2439 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
aDILDING APPLICATION & PERMIT /� A F�
♦ aooR ss y X / Q
��/� BUILDING -ELECTRICAL-PLUMBING-MECHANICA4
L / , La 3 d
OWNER'S - - - - -- - --
NAME PLAN CHECK VALIDATION
� Sf Z'9tt` QTY. ELECTRIC PERMIT FEE
l '�'7 PHONE J'
CONTRACTORS
NAME t0 OUTLETS-SWITCHES-RECEP 5.00/1.00 ,N
uc.No. LIGHTING FIXTURES 5.00/1.00 '
CON ACTOR'S h
AD Ess APPLIANCES-RESIDENTIAL 4.00 t
_ PHONE ANELS 5.00 DATE OF APPLICATION .k
CHITECT PLAN CHECK FEE P.C.NO.
OR SIGNS 6.00 ,
ENGINEER -
uc.No. SIGNS TRANS. 3.00
AN 'Ess ENa. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 15.00 • n J� 4
APPucnrvrs
ADDRESS MOTORS SEE FEE SCH.
�
�- SERVICE CHANGE 10.00
La w o LICENSED CONTRACTORS DECLARATION F
a Ow I hereby a(fum that 1 am licensed under Provisions of Chapter 9 ISSUANCE DATE
w< (commencing with Section 70001 of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H w i Rofessions Code,and my license is in full tone and effect. cz- U El
O w - icenu�'la Lic.Number��As�
9 m a w UutelT Contractor
a x -. BUILDING PERMIT
Ica
OWNER-BUILDER am exempt DECLARATION
o a D INFORMATION
X ;LL N 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
F u O a Law for the following reason.(Sec.7031.5.Business and Professions PERMIT ISSUANCE �,ep. VALUATION $/FT.
Code:An 5.00
w ycityor coo ntywhiny structure permit
II ¢ Q O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. -
O LL requires the applicant for such permit to file a signed statement that TOTAL r' _
w $ he is licensed pursuant to the provisions of the Contractor's License PERMIT TO
r z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe tLeG7-
Q
iBusiness and Professions Code)or that he is exempt therefrom and QTY. IS PERMIT FEE -
f0
¢I-$ the basis for the alleged exemption.Any violation of Section 703L5 STORIES TYPE CONSTR.
by any applicant Bora permit subjects the applicant Ina civil penally ALTER-DRAIN -WATER (EA.) 4.00
of not more than live hundred dollars(45001.10),):
❑ I,as owner of the property,or my emPloyecs with wages as BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS
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 does such work FIXTURES-PER TRAP 4.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve•' GAS-EA.SYSTEM-1INC.4OUTLETS 4.00 -
ments are not intended or offered for sale.If,however,the building
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 RES IND CON Pa Omer
prove for purpose ofsalt.). INDUSTRIAL WASTE INTER. 20.00
JP( 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. 5.00 ASSESSORS PARCEL NO.
and Professions Cad¢The Contractor's License Law does not apply
to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5 (EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to
life Contractor,Cicensc Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ 1 am'exemptinder Sec. 711 ,B.51!C.I'.,this WATER HEATER W/VENT 4.00
reason
Date 7 Owner WATER SVSTEM 4.00 ACC.DATE ACC.FILE NO.
WORK ERS'COMPBNSAI'ION DECLARATI � WATER TREATING EQUIP. 4.00
I hereby affirm that I have a certificate of consent to self-insure, ZONING or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO-
COPY thereof(Sec.3800,Lxb,C.).
Policy No. Company
O ❑ CrNified copyj5,heodby furnished. FIRE SPRINK ENERGY T 24'
Z 2 ❑ Certified Is file!y y` /f� nmspection division. MISC..- REFER TO ORD.
Applicant K - '/ `//�/A v❑ N❑ v ❑ _N,❑
rn PERMIT ISSUANCE 6.00 FLOOD zorvE A.L.u.c.
CC CIiRTIRCA i 01°17XI'-MPTION FROh1 WDRKIiRS'
UJ COMPENSATION INSURANCE PLG.CONTR. LPL.NO, PLG.
IL 0 (This section need not be completed if the Permit is ((it one TOTAL Y❑ N❑' v C3
hundred dollars(S 100)or loss.)
U O I certify that in the performance of the work for which this per- OTV MECHANICAL PERMIT FEE FEE SUMMARY
LL {- mit is issued,I shall not employ any person in any manner so m to r
U became subjec,to the Worker,Compensation Laws of California.
w
Date-Applicant r BUILDING
aALTER OR ADD TO MECH. 4.00
,} m NOTICE TO APPLICANT: If,after making this Certificate of Ex-
1... ? emption,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 10PMC.F.M.1 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0,000C.F.M.) 5.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.CJ. HEATING UNIT PTO 100,000 B.T.U.) 4.00
Lender's Name ���� J,�
Lender,AdJre ��,e�/ -fes HEATING UNIT(OVER 100,0008.T.U.17.50 ELECTRIC
I certify that I 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 nt
couy PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4.00'
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 110,000 BTU)SEE FEE SCH. MECHANICAL
ubovo-mtnliontd Property for inspection purposes.
(We) agree to save, indemnify and keep hormless the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments, Costs and expenses which CONST.TAX
may in any way accrue against said City in consequence of the PERMIT ISSUANCE 3.00
grantingoft ' permit MECR.CONT. LIC.NO. MECH,
2. TOTAL TOTAL
Signature o Y pplhcun[/ oar,char Pate
OFFICE COPY
• Citi of Cupertira
10300 Torre Ave March 21,' 1983
(408) 252-4505
Ext: 228,229
Mr. Bud Hoffman
10495 N. De Anza Blvd.
Cupertino, Ca. 95014
Dear Mr, Hoffman:
After reviewing. our files, we find that permit no. 2439
• issued on 9-1-82 for electrical permit
has exceeded the maximum alloted time of 180 days since:
® 1.) Permit was issued.
2. ) Last called inspection.
Options for renewal are listed under Sect. 303(d) 1979 Uniform
Building Code. (enclosed)
In order to close our files, your cooperation would be appreciated.
CITY OF CUPERTINO
/
Jo' hnBusto
Building Official
JB:jj
•