjects the applicant to a civil penalty STORIES TYPE CONSTR. of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 O I,as owner of the property,ar my employees with Wages'aa BACK FLOW PROTECT.DEVICE ' their sole compensation,will do[he work,and the Structure is not 4.DD OCC.GROUP RES.UNITS es intended or offered for sale (Sac. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 ,R,� 3„ / Code:The Contractor's License Law donot apply to an owner of - property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 ' himself or through his awn employees,provided that such Improve. SO.FT.FLOOR AREA TOTAL ACREAGE ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1.INC.40UTLETS 6.00 . z� or improvemenl is sold within one year of completion,the owner- 3 builder will have the burden of proving that he did not build or im. GAS-EA.SYSTEM-OVER 4 (EA.) - . 2,00 BUILDING USE prove for purpose of sale.)' INDUSTRIAL WASTE INTER. 30.00 RE5 IND I. CDN „ PB other ❑ d a5 owner of the proper.t the exclusively contracting with - ❑ , I] O •❑ licensed colons od to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. • 6.00 and Professions Code:The Contractor's License Law does not apply ASSESSORS PARCEL NO. to an'owner of property who builds or improves thereonand who LAWN SPRINKLERS-OVER 5(EA.) 1.00 r con tracts for such projects with a con lractor(a)licensed pa the to - theContractor'sLicenseLaw. SEWER-SANITAR V-STORM EA.200ft/10.00 TRACT NO: PARCEL NO. ❑ •I um exempt under Sec, ' ,B.&P.C.for Ih Ls reason WATER HEATER W/VENT - 6.00 / ] Owner Date - WATER SYSTEMV J ' FILE_ N0. I ,ACC.D TE ACC. s WORKIiRS'COMPENSATION DECLARATION 5'00 WATER TREATING EQUIP, 5.00 I hereby affirm(hat I have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.), g / 9Q Policy No. Company O Certified copy is her furnished. - �,,� �Certif copy is d th the 'nspection division. FIRE$Pfl INK ` ENERGY T 24 � p4 Applicant MISC.- REFER TO ORD. YQ• N� Y � N� , 0-_w CF FICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C. W COMPENSATION INSURANCE PLG.CONTR. CL O (This section Deed not be completed if the perinit i5 LIC,NO. PLG. - TOTAL Y N�. V N[30 Z hundred dollars($100)or less.) fOr one ' U O 1 certify the( in the performance of the work for which(his Per. FEE SUMMARY LL U' .mit,is issued,1 shall not employ any person in any manner So as to DTV. MECHANICAL PERMIT ,FEE (] W become subject to the Workers'Compensation Laws of California. W Date AppliICAN :,IALTER OR ADD TO MECH. 5.00 BUILDING tJ� } m NOTICE TO APPLICANT:, L after making this Certificate of Ex- Z emption,.y06 should become subject to the Workers Compensation APPLIANCE' 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 101000CF.MJ- 4,00 FEE .CONSTRUCTION LENDI NG AGENCY AIR HANDLING UNIT(OVER 10400C.F.M.) 6.00 'SEISMIC FEE �S I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). HEATING UNIT MICROFILM' (TO 100,000 B.T.U.) 6.00 r Lender's Name Lenders Address HEATINGUNIT(OVER100,000B.T.U'.)9.50ELECTRIC 1 certify that I have read this application and state dial the above VENT LAT ON FAN (SINGLE) 4.00 information is correct.1 agree to comply with albcity and county tl ordinances and slate laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING u ,• hereby authorize rePresonlatives Of this City to enter upon the above-mentioned property for inspection purposes. BOI LER-COMP (Oval 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to Save, indemnify and keep harmless the City of MISC,- REFER TO ORD. Cupertino against habi s,IS menu, costs and expenses which CONST.TAX Q may in any way ace ag said C' in consequence of the PERMIT ISSUANCE I10.00 . � 7 gra of this permit - MECH.CONT. LIC.NO. MECH: TOTAL o'!s r n re of Applicant/ pntractor u e TOTAL ' OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING I ERNnT puMBeR CITY , OF CUPERTINO /� QQl INSPECTION DIVISION ' "' k 82x31 JOB INSPECTION RECORD , - PERM IT..EXP,I RATIO ia`z��Dn 11 �eW'�r. JOB ADDRESS o UNIT# LOT# l �( . .c - - PERMIT E9CP.IRES IF WORK OWNER CONTRACTOR IS NOT STARTED WITHIN INSPECTION DATE INSPECTOR INSPECTION RECORD 180DAYS OFPERMITISSU- FOUNDATION C ANCE OR ABO DAYS FROM -.