11580 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION '• PERMIT NUMBER
BUILDING APPLICATION & PERMIT 11580
ADDRESS
10431 N. De"an BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME 408 QTY. ELECTRIC PERMIT FEE
•
Apple Computer PHONE 996-1010
NAMER"cTOR's UTLETS-SWITCHES-RECEP 10.00/1.00
Carl Holvick Co. LIC NO 170234 ILIGHTING FIXTURES 10.00/1.00
oEssTOR'a RES
IDENTIAL 4.00mo 94303 41.", JAPPLIANCES-
Box 10845 Palo Alt(r)HONE 960-• r
PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS.(OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGIN ER
uc.No.r`1 ORS(1 SIGNS TRANS. 3.00
ARCH OR ENf',.}1960 The .Uameda, Ste 18 XABFRIAIJI�LIGATION
ADDRESS SPECIAL CIRCUIT 5.00
zip 99 126 TEMP.METER OR POLE INS. 20.00
G
f+
APPLICANS MOTORS SEE FEE SCH. _ 01 �4�='J
T
ADDRESS
Box 10R4S, Palo Mtn, C4303 SERVICE CHANGE 20.00 City of Cupertino
LICENSED CONTRACTORS DECLARATION
¢u U -I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
aHi Q w (Commencing with Section 7000)Of Division 3 Of the Business and BLO , ELECT. - PLG. MECH,
H N i Professions Code and my license is in full is :nd eeffect. ❑ ❑ ❑
z o A- License a Lie.Numb
to m F w Date ConUactoAl
¢ y L BUILDING PERMIT
¢ ¢ w OWNER-BUILDER D . ARATION INFORMATION
`x o u N 1 hereby affirm that 1 am exempt from the Conine is License MISC.- REFER TO ORD
w �+u y p VALUATION $/FT.
H ¢ o¢ Law for the fallowing reason.(Sec.703 LS,Business d Professions PERMIT ISSUANCE 10.00
Code:Any city or county which requiresa permit construct,alter,
¢2Q0 improve,demolish,or repair any structure,prio o its issuance,also ELEC.CONTE. LIC.NO. ELEC. 25,000
-0¢ requires the applicant for such permit to file aimed statement that TOTAL PERMIT TO
K
8 he is licensed pursuant to the provisions of a Contractor's License
i
Law(Chapter 9(commencing with Sectio 000)of Division3ofthe
q ic Business and Professions Code)or Dix to is exempt therefrom and QTY. PLUMBING PERMIT FEE Demolish 2 Bld S.
¢ I- the basis for the alleged exemption. y violation of Section 7011.5 STORIES TYPE CONS7W
d ; by any applicant for a permit Subic s the applicant to a civil penalty ALTER-DRAIN IEA.) 5.00
of not more than five hundred d ars(5500).):
❑ 1,as owner of the prop y or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 DCC.GROUP RES.0 NITS
their sale compensation,wit o the work,and the structure is not
intended or offered for (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CONDE 5.00
Code:The Contractor's cense Law does not apply to an owner of
property who builds ar mproves thereon,and who does such work FIXTURES-PER TRAP 5.00 SD FT.FLOOR AREA TOTALACREAGE
himselforthroughhi own employees.provided that such improve- GAS-EA.SVSTEM-11NC.40UTLETS 6.00
ments are not intim d or offered for sale,If,however,the building
or improvement i Id within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDIN USE
builder will have he burden of proving that he did not build or im. RES IND PB Diner
prove for purp ofsaleJ. INDUSTRIAL WASTE INTER. 30.00
❑ 1,as a or of the property,am exclusively contracting with El 13 ❑ ❑
licensed c° Tactors to construct the project(Sec. 7044,Business ILAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSES57 P CLL NO.
and Profs ons Code:The Contractor's License Law does not apply
to an o er of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contra for such projects witha Conlraclor(s)licensed pursuant to
SEWER•SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO.
the C tractor's License Luw.
❑ lam exempt under Sec. ,B.&P.C.for this WATER HEATER W/VENT 6.00
Tea n
O el Oate WATER SYSTEM 5.00
ACC.GATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affum that I have a certificate of consent boself-insure, '
or a certificate of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
copy thenrsfsSau.J Lab.C.). -
Policy N rllAAllllllllllJJUUll11 mean
(] ❑ Cert' op is here u fished. FIRE SPRINK ENERGY T-ia
Z Z p Car fie is a le c' i; in tion division. MI REFER TO ORD. '
O Applicant '- Y ❑ N❑ V ❑ N❑
F -y PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.L.
Lu IFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE ._.�� PLG.CONTR. LIC.NO. PLG.
EL O (This section need not be completed if tha.t� tl s fur one TOTAL Y❑ N❑ V❑ N❑
:) Z hundred dolhoi($100)or less.)
U O 1 certify that in the performysL ofe f the work for which this per. QTY. MECHANICAL PERMIT FEE FEE SUMMARY
LL F mit is issued.I shall noyyr�mm��toy any person in any manner so as to
U become subject M(EWorkcri Compensation Laws of California.
O EL Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
} N TO APPLICANT: If,after making this Certificate of Ex-
I.. z erilplion,you should become subject to the Workers'Compensation APPLIANCE5.00 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 10,000C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 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. MICROFILM
3097,Civ.C.). _(yODE
Lender's Address HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
1 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
ordinances and state laws relating to building construction, and BOILER-COMPI3 H.P.or 100,000 B.T.U.) 6.00
'• hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 700,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD.
Cupertino agai st liabil'us,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX
may ' sRe s y ac I ainst said ity consequence of the ,�^fl
gr ling fth' pen It. MECH.CONT. LIC.NO. MECH.TOTAL TOTAL
to o' pplicant/CiAlffalloi Data
OFFICE COPY