5720APPLICANT TO FILL IN INFORMATION WITHIN RED LINES = USE BALLPOINT PEN ONLY
BU I LDING PROJECT I IDENTIFICATION
& PERMIT
E,- LE'.CTRICAL-PLUMBING -MECHANICAL
D' I°N
PERMIT NUMBER
r 7 2 O
BUILDINGErik's Deli 03-1138(APPLICATION
ADDRESS
e t P e
ONWAMNEEP'S f CTC
Erik Johnson PHONE
QBM1TUVIL"G-`
io', M,"VT,
ELECTRIC PERMIT FEE'`
PLAN CHECK VALIDATION
-
DATE OF APP LIGATION
NANsnERacrORs
Orvin En ineerin LIC.NO.15O751
UTLETS- SWITCHES -RECEP 5.00/1.00
LIGHTING FIXTURES 5.00/1.00
ADDDRESS ra R's Fremont, CA 94538
4077 Pestana P1. 41Z/651-17
APPLIANCES - RESIDENTIAL 4.00
1 PANELS 5.00
ARCHITECT0.
ENGINEER
LSC, NO.
SIGNS 6.00
PLAN CHECK FEE P.C. NO.
SIGNS TRANS. 3.00
moo Ess ENc.
ZIP
SPECIALCIRCUIT 5.00
PERMIT VALIDATION
S
0
ISSUANCE DATE/
LECT. PLG. MECH.
� � ❑ ❑ ❑
u
ITEMP. METER OR POLE INS. 15.00
ADDRESSPLICAra
MOTORS SEE FEE SCH.
' SERVICE CHANGE 10.00
LICENSED CON"PRACfORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapler rI
(commencing with Section 7000) of Division 3 of the Business and
Professions Co p�t,L•,� IIyl my license is in lull for -o nsj �jjy.t.
License Class _l.. -1D_ Lie. Number�-U-f lj) I
Date8�2.O-!84 ContmclnrOR$IN-E-NC
OWNER -BUILDER DECLARATIONU
I hereby affirm That I am exempt from the Contractor's License
Law for the following reason. (Sec. 7031.5, Business and Professions
Code: Any city (it county which requiresa permit toconstruct,ulter,
improve, demolish, or repair any stmcl ure, prior to its issuance, also
requires the applicant for such permit to file a signed statement that
lie i5 licensed pursuant to the provisions of the Contractors I.icenu
Law (Chapter 9(commencing with Section 7000)of Uivision3of the
Business end I'rofesaluns Code) or that he is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5
fora permit subjects $5000.licanuoacivil penalty
by any more
of not more than five hundred dollars (my employees
O I, as owner at the property, or my employees with wages as
their sole compensation, will do the work, and the structure is not
intended or offered for mule (See. 7044, Business ind Professions
Code: The Contractor's License Law does not apply to an owner of
property who builds nr III mo,cs thereon, and who does Inch work
himself or through his own employees, provided that such improve-
mentsarenotintendedorofferedforsale. ll', however, the building
or improvement is mild 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 the.l.
❑ L as owner, of the property, he exclusively contracting coding with
licensed,]contractors : construct re Contrathe project (Sec. 71144,Bu sines
.
to Profession,wneof grope The Conbuilds o License s til docs not apply
to tr owner of property who builds tr improves thereon, and who
contracts for such censeprojects with u conlmctoR sl licensed pursuant to
' the Contractors License Law.
❑ loco exempt under Sec. ,B.&P.C. (or this
reason
rDINGiP,_ERMI,T�;,,-, %,
- INFORMATIUN::
MISC.- REFER TO ORD
PERMIT ISSUANCEVP/i
- 6,00
O�i� $jFT.
tq6"O"
ELEC. CON TR. LIC. NO.
CLEC.
TOTAL
PERMIT TO
��-
OTY. „ PLUMBING PERMIT, FEE1-
*
STORIES
TYPE CONSTR.