���Y �'� U / �u• V' LAS,CALLED INSPECTION; UFER, PREGUNITE •// b) K a }PEaMrt IAL onnoN • :>: rl POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ? '. •%L•. UNDERGROUND /SLAB PLUMBING ELECTRICAL .. - ISSUANCE DATE MECHANICAL - - - BLDG. ELECT P G. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUI ING RMIT WOOD FL00 IN ORMA_ION • It PLUMBING ( - yAwnnoN - ( /FT. 1 tip- MECHANICAL ELECTRICAL .r, - PERMITTO - FRAMING S INSULATION STORIES,i �•• TYPE CONSTR. ' ' � � _ � ... - *�� - OCC.GROUP RES.UNITS' PLACE'NO SUBFLOOR UNTIL ABOVE HAS BEEN,SIGNED ti • •ROOF ,,_ I I SO,FT.FLOOR AREA TOTAL ACREAGE, DIAPHRAGM" BUILDING USE - RES IND CON 'Ps 00 , APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ . ❑' ❑ ❑ . El ROU ASSESSORS PARCEL NO. GH ' - PLUMBING T. !'1..,--=i GAS-TESTTRACT NO, PARCEL NO. ` MECHANICAL _ � ;;;. ACC.DATE ACC.FILE NO. . - ELECTRICAL J/.�-�-5' .FINALS - - - DATE INSP' - � FRAMING _ _ SAN 0 - - ZONING ENG,SITE.NO., INSULATION . . - PLUMBING - GAS .� MECHANICAL - FIRE SPRINK - ENERGY T-24 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ N❑ Y ❑ NO FLOOD ZONE A.L.U.C., !' LATH-INTERIOR ELECTRICAL S s • LATH-EfERIOR / FIRE-DEPT. - Y.❑ ."❑ °❑ "❑ SHEE KIjL d h GRADE FEE SUMMARY SHEAR I ERIO BUILDING a -( SHEAR EXTERIOR T - TEMPOR RY APPROVALS BUILDING '.�, ./ :•�; FIREWALLS ELECTRIC .PLAN CHECK _ GAS. NO TAPE OR PLASTER UNTIL ABOVE HAS B IGNED OCCUPANCY SEISMIC FEE OCCUPANCY OF BUILDING IS NOTPERMITTED UNTIL BUILDING FINALISSIGNED BY BUILDING INSPECTOR. MICROFILM - ARRANGE FOR INSPECTION BY PHONING 252-4505, ELECTRICLU - ONE.WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBINGO� PLEASE GIVE JOB ADDRESS WHEN PHONING. z II - SEE PERMIT FOR EXPIRATION DATE - MECHANICAL IMPORTANT! CONST.TAX PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL' ; l 1 ' OFFICE COPY , - , APPLICANT TO;FILL IN INFORMATION WITHIN RED LINES— USE BALL POINT PEN ONLY • ` BU LDING PROJECT I DENTI FICATION -'' _ PERMIT NUMBER DING ADDRESS APPLICATION & PERMIT R /S�1 ' O-z • .V 1 . 'BUILDING=ELECTRICAL—PLUMBING—'MECHANICAL � ' 8231 V Z ' NAME Eq'S��//�� 'I' /rW( PLAN CHECK VALIDATION NI1IERr� 1-iIW. •{JrrlVY� Wtt-UQ/I PJ. OTV., PNrE -5436 ELECTRIC PERMIT '`FEE • ` CONTRACTOR'S NAM E- ' � UTLETS-SWITCHES-RECEP 10.00/1.00 /OOy— uCNO, LIGHTING FIXTURES 10.00/1.00 . /' 3 rorvrnScioR'sp ...moi ADDREssL , APPLIANCES-RESIDENTIAL 4.00 I al MIINr "r`e AL PHorvE s�J�y PANELS 10.00 . ARCHrtECT DATE OF APPLICATION DR C�eDL=NNJb PJUD+I170W AIA PANELS (OVER 200 AMP)' 20.00 - • PLAN CHECK FEEP.C.NO. ENGINEER _ uc.NO.G w SIGNS TRANS.' ARCH.OR ENG. ADDq ESs 23895'3Jnont�y"' 12D, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION r, LOS, CO S '.Cfq zIP - $p3p EMP.METER OR POLE INS. APPLICANT'S J�El.$M IS QV�✓ZOw MOTORS P ADDRESS EE SGH, SERVICE CHANGE ' -- - D.00 ,'/a,.�p" D to/1`�q?r4 198 FOO' LICENSED CONTRACTORS DECLARATION TEMP.POLE �j `.) OO a Z0 W I hereby affirm that I am licensed under provisions of Chapter 91 • - ' Z (commencing with Section 7000)of Division 3 of the Business and p ISSUA F w Z Professions Coda and my license is in full fore d ffac - 't ,oI JJp BLDG. ELECT. PL . z O License Class Lie.Nwuber O w I- Dale 7, 2 Conlmetor r - 01 ❑ Q y J E ¢ w OWNER DER DECLARATION - r' BUILDING PERMIT 'xa ;'1- I hereby affirm(hat 1'am exempt from the Contractor's License MISC.— REFER TO ORD INFORMATION H u.00 Law for the following reason.(Sec.7031.5,Business and Professions 'PERMIT ISSUANCE VALUATION - SIFT, f wff Code:Any city or county whichrequimsapermit toconstrucgalter, 19x00 /q Z ¢ el 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. L_IC.NO. ELEC. �` i a, 0, requires the applicant for such pertni Dto file a signed statement that / w S m he is licensed pursuant to the provision's of the Contractor's License TOTAL C4 .PERMIT TO z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe ° s/N� 4 m c Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT - FEE ' $ the basis for the alleged exemption:Any violation of Section 7031.5 II I' E .