5438 ?LICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
t t BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
RDI LDINc APPLICATION & PERMIT
ADDRESS 5438
10500 Rid oV leW Ct. BUILDING - ELECTRICAL-PLUMBING-MECHANICAL
OWNER'S PLAN CHECK VALIDATION
""ME DTV. ELECTRIC PERMIT FEE
Tril ooV PHONE
CONTRACTORS UTLETS-SWITCHES-RECEP 5.00/1.00
"AME Allan Automatic Sprinkle
LIC.No. LIGHTING FIXTURES 5.00/1.00
r-on pPL1ANCES-RESIDENTIAL 4.00
ADDRESS
439 Eccles. Ave. SSFPNONE 952-8383 PANELS 5.00 DATE OF APPLICATION
ARCHITECTSIGN$ 6.DD PLAN CHECK FEE P.C.NO.
OR
ENGINEER
LIc.No, SIGNS TRANS. 3.00
ARC"OR ENG, SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ADDRESS
ZIP TEMP.METER OR POLE INS. 15.00
APPLICANT'S MOTORS SEE FEE SCH.
ADDRESS,
SERVICE CHANGE 10.00 / ,([
w o o LICENSED CONTRACTORS DECLARATION V���"
is-F.o U I hereby afRrm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w<e_ (commencing with Section 1000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r w z Professions Code,and my license is in full force and effect. ElElEl ❑
Z.o T- Licenselass C 616 Lic.Number_152678
o m F D Date Contractor
< Y OW A��II� AutomatLc BUILDING'P.ERMI,T'.7,yPs t
CE a w LDIiR DT:CLA INFORMATION
w3 LL H I hereby affirm that I am exempt from the Contractor s License MISC.- REFER TO ORD
LL o a Law for the following reason.(Sec.7031.5.Businessand Professions PERMIT ISSUANCE VALUATION 5/FT.
- Code:Any city or county which requires permit m construct,alter, 6.00
te aa or to its issuance,also ELEC.CONTR. LIC.NO. ELEG Z.S 90
Q O improve,demolish,or repair any structure,prior
Q¢ requires the applicant lot such permit to file is signed statement that TOTAL PERMIT TO .
heis licensed pursuant to the provisions of the Conlrmtor's License modlf V
F z i
Law(Chapter 9(commencingwith Section 7000)ofllivision 3 ofthe
a Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
¢ ro the basis for the alleged exemption.Any violation ofSection7031.5 STORIES TYPE CONSTR.
w. _' by any applicant for a permit subjects the applicant to a civil penally ALTER-DRAIN&VENT-WATER (EA.) 4.00
of not more than five hundred dollars(5500).):
❑ I,asowner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 . OCC.GROUP RES.UNITS
their sale 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 dues not apply to an owner of
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SQ FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve.
mems are not intended or offered for sale.I L however,the building GAS-EA.SYSTEM-l1NC.4OUTLETS 4.00
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 Aid not build or int- RES IND CON PB Other
prove for purpose of sale.). JiNDUSTRIAL WASTE INTER. 20.00
❑ I,as owner of the property,am exclusively contracting with 11 El El El El
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
and Professions Code:TheCommCtor s License Low 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 contractors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
the Coulmctols License Law.
❑ I it,uxe.npl under Sec. ,B.&P.C.for this WATER HEATER W/V ENT 4.00
reason
Owncr Dat. WATER SYSTEM 4.00 ACC,-DATE ACC.FILE NO,
W6RKBRS'C0MPI7NSA'FI0N DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that I have a cerli0cate of consent to sclfainsure. ZONING ENG.SITE NO.
or u certificate of Workers'Compensation Insurance,or u certified
copy thereof l Sec 3800,Lab.C.).
%� Policy No.��'' ((l1$$j1llspan �1Yf.(.y9-ipn-I:nB-e
O ❑ CCrti1fLTYcXYsYmrchy lurni511i•11� FIRE SPRINK ENERGY T 24
Z Z ❑ Certified i y- lil-d w'I m city inspection division. MISC.- REFER TO ORD. Y� NEI Y No
pp,,// AuphCanl
Fy\ PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.c.
� - CERTIEICA'f li0 Ii X1:M I'F ION I ROM )RKIiRS'
Lu > COMPENSATION INSURANCE: PLG.CONTR. LIC.NO. PLG. Y[] N� Y❑ N
1 O ('Phis section need not be completed if the permit is for one TOTAL
D Z hundred doll...IS 100)or less.)
U O 1 certify that in the performance of the work for which this Per QTV MECHANICAL PERMIT FEE FEE SUMMARY - }
LL F mit is issued,I shall not employ any person in any manner so as to
Owbecome subject to the Workers Compensation Laws of California. BUILDING 38.50
n Dace ApplicantALTER OR ADD TO MECH: 4.00
>_ M NOTICE 'TO APPLICANT: If. ft
aer making this Certificate of lia-
r Z eruption,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK 25.03
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M) 3.00
CONSTRUCTION WINDING AGENCY AIR HANDLING UNIT(OVER 1000C.F.M.) 5.00 SEISMIC FEE .50
I hereby affirm Drat there is a construction lending agency for EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this p.rmil is issued IS 11. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's NameHEATI NG UNIT IDV ER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC
I Certify that I have read Ibis application and state that the above VENTILATION FAN (SINGLE) 3.00
information is Correct. I agree to comply with all city and anly PLUMBING
ordinances and slate laws relating to building Construction,mand BOILER-COMP(3 H.P.Of 100,0008.T.U.) 4.00
hereby authorize representatives of this city m ewer upon the BOILER-COMP(Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree m save, indemnify and keep han..I.. the City of MISC.- REFER TO ORD.
Cupertino against liabilities,judgments.Costs dad expenses which CONST.TAX
'
may 'n 77ny ay accrue against said City in consequence of the PERMIT ISSUANCE 3.00
gran /5f1h permit MECH.CONT. LIC.NO, MECH.
1� 04/18/84 TOTAL TOTAL 64.03
/\iSibatureofAglicdht/PCon,4ractor Uule
OFFICE COPY