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2265 APPLICANT.TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PENONLn BUILDING PROJECT IDENTI FICATION ,APPLICATION,& PERMIT P Ir UMBER euIT N A IDR EZZ Ess BUILDING- ELECTRICAL—PLUMBING —MECHANICAL - OWNER'S PLAN CHECK VALIDATION NAME - QTY. ELECTRIC PERMIT FEE ACTOR'S PHONE NAME Z - NA .. ' OUTLETS-SWITCHES-RECEP 5.00/1.00 LICNO. LIGHTING FIXTURES 5:00/1.00 OT RACrGR'$ESS APPLIANCES:RESIDENTIAL 4.00 CONTRACTOR PHONE PANELS 5.00 DATE OF.APPLICATION' ARCHITECT - SIGNS 6.00 ENGINEER PLAN CHECK FEE .C.NO. OR ' LIC,NO. SIGNS TRANS. - 3.00 ' ENGINEER ENG' ,. SPECIAL CIRCUIT - 5.00 PERMIT VALIDATION . TIP TEMP.METER OR POLE INS. 15.00 - APPLICANTS MOTORS SEE FEE SCH. ADDRESSOREss SERVICE'CHANGE 10.013 , , 0 2 LICENSED CONI'RACI'ORS DECLARATION �0 Z. U I hereby affirm That I or;licensed under piovisions of Chupmr 9 ISSUANCE.DATE Z w (commencing with Section 70001 of Division 3 of the Business and' a e. 2 81982BLDG. ELECT. PLG. MECH. F L i Professions Code,and my license is in full or and effect ❑ ® ❑ ❑ ZO i L'i 0 License Class .tic m Nuber Date Contractor BUILDING PERMIT a x« a OWNER-BUILDER DECLARATION w u INFORMATION w ;n I hereby affirm that I am exenlpt'fmm the Contractor's License MISC.— — REFER TO ORD 1 U. VALUATION $/FT. HLLoa Law forthe following reason, 7031.5,Business and Professions PERMIT ISSUANCE 6.00 Yes 5 Code:Any city or county which ouppiresa permit toconstnmt,alter, - Ie LC G 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIC.NO. ELEC. Q°S/ f[ requires the applicant for spell pernut t0 file'a signed Statement that TOTAL / PERMIT TO w roa. -he is licensed pursuant to the provisions of the Contractor's License ` r Z i Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe a Rusioess'and Professions Code)or that he isexempt therefrom and OTV. PLUMBING PERMIT FEE M F o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. aim by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 4,0D of not are than five hundred dollars(55001.1:. - - ❑ 1:as owner of the property,,or my employees with wages as _ BACK FLOW PROTECT.DEVICE 2,00 OCG GROUP BEs.urvtrS 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. 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 4.0.0 SO,FT.FLOOR AREA TOTALACREAGE • himself or through his own employees,provided Him such"improve- ' -EA.SYSTEM-1 q,00 mentsare not intended or Offered for Sale.IL however,the.building GAS 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 m_ RES IND CON PB Other prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 El -IN CO .� ❑ I,as owner of the property,uexclusively 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 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 wit,a conlruclorfs)licensed Inrsuatr to - tireContractor'sLicenseLaw. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO, PARCEL NO. O I am exempt under Sec. ,B.&PC.for this at ' WATER HEATER W/VENT 4,00 D X Date Saner WATER SYSTEM 4.00 ACC.DATE ACC.FILE No. WORKERS'COStP17NSA'1'ION DECLARATION” WATER TREATING EQUIP. 4.00 - I hereby affirm that I have a certificate of consent to self-insure. or a certificate of Workers Compensation Insurance,or a certified _ ZONING ENG,SITE N0, copy thereat(See.3800,Lab,CA Policy No. Company Q ❑ CL,ified copy is hereby furnished. FIRE SPRINK ENERGY T-24 Z ❑ Certified dopy is filed with the city inspection division. MISC.- REFER TO ORD. - O Applicant Y N� V ' O IN N 6 PERMIT ISSUANCE 6.00 LU — CIiRI'IPICCOMPNSAiION INS FROM N'ORKIiRS' FLOOD ZONE A.L.u.c. W COMPF.NSKI'ION INSURANCE PLG.CONTR. .LIC.NO. PLG. CL 0 (This section need not be completed if the permit is for one TOTAL V❑ N❑ Y❑ NQ hundred dollars IS 100)or less I r' U O I certify that in the performance of the work for which this per. OTV. MECHANICAL PERMIT FEE FEE SUMMARY LL F- it is issued, I shall not Cmploy any person in any manner sons W O L) become subject to the Worker Compensation Laws of California. ad a Da(O Applicant ALTER OR ADD TO MECH. 4.00 BUILDING } U) NOTICE '10 APPLICANT: If,after making this Certificate of Ex- ).,_ Z emption,you should become subject to the Workeri Compenvuion APPLIANCE 4.00 PLAN CHECK Provisions of tine Laboi COLIC, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. - AIR HANDLING UNIT(TO 10,000C.F.M.)- 3.00 - CONSTRUCTIONLENDINGAGENCY AIR HANDLING UNIT MER 10,0000fiM.) 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.C.). HEATING UNIT(TO 100,000 B.T.U.) ,4.00 Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50 Lenders AAdrgss ELECTRIC I Certify that 1 have read this application and slate Hot the above VENTILATION FAN (SINGLE) 3.00 ' Ffmolaces ordinaccs correct. I agree to comply with all city and county BOILER-COMP(3 H.P.Or 100,000 B.T.U.) 4.00 PLUMBING` and state laws relating In building construction, and hereby mdhoriee,representatives mf this city to Cuter upon the 801 LER-COMP e (Over 100.600 BTU)SEE FEE SCH. ' MECHANICAL above mentioned property for inspection purposes. (We) agree It, save, indenmlfy and keep lunmllehs the City'of MISC. REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 3,00 CONST.TAX may in any way accrue against said City in consequence of lire granting of this permit MECH.CONT. LIC.NO. MECH.. 72 PL rorAL TOTAL Signature of Applicant/CorrraclorDate .OFFICE COPY r' Citm of Cupertino 10300 Torre Ave March 21, 1983 (4o8) 252-4505 Ext: 228,229 Mrs. Marianne Perish 10075 Imperial Ave. Cupertino, Ca. 95014 Dear Mrs. Perish: After reviewing our files, we find that permit no. 2265 • issued on 7-28-82 for electric 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 �W I dw� John Busto, Building Official JB:jj