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2907 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BU LDING PROJECT IDENTIFICATION PERMIT NUMBER BUILDING APPLICATION & PERMIT 2907 � n O �] ADDRESS 20210 Lynton Court 2 .7 I �- BUILDING - ELECTRICAL-PLUMBING -MECHANICAL .2E NESS ! •' "'P d q 1 �� O' �f PLAN CHECK VALIDATION OTY - ELECTRIC PERMIT '*`"t' pV "'A James Mitchell PHONE V, Pt a S�Y•i i w NAMERAcroRs UTLETS-SWITCHES-RECEP 5.00/1.00 Atlas Funiace CO. LIC.ND, 137803 LIGHTING FIXTURES 5.00/1.00 -T CONTRAC AODRESSTORb APPLIANCES-RESIDENTIAL 4.00 Commercial St. PHONE 739-0516 PANELS 5.00 DATE OF APPLICATION ORRCHITECT SIGNS 6.00 PLAN LHECK FEE P.C.N0. ENGINEER LIC.No. SIGNS TRANS. 3.00 ADDRESS ENG. SPECIAL CIRCUIT 5,00 PERMIT VALIDATION ZIP EMP.METER OR POLE INS. 15.00 ADRESS ADDREas MOTORS SEE FEE SCH. SERVICE CHANGE 10.00 WO o LICENSED CONTRACTORS DECLARATION y J FZ w 1 hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE m a_$ (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. Z Professions Code,a d license is in full fo 0=c License Ig Lic.Numb.'�- ❑ ❑ ❑ vs H w Dale Contractor rDan s: s � r.". "4.BUILDING'.PERMITi,z;.r m w u OWNER-BUILDER DECLARATION {'. ';k1j",.INFORMATION MISC.- REFER TO ORD ` ('"'- LL N I hereby affirm that l am exempt from the Contractor's License vALUAn ON S/FT. � ous Law forthe following reason. 7031.5,Business and Professions PERMIT ISSUANCE 6.00 Code:Anycityorcounty which requires a permit to construct.alter, i¢FO improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. iL D LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT TO w m he is licensed pursuant to the provisions of the Contractor's License (Chapter newith Sl ;000Dof the D , Business adProfessiosCod )ar that he cmptherz(romadTY , PLUMBING PERMIT MY )FEEL' it the basis for the alleged exemption.Any violation of Section 70315 ,.> .:,s ,. . _.''• .5.. .iyin .'� -"e� ..L.x�.-fit STORIES TYPE CONSTR. A. by any applicant for a permit subjects the applicant loa civil penalty ALTER-DRAIN -WATER (EA.) 4.00 of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 2.00 DLC.GROUP RES.UNITS their sole compensation,will do the work,and the structure is not intended ar offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 60,FT.FLOOR AREA TOTAL ACREAGE himself or through his own employees,provided that such improve. ments are not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00 or improvement is sold within one year of completion,the owner. `.L builder will have the burden of proving that he did not build or im. GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE prove for purpose of sale.). RES IND CON PS Omer ❑ I,as owner of the property,am exclusively contracting with INDUSTRIAL WASTE INTER. 20.00 ❑ ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon.and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractorro licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ lam exempt under Sec..,BAP.C.for this WATER HEATER W/VENT 4.00 reason Date Owner WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORXERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 1 hereby affirm that I have a certificate ofcoment Io self.insure. ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified \ copy them o(J$e�)R00,Lab.C.l. Policy Na. 1 copy Company HOm Tfl Tn S._ 0 I ❑ Certified copy is here by furnished. FIRE SPRINK ENERGY T-24 Z Z X Certif d Py is�I led 1 the it inspection division. O Applicant ✓11'.rl°an N'yfTa CB �('�_ MISC,- REFER TO ORD.IF Y ❑ NE] Y ❑ N[] ~ y PERMIT ISSUANCE 6.00FLOOD ZONE A.L.U.C. � - CERTIFICATE OF EXEMPTION FROM WORKERS' LU COMPENSATION INSURANCE: PLG.CONTR. LIC.NO. PLG. Y❑ N� Y❑ N❑ CL O (This section need not be completed if the permit is for one TOTAL Z) Z hundred dollars IS 100)or less.) L) O 1 certify that in the performance of the work for which this per. QTY. MECHANICAL PERMIT- �� FEE SUMMARY.ULF mit is issued,I shall not employ any person in any manner so as toO L) become subject to the Workers'Compensation Laws of California.Date Applicant ALTER OR ADD TO MECH. 4.00BUILDING 0 NOTICE TO APPLICANT: If,after making this Certificate of Ex- I. Z emption,you should become subject to the Workers'Compensation APPLIANCE 4,00PLAN CHECK Provisions of the Labor Code, you must forthwith comply withFEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 p3.00CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00SEISMIC FEE 1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WIT ) the performance of the work for which this permit is issued IS". MICROFILM 3097,Civ.C.). 1 HEATING UNIT(TO 100, 00 B.T.U.) 4.00 Lender's Name Lender's Address H EATI NG U N IT(OV ER 1Q 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 county 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 theBOlr'G ILER•COMPfoves too,00a 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 against liabilities,judgments, costs and expenses whichCONST.TAX may in any way accrue against said City in consequence of IIIc PERMIT ISSUANCE 3.00 3.00 grantingAo,.f��this perm' MECH.CONT. LIC.NO. MECH. /� Awzw1iTOTAL �17/�� , `' Signature of Applicant/Contractor Uma Atlas Furnace 137803 7.00 . Tti#AG ,, OFFICE COPY t,