14229 APPLICANT TD_F_ILL`IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
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BUI LD1 NO hHDJECT I DWI FICATION PERMIT NUMBER
A ,ORE APPLICATION & PERMIT 14229
A DRE 9
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
j ' OWN ~
15,eyr' i1��y,10"R � � E`T PLAN CHECK VALIDATION
N E n/ •si LL E��+Lw�ECpY-3gI
AA1B V PHONEvYV-O _ '.A' ,L��'nW.'t'Ciy'9�9Nt'.I�a�iY.`:)':. Y.v •{ r..gr'Q .^i
cox ACTOR'S „I� v4 S00 OUTLETS-SWITCHES-RECEP 10.00/100 0-
NAME
❑C,NO. LIGHTING FIXTURES 10.00/1.00
-
CONTRACTOR'S GR'9
ADDRESS PPLIANCES-RESIDENTIAL 4.00
A - -
PHONE PANELS 10.00 DATE OF APPLICATION
ARRCHITECT PANELS (OVER 200 AMP) 20.00 PLAN CHECK FEEP.C.NO.
ENGINEER
- LIC.NO. ISIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE I S. 20.00
ADDRESSTe MOTORS r J SEE FEE SCH, _�1J QTR.-g-•�
P) SERVICE CHANGE I' 20.00 //'
} e o pop LICENSED CONTRACTORS DECLARATION ' F QII1110 �/I 7I g 7
«a u b I hereby affirm that I em licensed under provisions of Chapter 9 ISSUANCE DATE
(commencing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
r Professions Code,and my license Is in full force and effect.
o - License Clan Llc.Number - ® ❑
F L f w Dale - - Contractor
4 , i J OWNER-BUILDER DECLARATION f �i�ss'•''BUII: I O PERMIT,
1: ¢ :S r5v'$y`,Y".INFO11MATIDN
X a I hereby af1}rm ihet I em exempt from the Contractor's License MISC.- REFER TO ORD
w u.0 Law for the following mason.(Sec.7031.3;Businessand Professions PERMIT ISSUANCE 10.00 VALUATION S/FT.
�wW� Code:Any city or County which requires a permit to construct,eller, O'
¢.9 O Improve,demolish,or repair any altuclurc,pfia'lO ale lisuantt,also ELEC.CONTR. LIC.NO. ELEC.
requires the applicant for such'"mall to file a sighed elmemenI hot TOTAL O'er
W m he is licensed pursuant to the provulons of the Cantraclor's License PERMIT TO
< Law fChepter9(commencing with Section 7000)of Division 3 of the 'Q.'y" 'i'• '`w@r,�•J.d[ys(�@I,
h = O, Bminess end Professions Code)or thil he B exempt Division
end �TII .LVMBINOIP, E°"• ��
r the bub for the alleged esemptl m Any al0laton ofSeclbn 7031.3 _ ',�_,*i'1i'jk 1 STORIES TYPE CONSTR.
bAN
y Il10
an. the fore permit dollars the applicant loaclvil penally ALTER-DRAIN St VENT-WATER (EA.). 5.00
gr;• of not more than Ove hundred dollen(f3 amp
++'I. ❑ I,as ..at
of the proDeNy,of my,employeea with wage'as BACK FLOW PROTECT.DEVICE - 4.00 CC.GROUP RES.UNITS
their Pale eompeusallon;will do the work,and the structure b not
Intended ar offend for Sole(See. 7044, Buelnes' snit Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contnctar's License Lew don nor apply to an owner of
property who bulide or Improves thereon,end who does such work F IXTUR ES-PER TRAP 5.00 I
• himself or through hb own employees,provided that such Improve- sa PT.FLOOR AREA TOTAL ACREAGE
menu are not intended or offered for Mile.If,however,the building GAS-EA.SYSTEM-I INC.4 OUTLETS 5.00
or Improvement Is Paid within one year of completion,the owner. GAS•EA.SYSTEM•OVER 4 IEA.) 2.00
+s„ bullder will have the burden of proving that he did not bulid or Im- BUILDING USE
Prove for purpose of Sole.). INDUSTRIAL WASTE INTER3000 RES IND CON PB Omar
` ❑ I,a owner of the property,am exclusively contracting will, . . El O
Beerued Contractors to Construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Lew does not apply
to an owner of properly who build,or Improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
'la'N:• �` ' Contracts for such projects with a contractor(s)licensed pursuant to
the Contractors License Law. T SEWER-SANITARY-STORMEA.200ft/10.00 TRACT NO. PARCEL NO.
