6525 APPLICANT TO FILL IN INFORMATION WITHIN.RED,LINES- USE BALL POINT..PEN ONLY
a
13UI LDI NG PROJECT I DENTI FICATION - PERMITNUMBER .
BUILDING - APPL"ICATION'& PERMIT
ADDRESS ,. Suite 206 _ _ _ _ 6525
y 20045 ' 'Stegen5 Creek Blvd BUILDING'-ELECTRICAL-PLUMBING-MECHANICAL '
f�IOM[rvER'S - g j CHECK VALIDATION
'NAME Frederick Petri, Geor e
5 QTY:: ELECTRIC PERMIT. . FEE, '
- Somp Frank Bilbao P(4,j5)948-784
NAME 6
croRs UTLETS-SWITCHES-RECEP 5.00/1.00
NAME
S ri "ElectrinlD.ND. 296728-C 0 LIGHTING FIXTURES 5.00/1.00
MNTRACTons APPLIANCES-RESIDENTIAL ' 4.00
ADDRESS
1303 Lick AVE PBDNE 298-3134 PANELS, 5.00 DATE OF APPLICATION
ARCNITECI i" "I- ' SIGNS - 6.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER ,Rad - Rooker
}r " LIC.rvo. ' SIGNS TRANS. 3.00
ARCH OR ErvG. Y• PERMIT VALIDATION a-' -
ADDRESS - SP 5.00
5.00
- xlP• EMP.METER OR POLE INS. 15.00 S �J
APPLICANT s
ADDDRESSDRESS - MOTORS SEE FEE SCH
`
1303 Lick Avenue' S.J. 9511('It SERVICE CHANGE 1000
w o a LICENSED CONTRACTORS DECLARATION'
Q u 1 hereby affirm that I am licensed under Provisions of Chapter 9 ISSUANCE DATE
m a m (vo...mooring with Section 7000)of Division 3 of the Business and - BLDG.. ELECT. PLG. MECH.
m Z I'mfessiuns Code,and my license is in full force and effect ❑ ❑ ❑ ❑
Z 0'.- License Class_ Iaic..Number, '
Date Contractor
BUILDING PERMIT
Ix w 4 OWNER-BUILDER DECLARATION - . - INFORMATION 1
row .
;LL m I herehyalfinn that I am exempt IRnn the Contractor's License MISC.- REFER TO ORD ,VALUATION
r LL N as Law for the following reason.ISec.7031.5;Businessand Prafeeslons PERMIT ISSUANCE - 6.00 E/FT.
Code:Any city or aunty which requires permit to construct,alter, -
a ¢¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. - LIG NO.. ELEC.
wOca LL requirestheupplicantforsuch permit to file a signed statemcalthat S Yi Electri 296728G O1TAL PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
FZi law(Chader,9(conutio
nencing with Secn 7000)ofDivision 3 of r
the '
a Itusiness and Professions.Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE 6
mthe basis for the alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty gLTER-DRAIN&VENT-WATER IEA.) 4.00 -
of not none than Five hundred dollars(1500)J:
t..• ❑' I,as owner of the property,or.my employees with wages as' - BACK FLOW PROTECT. DEVICE 2.00 '� OCc.GROUP RES.UNITS
their sole 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 docs not apply to anowner of
Properly who builds or improves theram,and'who Loci Such work FIXTURES-,PER TRAP 4.00 SD.FT.FLOOR AREA TOTAL ACREAGE
v himself or through his own employees,provided that such improve-
menls am not intended or offered for sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 4.00
' or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE
an Ider will have tire that e burden or proving the did not build or im- - RES IND. CON PB Other
,prove for purpose ofsale.). f '•, INDUSTRIAL WASTE INTER. 20.00
❑ I,as owner 01 tire property,am exclusively contracting with' 13El El ❑
licensed contractors to construct the Project(Sec.7044;Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO.
i I and Professions Code:*the Contractor's License'law does not apply
to an owner of moperty who tiuilds or improves thereon,and who LAWN
.SPRINKLERS-OYER 5 IEA.) 1.00 '
contracts for such projects with a courractuds)liecnud Dominant to
the Conturelm's License Law. - SEWER-SANITARY-STORM EA.200ft/8.00 ` TRACT NO. PARCEL NO.