- by anyapplicant fora permit subjects the applicant to a civil penalty STORIES TYPE CONSTR. of not more than five hundred dollars($500).): ALTER-DRAIN&VENT-WATER (EA.) 5.00 O I,as owner of the property,ar my employees with Wages'aa BACK FLOW PROTECT.DEVICE ' their sole compensation,will do[he work,and the Structure is not 4.DD OCC.GROUP RES.UNITS es intended or offered for sale (Sac. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00 ,R,� 3„ / Code:The Contractor's License Law donot apply to an owner of - property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 ' himself or through his awn employees,provided that such Improve. SO.FT.FLOOR AREA TOTAL ACREAGE ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1.INC.40UTLETS 6.00 . z� or improvemenl is sold within one year of completion,the owner- 3 builder will have the burden of proving that he did not build or im. GAS-EA.SYSTEM-OVER 4 (EA.) - . 2,00 BUILDING USE prove for purpose of sale.)' INDUSTRIAL WASTE INTER. 30.00 RE5 IND I. CDN „ PB other ❑ d a5 owner of the proper.t the exclusively contracting with - ❑ , I] O •❑ licensed colons od to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. • 6.00 and Professions Code:The Contractor's License Law does not apply ASSESSORS PARCEL NO. to an'owner of property who builds or improves thereonand who LAWN SPRINKLERS-OVER 5(EA.) 1.00 r con tracts for such projects with a con lractor(a)licensed pa the to - theContractor'sLicenseLaw. SEWER-SANITAR V-STORM EA.200ft/10.00 TRACT NO: PARCEL NO. ❑ •I um exempt under Sec, ' ,B.&P.C.for Ih Ls reason WATER HEATER W/VENT - 6.00 / ] Owner Date - WATER SYSTEMV J ' FILE_ N0. I ,ACC.D TE ACC. s WORKIiRS'COMPENSATION DECLARATION 5'00 WATER TREATING EQUIP, 5.00 I hereby affirm(hat I have a certificate of consent to self-insure, or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO. copy thereof(Sec.3800,Lab.C.), g / 9Q Policy No. Company O Certified copy is her furnished. - �,,� �Certif copy is d th the 'nspection division. FIRE$Pfl INK ` ENERGY T 24 � p4 Applicant MISC.- REFER TO ORD. YQ• N� Y � N� , 0-_w CF FICATEOF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C. W COMPENSATION INSURANCE PLG.CONTR. CL O (This section Deed not be completed if the perinit i5 LIC,NO. PLG. - TOTAL Y N�. V N[30 Z hundred dollars($100)or less.) fOr one ' U O 1 certify the( in the performance of the work for which(his Per. FEE SUMMARY LL U' .mit,is issued,1 shall not employ any person in any manner So as to DTV. MECHANICAL PERMIT ,FEE (] W become subject to the Workers'Compensation Laws of California. W Date AppliICAN :,IALTER OR ADD TO MECH. 5.00 BUILDING tJ� } m NOTICE TO APPLICANT:, L after making this Certificate of Ex- Z emption,.y06 should become subject to the Workers Compensation APPLIANCE' 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 101000CF.MJ- 4,00 FEE .CONSTRUCTION LENDI NG AGENCY AIR HANDLING UNIT(OVER 10400C.F.M.) 6.00 'SEISMIC FEE �S I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). HEATING UNIT MICROFILM' (TO 100,000 B.T.U.) 6.00 r Lender's Name Lenders Address HEATINGUNIT(OVER100,000B.T.U'.)9.50ELECTRIC 1 certify that I have read this application and state dial the above VENT LAT ON FAN (SINGLE) 4.00 information is correct.1 agree to comply with albcity and county tl ordinances and slate laws relating to building construction, and BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 6.00 PLUMBING u ,• hereby authorize rePresonlatives Of this City to enter upon the above-mentioned property for inspection purposes. BOI LER-COMP (Oval 100,000 BTU)SEE FEE SCH. MECHANICAL (We) agree to Save, indemnify and keep harmless the City of MISC,- REFER TO ORD. Cupertino against habi s,IS menu, costs and expenses which CONST.TAX Q may in any way ace ag said C' in consequence of the PERMIT ISSUANCE I10.00 . � 7 gra of this permit - MECH.CONT. LIC.NO. MECH: TOTAL o'!s r n re of Applicant/ pntractor u e TOTAL ' OFFICE COPY