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6536 APPLICANT TO'FILL IN INFORMATION WITHIN RED LINES -.USE BALL POINT PEN ONLY �•-...� BULLDI NG PROJECT I DENTI FICATION PERMIT NUMBER BGILDING ., APPLICATION & PERMIT Roofless D BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 6536 OWNERS sta udsl" ' .Ix+�^ PLAN CHECK VALIDATION NW .Is r 12ELECTflIC PERMIT Eiib © PHONE •�, CORYRACTORS NAME (al D UTLETS-SWITCHES-RECEP 5.00/100 ( A LIC.No. rj x7J LIGHTING FIXTURES 5.00/1,00 cONTRACTOR•S �ItcJ/ APPLIANCES-RESIDENTIAL 4.00 Aopfless. Thr ,Q- PHONE PANELS 5.00 DATE OF APPLICATION pgcHUEcrI SIGNS 6.00 PLAN CHECK FEE P.C.NO. f ENGINEEfl - - - LIC.No. SIGNS TRANS. 3.00 ARo.OR ENG. _ SPECIAL CIRCUIT '5.00 PERMIT VALIDATION ESS iIv EMP.METER OR POLE INS. 15.00 APPLICANTS MOTORS SEE FEE SCH. SERVICE CHAN 10.00 '.Foo LICENSED CONTRACTORS DECLARATION - 0 'f z W 1 hereby affirm that 1 am licensed under pecvisimrs of Chapter 9 ISSUANCE GATE a - (Commencing,with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH. F a i Professions Co#OW ,.R-BUeLrDER icse is in full fore ggLk o m - Lie La, Number 4 - ° Date - Contractor City Of NperttBO 0 ❑ gyf G y"fi-BUIL'DING PERMIT ¢ ¢i o DECLAR --+P , -, N FORMATION E 3 I hereby affirm that 1 am exempt from the, License MISC.- EFER TO ORD1. .. om VALUATION SIFT. a Law for the following reason.(Sec.requires a,permit to construct,nil Professions PERMIT ISSUANCE - 6.00 f ea Code: e,demysh caunly rmpair chrequturv,prmillouane, ter, - ¢ ¢ a p improve,demolish,or repair any structure,prior to its issuance,also E EC.CONTR. LIC.NO. ELED. n '.C!70e LL requires the applicant for such permit to file a signed statement that G TOTAL (�( - PERMIT TO a w m he is licensed pursuant to the provisions of the Contractor's License _ _ _ , ,F z rm Law(Chapter 9(commencing with Section 7000)of Division 3 of the a}'�,x^ I*.xku 6a i.'t }- E��•T a Business and Professions Code)or that he is exempt therefrom and DT,IVa I r,.' z, ,.PLUMBING PERMI7a' " ' n4 FE Q f o the basis for the alleged exemption.Any violation of$eclion 7031.5 Tgf +. r .�',`I!'a STORIES TYPE CONSTR. Lam by any applicant for a permit subjects the applicant 10 a civil Penalty ALTER-DRAIN -WATER (EA.) 4.00 of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as BACK F LOW PROTECT.DEVICE 2.00 their Sole compensation,will do the Work,and the Structure is not DEC.GROUP RES.UNITS 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 4,00 -Fa-Pr.vLoofl 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, builder will have the burden of proving that he did not build or im- iGAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE prove for purpose of sale.). RES IND CON PB Orhai ❑ 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.OD contracts for such projects with a contractor(sl licensed pursuant to the Contr9ctor's License Law. - SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ Iam exempt under Sec.' ,B.AP.C.for this reason WATER HEATER W/VENT 4.00 Owner Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO. WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 I hereby affirm that I have a certificate of consent to self-insure, ora certificate of Workers'Compe b�f r�Is Fe,oryyn cued ZONING, ENG.SITE NO. COPY the Se ). `�/ L/(�i•Tt7/ 'Policy No r - �' '❑ Ce ed cop Hllfy furtl Ulf • FIRE SPRINK ENERGY T24 Z_ 2 ,.&"Ccrf l copy.is filed with the city inspection division. MISC- REFER TO ORD. O Applicant Y❑ N y'❑ N❑ ~'m PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C. Ir J 'CERTIFyolICATEOF iX.MPTI NFR WORKERS' LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG, CL ❑ (This section need not be completed if the permit is for one 'TOTAL Y❑• N❑ Y❑ N Z hundred dollars IS 100)or less.) . . U O- I certify that in the performance of the work for which this per OTaV6?j".''A MECHANICAL"P,ERMIT x'x "`FEE. "FEE SUMMARY =s. LL F mit is issued,I shall not employ any Person in any manner so as to '.rg s - O L) become subject to the Workers'Compensation Laws of California. ' CIL Date Applicant - ALTER OR ADD TO MECH. 4.00 BUILDING } to NOTICE TO APPLICANT: If,after making this Certificate of Ex- ? emptiun,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK provisions,of the Labor Code, you must forthwith comply with ,FEE U such provisions Or this pencil shall be deemed revoked. AIR HANDLING UNIT(TO 1O=C.F.M.) 3,00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10MOGEM.) 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(OV ER 100,000 B.T.U:)7.50 Lender's Address ELECTRIC I certify that I have read this application and stale that the above VENTILATION FAN (SINGLE) 3.00 • ,information is correct. 1 agree to comply with,all city and county PLUMBING ordinances and stale 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 [tie above-mentioned property for inspection purposes. BOILER-COMP Ova,/00,000 BTU)SEE FEE BCH. MECHANICAL (We) agree to save, indemnify and keep harmless the Cily'of MISC.• REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 3.00 CONST.TAX may in y way ac a against said City in consequence of the gra lih fthis per MECH.CONT. LIC.NO. MECH. g TOTAL TOTAL amre of Ap icanl/Contractor (e OFFICE COPY - '