09575 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT 1 DENTI FICATION PERMIT NUMBER
BUILDING APPLICATION & PERMIT 09575
ADDRESS
1046 Cranberry Drive BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S • y PLAN CHECK VALIDATION
NAME QTY.'` +rELECTRIC PERMITt -4•H' FEE;�
Tom Clayton PHONE 255-6385
CONTRACTOR
NAME UTLETS•SWITCHES-RECEP 10.00/1.00
N
Atlas LID.ND. 465266 ILIGHTING FIXTURES 10.00/1.00
CONTRACTOR'SPPLIANCES-RESIDENTIAL 4.00
ADORE ss
155 Commercial St. PHON739-o516 PANELS 10.00 DATE OF APPLICATION
ARCHITECT Sunnyvale, 9457T_ PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.No. SIGNS TRANS. 3.00
ARCH.
DD ESS ENc' SPECIAL CIRCUIT S.00 PERMIT VALIDATION
ZIP TEMP.METER OR POLE INS. 20.00
APPLICANT'S MOTORS SEE FEE SCH.
ADDRESS v`
SERVICE CHANGE 20.00
Woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 �YL'•
a v u 1 hereby affirm that 1 am licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. I PLG. MECH.
N i Professions Code,and my license is in full force Rd�e t ❑ ❑ ❑ y�
i O set - License Class Lie.Number las
o N w Date Contractor
¢ y •>?� ,.BUILDING PERMIT,�;r#4--'j
¢ 0 w " OWNER-BUILDER DECLARATION '•:.'?.,CINF.ORMATION,<';k':^lr'''
AOA MISC.- REFER TO ORD
W r. ti I hereby affirm that I am exempt from the Contractor s License VALUATION S/FT.
U.
Law for the following reason.(Sec.7031.5.Businessind Professions PERMIT ISSUANCE 10.00
Ewwf Code:Any city or county which requires a permit to construct.alter,
2 ¢ ¢O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
D Q requires the applicant for Such permit to file a signed Statement that TOTAL PERMIT TO
w m N he is licensed pursuant to the provisions of the Contractor's License
a
Law(Chapter 9(commencing with Section 7000)of Division 3 of the :'ts /�/ •i o Business and Professions Code)Cr that he is exempt therefrom and OTV.'- e't PLUMBING PERMIT.: y`6 L FEE'"
je s-$ the basis for the alleged exemption.Any violation of Section 7031.5 _ :, .::"•. -• �`•r-s •� - _ ) '1-'P, STORIES TYPE CONSTR.
w. by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00
of not more than five hundred dollars SSW).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 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. 5.00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SD.FT.FLOOR AREA TOTAL ACREAGE
metals re not hrough
ownemployees,for Sale.
If.
ed that however,the
improve- GAS-EA.SYSTEM-1 6.00
menti are not intended or offered for sale.If.however.[he building
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.1 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im RES IND CON PB Omer
prove for purpose of sale.). INDUSTR IAL WASTE INTER. 30.00
❑ 1,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCELNO.
and Professions Code:The Contractor's License Law does not apply
to an owner of properly who builds or improves thereon.and who LAWN SPRINKLERS•OVER 5(EA.) 1.00
contracts for such projects with a contractorls)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec.-.BAP.C.for this WATER HEATER W/VENT 6.00
reason
Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that 1 have a certificate of consent to self-insure. ZONING ENG.SITE NO.
or a certificate of Workers'Compensation Insurance,or a certified
copy thereeG 0,Lab.Cp.ny 1. Allied Pac.
Policy No.Gl ompany
Q -[Z•Certified copy is hereby furnished. FIRE SPRINK ENERGY T24
'�`ant-fie filed with the city inspection division.
Zp Applicant A'�yd,.� MISC.- REFER TO ORD. v❑ N v ❑ N❑
CCy CERTIFICATE OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOODZONE A.L.U.C.
W > COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CL O (This section need not be completed if the permit is for one TOTAL Y F] N❑ Y [:] N[]
=1 Z hundred dollars IS 100)or less.l - 1V
V O 1 certify that in the performance of the work for which this per- OTV: . MECHANICA Is FEE FEE'SUMMARV ...,IJ q,
UL I- mit is issued,1 shall not employ any person in any manner so as to - "i '
U become subject to the Workers'Compensation Laws of California.
O W Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} y NOTICE TO APPLICANT: If,after making this Certificate of Ex t
� Z emplion•you should became subject to the Workers'Compensation APPLIANCE C.,;) I"' "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 10,0MC.F.M1, 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT IOV 1QP&dFWI&0O SEISMIC FEE
1 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. o MICROFILM
3097.Civ.C.). 1 HEATING UNIT(TO 100,000B.T.U.) 8.00 V
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
Lender's Address
I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county PLUMBING
Yt ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,00 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOI LER-COMP Over 100,000 B UI SEE FEE SCH. MECHANICAL /
•' above-mentioned property for inspection purposes.
(We) agree to save. indemnify and keep harmless the City of MISC.- FE O R,
Cupertino against liabilities,judgments, costs and expenses whichCONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 1 0/w
n.00
gmnti crib permit MECH.CONT,-7_ LI O. MECN.
x s•n TOTAL
.,i �i^
;,_TOTAL:,;.
Signaturepplicant/ ontrac ate Atlas 465266 $18.00 T.
OFFICE COPY