09574 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUT
PROJECT IDENTIFICATION PERMIT NUMBER
ADRESSN APPLICATION & PERMIT 09574
AUT LDI
10345 Norwich Avenue BUILDING -ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME QTY. ELECTRIC PERMIT FEE
Stephen Treet PHONE 252-7431
CONTRACTORS
NAME OUTLETS-SWITCHES-RECEP 10.00/1.00
Atlas Heating LIC.No. 465266 LIGHTING FIXTURES 10.00/1.00
CONTRACTOR's
ADDRESSDRESSPPLIANCES-RESIDENTIAL 4.00
ADDRESS
155 Commercial Sty PHONE 739.0516 PANELS 10.00 DATE OF APPLICATION
ARCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIC.NO, SIGNS TRANS. 3.00
ARCH.OR ENG. SPECIAL CIRCUIT 5.00 PERMIT NALI DATION
ADDRESS
ZIP TEMP. METER OR POLE INS. 20.00
APPLICANTS MOTORS SEE FEE SCH.ADDRESS
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION TEMP.POLE 30.00
¢ u u I hereby affirm that 1 am licensed under provisions of Chapter 9 - ISSUANCE DATE
N ¢aa, (commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
H n z Professions Codti gtIy license is in lull formml86
z o m - License Class-l/ GG VVLia Number `Y19977 LLAAIli
o w F w Date-1-9-8165-Contractor�'tla
a x s J BUILDING PERMIT
OWNER-BUILDER
¢ ¢ w a DIiCLA RATION INFORMATION
D
I- I hereby ffirm Ihul um Iron the Coniractor's License MISC.-
REFER TO ORD
aexempt
w0 J Law Ibr tire following reason.(Sec.7031.5,Businessund Professions PERMIT ISSUANCE 10.00 VALUATION $/FT.
L• N0 Code'.Any city or county which requios a permit to construct,alter,
¢ ¢o improve,demolish,or repair any structure.prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
D¢ requires the applicant for such permit to file a signed statement that TOTAL PERM T O
n w m he is licensed pursuant l0 the provisions of the Contractor's License M
HiQ
Law(Chapter9(cammencingwith Section 7000)ofOivisiun3oftheFEE
/-I
Business and Professions Code)or that he is exempt therefrom and OTV. PLUMBING PERMIT
STORIES TYPE CONSTR.
0c 0 the basis]mthe alleged exemption.Any violation of Section 7031.5
i ; $ by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN& VENT-WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
O 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00
their sole compensation,will do the work,and the structure is not OCC.GROUP RES.UNITS
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:'Phe Contractor's License Law docs not apply to on owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT,FLOOR AREA TOTAL ACREAGE
joems l re Through his own employees,provided that such im building
rents are through
intendeugh]itd onemmdfor sa provided
that such
building GAS-EA.SVSTEM-11NC.40UTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct lire project(Sec. 7044, Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law docs 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 contmclols)licensed pursuant to
the Contractor's License Law. SEWER-SAN ITARV-STORM EA.2001t/10.00 TRACT NO. PARCEL NO.
❑ I um exempt under Sec. ,BAP.C.for this WATER HEATER W/VENT 6.00
Halon
Owner Date WATER SYSTEM 5.00 ACC.DATE ACG FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00
1 hereby affirm that I have a certificate ofconsent to self-insure, ZONING ENG.SITE N0.
or a certificate of Workers'Compensation Insurance,or a cerlificJ
copy to 3 17 i P&cifin
Policy NI _. -
Tet
Oq� Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
Z Z �li Colitic SET ged�'lltt Jhe city inspection division. MISC.- REFER TO ORD. ❑ ❑ ❑ ❑
O Applicant II lll8 Y N Y N
~ vaPERMIT ISSUANCE 10.00 FLOOD ZONE A.L.uc.
LU '
CERTIFICATE COMPH EXEMPTION PROM WORKERS'
LU need not be completed
INSURANCE PLG.CONTR. LIC.NO. PLG. Y❑ N❑ Y ❑ N❑
CL O (This section nreJ not be completA if the permit is for one TOTAL
7) Z hundred dollars IS 100)or Icss.l
U O I certify that in time performance of time work for which this per OTY. MECHANICAL P i FEE FEE SUMMARY
UL r mit is issued,I shall not employ any person in any manner so as to
U become subject to Lite Workers'Comperuation Laws of California.
a Dat Applieant ALTER OR ADD TO MECH. BUILDING
} W NOTICE TO APPLICANT': If,after making this Certificate of Ex-
emption,you should become subject to the Workeri Compensation APPLIANCE 5.00 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
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVERnm�".1`6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
Ore performance of the work for which this permit ix issued ISce. HEATING UNIT(TO 100,000 B.T.LL) 8.00 MICROFILM
3097,Civ.CJ. X 8 QQ
Lender's Name
Lenders Add, HEATI NG UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC
ess
I certify that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
® information is correct. I agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and stat laws relating to building construction, and
hereby authorim representatives of this city to enter upon tire BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless Ore City of MISC.- T' EFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
May in a way accrue against said City in consequence of the
PERMIT ISSUA CE 10.00 IQ Q
grail OI this ps n 1. MECH.CONT. LIC.NO. MECH.
r // ,/- q I� TOTAL TOTAL
Signa eofApplicanl/Contractor / Date_ At1a8 Heating 465266 1800
OFFICE COPY