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14202APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDI NG PROJECT I DENTIFICATION 'APPLICATION &PERMIT BUILDING -ELECTRICAL -PLUMBING -MECHANICAL PERMIT NUMBER 14ZOZ BUILDING - ADDRESS Rainbow Dr., Lot #6 OWNER'S NAME The. Gregory Group PHGNE 595-2100 CITY. ELECTRIC PERMIT 'FEE PLAN CHECK VALIDATION - NAMERacroas UTLETS- SWITCHES -RECEP 10.00/1.00 Central Service CO.LIC.No. 171537 1 LIGHTING FIXTURES 10.00/1.00 CONTRACT ORB A Do APPLIANCES - RESIDENTIAL - 4.00 625 Charles Street PHONE 298-0556 DATE OF APPLICATION' PANELS 10.00 ARCHITECTOR ENGINEER LIC. No. 200 AMP) 20.00 PLAN CHECK FEE P.C. No. PLAN(OVER ' SIGNS TRANS. 3.00 nooeEss ENG. SPECIALCIRCUIT 5.00 PERMIT VALIDATION ITEMP. METER OR POLE INS. 20.00 ZIP D r,� ` ('' /�� As ADORESs 625 625 Charles St. � SJ 95112 MOTORS SEE FEE SCH. SERVICE CHANGE 20.00 - LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions COdgp�aa,. }gy license is in full forge d LicenseClesk--8-1--Lie. Numgef Ryl-1 Dare 1111 33 LSA Con[rucmfwenLra .SEL'Vl I66 ANCE ATE / BLDG. ELECT. PLG. MECH. ❑ ❑ ❑ - e BUILDING PERMIT � INFORMATION , OWNER -BUILDER DECLARATION I hereby collo that 1 so exempt from the Contractor's mr's Llceons Professions Law for the followingreason.(Sec.uires a,ermit to Code: city or county requiresa permit to constant, alter, - 'MISC. - REFER TO ORD PERMIT ISSUANCE 10.00' VALUATION $/FT. ELEG CONTE. LIC. NO. ELEC. - TOTAL e, d itwhich improve, d¢mu1151r, or repair any structure, print to its 19SrWpC¢, a15U any requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License ERMIT TO Law(Chapter 9(eommencing with Section 7000) of Division 3 oflhe Business and Professions Code) or that he is exempt therefrom and CITY. , PLUMBING PERMIT- - FEE the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant toacivilpenalty of not more than five hundred dollars ($500).): STORIE TYPE $TR, ALTER -DRAIN &VENT -WATER (EA.) 5.00 ❑ I, as owner of the property, or any employees with wages as their sale compensation, will do the work, and the structure is not BACKFLOW PROTECT. DEV ICE 4.00 - OGc. GROUP R .UNITS DRAINS -FLOOR, ROOF, AREA, COND. 5.00 intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of ' FIXTURES - PER TRAP 5.00 --- GAS-EA.SYSTEM-11NC.40UTLETS 6.00. So. FT. FLOOR AREA TOTALACREAGE property who builds or improves thereon, and who docs such work himself or through his own employees, provided that such improve- ments are not intended or, offered l'of sale. If, however, the building or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or im. prove for purpose of sale).RES ❑ L as owner of the property, am exclusively contracting with GAS - EA. SYSTEM - OVER 4 IEA.) 2.00 BUILDING USE IND CON PB Orne, ❑ ❑ ❑ ❑ ❑ INDUSTRIAL WASTE INTER. 30,00 licensed contractors to construct the, project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 - ASSESSORS PARCEL NO. LAWN SPRINKLERS - OVER 5 (EA.), 1.00 contracts for such projects with a contractor(a) licensed pursuant to the Contractor's' License Law. ❑ I an, exempt under Sec. ,B.&P.C. for this reason SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. ]. WATER HEATER W/VENT _ 6.00 - Owner Date WATER SYSTEM 5.00 ACC. DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORK ERS'COMPENSAI ION DECLARATION 1 hereby affirm that I have a certificate of consent W self -insure, or a certificate of Workers' Compensation Insurance, or a certified ZONING ENG. SITE N0. CPolicyNa S .Pacific Comn.` open pp Certified copy Is iereby furnish cal. r$ Certifi cor s 11 with the ci 'upection division. Applicant FIRE 6PRINK Y ❑ N❑ ENERGY T44 Y ❑ N❑, MISC.- REFER TO ORD. CERTWICATEOF EXEMPTION J OM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C, COMPENSATION INSURANCE (This section need not be completed if the permit is for ane PLG. CONTE. LIC. NO.PLG. Central Service TOTAL V ❑ NEJI Y ❑ N❑ hundred dollars(S 100) or less.) , I certify that in the performance of the work for which this per- mil is issued, I shall not employ any person in any manner so as to QTY. MECHANICAL PERMIT FEE , FEE SUMMARY BUILDING become subject to the Workers' Compensation Laws of California. Date ApplicantALTER NOTICE TO APPLICANT: If, after making this Certificate of Bx- OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK omption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions Or this perrAit shall be deemed revoked. AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 FEE AIR HANDLING UNIT (OVER 10)"C.F.M.) 6.00 SEISMIC FEE CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency I'or EXHAUST HOOD (WITH DUCT) 5.00 the performance of the work for which this permit is issued (Sec. 3097, Civ.0.). t MICROFILM HEATING UNIT (TO 100,000 B.T.U.)- 8.00 Lender's Name - Lender's Address HEATING UNIT (OVER 100,000 B.T.U.)9.50 ELECTRIC I certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 information is correct..) agree to comply with all city and county ordinances and state laws relating to building construction, and .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 above-mentioned property for inspection purposes. MISC. - .REFER TO ORD. (We) agree to save, indemnify and koharmless the City of ep Cupertino against liabilities, judgments, costs and expenses which may in any ay accrue against said City in consequence of the gm P goft spar it 1-13-87 CONST. TAX PERMIT ISSUANCE 10.00 MECH. CONT. LIC. NO. MECH. TOTAL - TOTAL Signature of AOPlicanl/Contrac Data OFFICE COPY