O lam exe pt under Sea ,B.AP.C.fur this WATER HEATER W/VENT 8.00
reason
rOwner" Dale WATER SYSTEM 6.00 '
f, ACC.DATE ACC.FILE N0.
WORKERS'COMPENSATION DECLAkATION WATER TREATING EQUIP. 5.00
I hereby affirm that I hive acertincmeofcomenl lowir-insure,
or a certificate of Workers'Compenallon Insurance,or a certified ZONING ENG.SITE NO.
copy thereof(Sec.3800,Lab.C.).
Policy No. Company
D CeNlfied copy Is hereby famished, FIRE SPRINK ENERGY T-24
Z 2 ❑ Certified Copy Is Ned with the city inspection division. -
?'F O' Applicant MISC.- REFER TO ORD. Y C] N rl Y O N[3
t:CCCERTIFICATE-OF EXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.C.
>
s LU COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG,
hI d 0, (This sectlim need nor be completed If the permit Is for one TOTAL Y� N Y 0 N❑
I'D 2 hundred dmlere(SI00)ar leaf re 1z a y
h C.I O 1 certify that in the performance of the work for which this per. µ �� � '" ps�I 3 � y) 'y' �y; ti( jKEErBUMMARY ',T�51`w'^i
mit Is Issued,I shell not employ any person in any in nnerPa a Io � �' EO AI✓ C L t1M1 }4 /,FH�'¢� orb 7 ..3.�..
�' became subject to the Workers'Compenatlon Laws of California. •tV- 11 .. . uTf.L..r.
O w Dale Applicant ALTER OR ADD TO MECH. 6.00 BUILDING
85 NOTICE TO APPLICANT: IL after making this Certificate of Ex-
+w ? emptlon,you should become subject to the Warken'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith Comply with FEE
,U such provisions or this permit shell be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 4,00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER I0AOOGRM.) 8.00 SEISMIC FEE i
I hereby affirm that there Is a conitructlon tending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance or the work for which this permit Is Issued(Sec.
�,- 3097,Civ.C.). HEATING UNIT ITO 100,000 B.T.U.) 8.00 MICROFILM
17 ,. Lender's Name
Lender's Address - H EATING UN IT IOV ER 100,000 B.T.U.)8.50 ELECTRIC d
' •r 1 certify that I have sad this applicatlon and male that the above VENTILATION FAN (SINGLE) 4.00
Information B Correct.I gree to comply with all city and county PLUMBING 1
ordinances and slate laws relating to building construction, and BOILER-COMP 13 H.P.or 100,000 B.T.U.) 6.00
hereby authorize represents tInspection purposes.Ives of this city to eat" upon the
above-mentioned property for BOILER-COMP lover BTUI SEE FEE SCH. MECHANICAL i
(We) agree to ave, indemnify and keep harmless the City of MISC.• REFER TO ORD.
Cupertino against liabilities,Judgments(costs and expenses which CONST.TAX j
may in any way accme pinsu aid City In consequence of the PERMIT ISSUANCE 10.00
1 nti aof thb pa C) _ _ MECH.CONT. LIC.NO. TOTAL ^ -��4f3stis
Signature of A sent coma 1 Dae �TOTA L ,t .;
t ala t: . if t+'
• -"•'• OFFICE COPY