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10242 APPLICANT TO FILL ININFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDINGAPPLICATION & PERMIT O e� A r) (� ADDRESS oO' 61A+61, � / G �F �/If/ BUILDING -ELECTRICAL-PLUMBING-MECHANICAL O NER'S es f�S t� 7�j� OTV. ELECTRIC PERMIT FEE PLAN CHECK VALIDATION H ,. NA ""-"S �ONE a 5-0 rcuAMTRA TORS r' e P OUTLETS-SWITCHES-RECEP 10.00/1.00 7 C .� /L a o00 Ivew LIGHTING FIXTURES 10.00/1.00 ADDRESSTOR'BY♦ /1 /n APPLIANCES-RESIDENTIAL 4.00 V U1 lD mt PHONE /']/y// PANELS 10.00 DATE OF APPLICATION ARCNITECT FE DR /� PANELS (OVER 200 AMP) 20.00 PLAN CHECK E P.C.NO.. ENGINEER/ / /', SIGNS TRANS. 3.00 ARCH.OR ENG, PERMIT VALIDATION ADOREss ..Si4Nd�e SPECIAL CIRCUIT 5.00 / oa er .4Ne ZIP TEMP.METER OR POLE INS. 20.00 APPLICANTS ADORES$CT.. ^ � tf ®Jz MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 w o o LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00 iQ w I hereby ffff[�m� t i l,aam lice n d under provisions of Chapter 9 ISSUANCE DATE ,a ¢ d fcommcn I�6[YHA eti,--,,��rr��,�yy� f Division 3 of the Business and BLDG. ELECT. PLG. M H N z Professions C�de y�C�nly in full for Z 0.- License lass - L55222222"'''"'''"Number w h w Dale 7�-_Conlmcfor Q y s BUILDING PERM Ic a w a OWNF-R.BUILDER DECLARATION ° A ° - MISC.- REFER TO ORD INFORMATIO w ; H I hereby affirm that 1 am exempt from the Contractor's License VALUATION $/FT. o¢ Lew for the following reason.(Sec.7031.5,Business and Professions ar a. y PERMIT ISSUANCE 10.00 w Code:Any City or County which requires a permit to construct,alter, 2 C Q O improve,demolish,or repair any structure,poor to its issuance,also ELEC.CONTR. LIC.NO. ELEC. i °°M requires the applicant for such permit to file a signed statement that TOTAL w b y he is licensed pursuant to the provisions of the Contractors License PE MIT TO FZr Law(Chapter 9(commencing with Section 7000)ofDivision 3 ofthe Q Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT FEE the basis for the alleged exemption.Any violation of Section 7031.5 ORI TYPE CON R. dF,_ by any applicant for a permit subjects the applicant toacivil penalty ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not more than five hundred dollars(8500).1: ❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT. DEVICE 4.00 DCC.GROUP RES.UNITS their sole compensation,will do the work,and the I Torture is not intended or offered for sale(Sec. 7044, Business and ProfessionsDRAINS-FLOOR,ROOF,AREA,CON D. 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 SQ.FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve- mentsamnotintendedor offered farsale,If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion,Lhe owner- GAS-EASYSTEM-OVER 4 (EA.) 2.00 builder will have the burden of proving that he did not build or an. . BUILDING USE prove for purpose of sale.). RES IND CON PB Other ❑ 1,as owner of the property,am exclusively Contracting with INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 600 ASSESSOR PARCEL 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 contractors)licensed pursuant to the Contractor's License Law. SEWER-SAN ITARV-STORM EA.200ft/10.00 TRACT NO. PARCEL NO. O lam exempt under Sec. •,B.&P.C.far this WATER HEATER W/VENT 6.00 rCUSam Owner - Date WATER SYSTEM 5.00 Ace.cATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 I hereby affirm that I.have a certificate of gansenf jo insure. ZONING or a certif c��_ab�Py�1qf ��kk Cy ,r7cerlil'ial ENG.SITE NO, copy'hered((sy,1CN'60tS:1.'�j. s/7 G Pgliyy No.// CompunS' O a Certified copy is hemb f in ed. FIRE SPRINK ENERGY T-24 Z Z ❑ Certifie o 's fl he city inspection division. MISC.- REFER TO ORD. O APPlicanl �s�a y❑ N❑ y E] NF] Cc'N CERTIFICATE OEXEMPTION PW ROM WORKERS' PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.U.O. LL > COMPENSATION INSURANCEPL TH, s LIC.NO, PLG. CL Z (This section need not be completed if the permit is for nom /$// TOTAL Y[D NE] Y ❑ NC] hundred dollars($100)or less.) U O I certify that in the performance of the work for which this per. OTY MECHANICAL PERMIT FEE FEE SUMMARY LL U mit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. O i Dare ApplicantBUILDING �- W NOTICE TO APPLICANT: If,after making this Certificate of F:x- ALTER OR ADD TO MECH. 5.00 L.. Z emption,you should become subject to the Workers'Compensalion APPLIANCE 5.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=CFM.) 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.), HEATING UNIT (TO 100,000 B.T.U.) 8.00 Lender's Name HEATING UNIT 100,000 B.T.U.)9.50 Lender's address ELECTRIC I certify that 1 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 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 10r 100,000 BTUI SEE FEE SCH. MECHANICAL above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MIS RE ERT ORD. Cupertino against liabilities,judgments costsand expenses which PER T ISSUANCE 10.00 CONST.TAX I may in any way accrue egains said City in consequence of the I gmnfin of this permit MECH,CONT. LIC.NO. MECH. l_ TOTAL QI SlgnaNre of Apphcanl/Contracmr API Date 1W 1 GB 3q all' Z� TOTAL / OFFICE COPY