❑ IBM exempt under Sec. ,BAP.C.forthis. WATER HEATER W/VENT 4.00
reason
Owner Hale WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION DECLARATION - WATER TREATING EQUIP. 4.00 -
I hereby alFiirm Ron I,have it certificate of consent to self-insure. ,
or a cerlifcale of Workers Compensation Insurance,or a certified - .ZONING ENG.SITE NO.
copy/,�F,p�(4Ctt5.51f,lab.C.�•1.t8tlOn LnSLLranC .
folic "'V _sktslSmpany
- ❑ Certified co y is'hereby furnished(" "FIRE SPRINK ENERGY T-24
Z Z. Applicant-
Ce, -d oPy, is filed wit y t ny�' elio id;inn. - ` -
O' Applica \���L�pp_��>�.�t1tLK�T � MISC.- REFER TO ORD. y❑ NQ Y ❑ N❑
~ m _�YCAT - ' PERMITISSUANCE 6.00 FLOOD ZONE A.L.U.C.
Lu CIiRTIF KATEPE EXEMPTION FROM WORKBRS'
W � ' COMPENSATION INSURANCE PLG.CONTR., uCf NO. PLG.
1
(This taction need not be completed if the permit is for one TOTAL V❑ N V[:] N❑
Z hundred dollars IS 100)or less.) r•v
U O 1 certify that in the Performance of the work for which This per- QTY. MECHANICALPERMIT .F 1.EE FEE SUMMARY'
' LL f mil is,issued,1 shall not employ any prison in any manner so as'In -
U lacome subject m(he Workers Compensation Laws of California.
0 n Date Applicant ALTER OR ADD'TO MECH. 4.00 BUILDING
} NNO'I'ICFi'10 APPLICANT: If,after making this Certificate of 17 -
.F Z emplion,you should become subject to the Workers'Compensation - APPLIANCE'•, -_ - .4.00 PLAN CHECK
provisions of the Labor,Co le, you must forthwith comply with FEE
U such provisions or this permit shall be deemed'revoked. AIR HANDLING UNIT(TO 10MC.F.M.) 3.00
- CONSTRUCI`ION LENDING AGENCY AIR HANDLING UNIT(OVER 110,000C.F.M.) 5.00 ' SEISMIC FEE
I,hereby Afhrnh Ilud them is a romtruction lending agency for EXHAUST:HOOD(WITH DUCT) '2.00 `.
the pertote ance of the work for which this Permit is issued ISec. - MICROFILM
3097,Civ.C.1 g k f AmeriCg HEATING UNIT(TO 100,000 B.T.U.) , 4.00 - -
Lender's Name-1-C.Mri G`eni-Or-.Y.1-B.E.d-B' r HEATING UNIT(OVER 100,000B.T.U.P.50
Lender's Address ELECTRIC d' �a.a ;
- I certify,d al l have read this application and state Was the above VENTILATION FAN (SINGLE) 3.00
information is correct. I agree to comply with all city and county PLUMBING
ordinances and state laws relating to building construction, and BOILER,COMP(3 H.P.or 100,000B.T.U.) 4.00 - -
I{ / hereby:authorize'representatives .1"Ahis city to carer,boupon (he MECHANICAL
ave-mentioned property for inspection purposes..' BOILER=COMPrhown 100,000 BTU)SEE FEE SCH. ,
(We) agree.to save; indemnify and keep harmless rhe City of MISC. - .REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which PERMIT.ISSUANCE 3.00 "CONST.TA_X
may in any way.-accrue aga�Lnsl said City in cons,-que a the' _
• ting this permit MECH.CONT. LIC.NO. - MECH, '
Q' TOTAL TOTAL
nyle�n urc ul'Applica t/Contractor,. ; U le ' +
t I 'OFFICE COPY - '