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11379• A APPLICANT TO FILL IN IN,,FQRMATION WITHIN RED LINES - US�BALL POINT PEN ONLY •, BUI LDI NG PROJECT I DENTI IATION APPLICATION & MIT BUILDING - ELECTRICAL- PLUMBING -MECHANICAL PERMIT NUMBER 11379 BUIL INDRESSG - AD S L�- r OWNER "nate QTY. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION Cox TRACTORS CfD NAME UTLETS-SWITCHES -RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 �LI-�CI-RlG LIC. No, 47 corvrneCTORs Lam. ADDRESS PPLIANCES- RESIDENTIAL 4.00 PANELS 10.00 PANELS (OVER 200 AMP) 20.00 ..11 ��q 40 �G� tW PRONE Ll S ARCHITECTNGINEEP EI/ DATE OF APPLICATION PLAN CHECK FEE P.C. NO. SIGNS TRANS. 3.00 AN H. ENa ADOPESS BS SPECIAL CIRCUIT 5.00 PERMIT VALIDATION PAID EMP. METER OR POLE INS. 20.Opk ZIP JUN 3 0 10u °Oeillnu APPLICANTS ADORESa R C'� �xC� �j; JJ . MOTORS SEE FEE SCH. SERVICE CHANGE 20,00 LICENSED CONTRACTORS DEC ARATION / 1 hereby affirm that 1 am licensed under provisions of Chapter9 V U C ATE 0951 (commencing with Section 7000) of Division 3 of the Business and BLDG. E ECT. I.G. MECH. Professions Code, a A license is in full fort a d IT License la / Lic. Number f Date_�et..7yr Cyy Contractor _ IG ❑ ❑ ❑ � BU DING PERMIT OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (See. 7031.5, Business and Professions Code; Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License MFORMATION MISC. - REFER TO ORD VALUATION $/FT. PERMIT ISSUANCE 10.00 ELEC. CONTR. LIC. NO. EL EC.. TOTAL PERMIT TO OTY, PLUMBING PERMIT FEE 1 Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempLrherefrom and the basis for the alleged exemption. Any violation of Section 7031.$ S DRIES PE CONSTR. ALTER-DRAIN&VENT-WATER (EA.) 5.00 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500L): ❑ 1, as owner of the properly, or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions BACK FLOW PROTECT. DEVICE 4.00 OCC. GROUP - RES. UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 Code: The Contractor's License Law does not apply to an owner at property who builds or improves thereon, and who does such work F IXTUR ES - PER TRAP 5.00 SG. FT, FLOOR AREA TOTAL ACREAGE himself or through his own employees, provided that such Report". mems are not intended or offered for sale. If, however, lire building GAS - EA. SYSTEM - I INC.4 OUTLETS 6.00 Limprovement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or an- prove for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business GAS - EA. SYSTEM - OVER 4 (EA.) 2.00 BUILDING USE REB' IND O PB Other ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS - 1 INC 5 V.B. 6.00 A5.9E580 P RCEL NO. and Professions Code: 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 contrachuds) licensed pursuant to the Contractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACTNO. PARCEL NO. ❑ [am exempt under Sec. B.&P.C,'a' "his reason WATER HEATER W/VENT 6.00 Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I have a certificate ofconsen" m self -insure, or a artificale of Workers' Compensation Insurance, or a Certified ZONING ENG. SITE N0. copy thereof(Sec. 3800, Lab.C.). Company FIRE SPRINK 'ENERGY T-24 py is hereby furnished y is Blc wm b m iI pettier div on. L�! -• �'i/s1'z Y ❑ N ❑ Y❑ N❑ATE MISC. - REFER TO ORD. PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.O. OF EXEMPTION FROM WORK ERS' M PLG. CONTR. LIC. NO. - PLG. TOTAL O M PI?NSATION INSURANCIi not he completed if the permit is for one N❑eed ITV. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars ($100) or less.) I certify that in the performance of the work for which this per. mi" is issued, I shall not employ any person in any mannerso as to become subject to rhe Workers' Compensation Laws of Californiu. Dam Applicant NOTICE TO APPLICANT: If, after making this Certificate of Ex emplion, you should become subject to 0m Workers' Compensation BUILDING ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK provisions of the Labor Cade, you must forthwith comply with such provisions or this permit shall be deemed revoked. FEE AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 AIR HANDLING UNIT (OVER 10,000C.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ.CJ. HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC Lender's Name Lender's Address 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and slate laws relating to building construction. and VENTILATION FAN (SINGLE) 4.00 PLUMBING BOILER -COMP (3 H.P. or 100,000 B.T.U.). 6.00 BOILER -COMP (over 100,000 BTU) SEE FEE SCH. MECHANICAL hereby authorize representatives of this city to enter upon. the .have mentiproperty for inspection purposes. no keep harmless the City of Cope o ag s[ liabilitieRIs, costs and expenses which m in any way acere d Ctry 'n consequence of the (We) tee save, inrant MISC. - REFER TO ORD. CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL TOTAL tmgo fsp raft �p a Signal re of Applicant/C tractor Dalk OFFICE COPY ELECTRIC SERVICE NOTICE P.G. b E. COPY BUILDING INSPECTORS NOTICE CITY QFCUPERTINO Inti-Cti .. To s You are hereby authorized to Connect electrical service for No. of Wires Size of Wires Size of Switch / Motor Load - Voltage Phase Heating Load K. W. Voltage Light 110 New Service_�Reconnect Na. of Meters Heat 120Three Wire More Service No. of Add. Meters Power'Three Phase Move Meter OO • ELECTRICAL INSPECTOR ELECTRIC SERVICE NOTICE ,L BUILDING INSPECTOR'S NOTICE CITVF CUPERTINO ToI--� You are hereby authorized to Connect electrical service for 'Owner or Tenant At myna- 419, �. No. of Wires Size of Wires t' Major Load Voltage _ Heating Load K. W._ OFFICE COPY Size of Switch 6M • Light I10 _New Service Reconnect i No. of Meters t Hear 1P0ihree Wire More Service i No. of Add, Meters nF Power Three Phase Mave Meier I' / @• ELECTRICAL INSPECTOR `�-n'/.L/`✓� r"