ALTER-DRAIN-WATER(EA.)4.00
BACK FLOW PROTECT. DEVICE 2.00
OCC. GROUP
RES. UNITS
DRAINS -FLOOR, ROOF, AR EA, COND. 4,00
FIXTURES - PER TRAP 4.00
GAS-EA.SYSTEM-1 INC.40UTLETS 4.00
50. FT. FLOOR AREA
,
TOTAL ACREAGE
GAS - EA. SYSTEM -OVER 4 IEA.) 1.00
BUILDING USE
RES
.. ❑ 1❑ ❑N ❑ Other❑
INDUSTRIAL WASTE INTER. 20.00 '
LAWN SPR INKLERS-1.INC5 V.B. 5.00
LAWN SPRINKLERS -OVER 5 (EA.) 1.00
ASSESSORS PARCEL NO.
SEWER -SANITARY -STORM EA. 2001t/6.00
TRACT No.
PARCEL No.
WATER HEATER W/VENT 4,00
Owner Date
WATER SYSTEM 4.00
WORKERS'COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure,
or a certificate of Workers Compensation Insurance, or a certified
eggly tlµu,((.egq�o. I'ab.Y.I.
41 ml con INA/AETNA
❑ Certified copy is hereby furnished.
xry[Cernif �sAyr ��(IILdtlj,..)Ile-yILspecnjnn dir vision,
Ap ifeant_SlL[-V- 1V llIS]1.N K1Pl
CFRT' IFICA'FE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed if the permit is for one
hundred dollars ($100) or lass.)
I certify that in the performance of the work for which this per-
nut Is issued, I shall not employ any person in any manner so as to
become subject to the Workers' Compensation Laws of California.
Dale Applicant
ACC.OATE
ACC. FILE NO.
WATER TREATING EQUIP. 4.00
ZONING
-
ENG. SITE NO.
FIRE SPRINK
V ❑ N❑
ENERGY T-24
V ❑ N❑
MISC.- REFER TO ORD.
PERMIT ISSUANCE 6.00
FLOOD ZONE
Y ❑ N❑
a. L. U.C.
Y ❑ 1
PLG. CONTRr LIC. NO.
PLG.
TOTAL
-
QTY. MECHANICAL PERMIT °-.FEEw
FEE SUMMARY '^s: N
-
BUILDING
17.50
ALTER OR ADD TO MECH. 4.00
NOTICE TO APPLICANT': If, after making this Ce Rll'Icatc of Ex-
eruption, you should become subject to the Workers' Compensation
provisions of the Labor Code, you must forthwith comply with
such provisions or this permit shell be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec.
3097, Civ.C.T
None
APPLIANCE 4.00
AIR HANDLING UNIT (TO 10=CF.M) 3.00
PLAN CHECK
FEE
11.38
AIR HANDLING UNIT(OVER 10,❑OOC.F.M.) 5.00
SEISMIC FEE
50
EXHAUST HOOD (WITH DUCT) 2.00
MICROFILM
HEATING UNIT (TO 100,000 S.T.U.) 4.00
Lender's Name
Lenders Address
I certify that I have read this application and state that the above
information is correct. 1 agree to comply with all city and county
ordinances and stale laws relating to building construction, and
hereby -authorise representatives of this city to enter upon file
abovCmuentioned property for inspection purposes.
(Wu) agree to save, in ity, and kee Ila mless the City of
Cupertino 1 1i. ties,,. dements, s fid expenses which
may i way act to against said y oiscq.cnce of the
gr n 4T is permit,
/qc..
re I''a t (tract ])air- 8/ ])air
HEATING UNIT 100,000 B.T.U.)7.50
ELECTRIC .
VENTILATION FAN (SINGLE) 3.00
PLUMBING
BOILER- COMP (3 H.P. Or 100,000 B.T.U.) 4.00
BOILER -COMP (Over 100,000 BTU( SEE FEE SCH.
MECHANICAL
MISC. - REFER TO ORD.
CONST. TAX
PERMIT ISSUANCE 3.00
MECH. CONT. LIC, NO.
/84 _
MECH.
TOTAL
TOTAL
29.38
OFFICE COPY