6988 .1
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES.- USE BALL POINT PEN ONLY
13UI LDI NG PROJECT I DENTI FICATION PERMIT NUMBER
JUILDI 0 20300 Stevens Creek Bl d. APPLICATION & PERMIT
ADOROlivetti Tenant 3rd Floor BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 6988
PLAN CHECK VALIDATION
NWNTE.E Cupertino City Center CITY:'xti'k+'" �I 's ELECTRICiPERMITt; Fav t4*FEE$
Associates PHONE
NAME AOTGRs 46UTLETS-SWITCHES-RECEP ' 5.00/1,00 41.0
Pim Electrlc,InC• uc. o. LIGHTING FIXTURES 45.00/1,00' 52.0
CONTRACTORS Alameda• PPLIANCES-RESIDENTIAL- 4.00
ADDRESS
P.O.Box 2380 PHONE 522-5335 PANELS 5.00 DATE OF APPLICATION
AARRCHITECT - SIGNS 6.00 PLAN CHECK FEE P.C.NO.
ENGINEER_ Gensler Asso. LIC.NO.
5273 SIGNS TRANS. - 3.00
ARCH.OR ENG. 5550 Kearny PERMIT VALIDATION
ADDRESS y _ SPECIAL CIRCUIT 5.00
San Francisco PIP TEMP.METER OR POLE INS. 15.00
APPLICANTS P p BOx 2380 MOTORS SEE FEE'SCH.
AODR Ess
Alameda, Ca1.94501 ISERVICE CHANGE 10.00
w o o LICENSED CONTRACTORS DECLARATION
a U I hereby oChair that I am licensed'under provisions of Charter 9 ISSUANCE DATE
Naw (commencing with Section 7000)of Division 3 of the Nosiness and BLDG. ELECT. PLG. MECH.
F y z Prol'c.xsions CoA• an y license is in full force f ❑ O ❑
G i m W License Class_ yy.,�_Q�{�gJ.,. -Lie.Numbe
T, y H J U.."o lU./.3}�-Con traclor� /
us r s +^.'•BUILD NCIIPERMIT
s w a OWNER-BUILDER DECLARATI 'd . N H
o ae v - r INFORM_ ATIUN
wI hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
.0 Law for the following reason.(Sec.703 I.S.Busine.,od Professions PERMIT ISSUANCE VALUATION
Code:Any city or county which requiresa permit reconstruct,alter, - - 6.00
TS 2¢p improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.N0. ELEC. -
G u requires the applicant for such permit m file n signet stntmncat that Pim Electric,Inc.323080 . TOTAL 99.OC ,PERMIT TO
n w m he is licensed pursuant to the provisions of the Contractor's License
r z i
Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe
i se BusinE
ess and Professions Code)or that he is exempt therefrom and CITY: PLUMBING PERMIT FE
(E E_ the basis for The alleged exemption.Any violation of$ection 7031.5 STORIES TYPE CONSTR.
n , by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN St VENT-WATER (EA.) 4.00
of not more than Ove hundred dallars($500).)r
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the st mcture is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND: 4.00
Code:The Contractor's License Law does not apply to an owner of
Property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 4.00 SO,FT.FLOOR AREA TOTAL ACREAGE
meats are not
ngh tende or offered for
If, othatsuch improve. GAS-EA.SYSTEM-1 4.00
mems are not intended sold orrthfeted for sale.If,mpleveq T he building.
or implder will
is sold within one year of completion,the owner- GAS-EA.SYSTEM=OVER 4 IEA.) 1.00 BUILDING USE
builder will have the burden of proving that he did not build or im- RES IND CON Pe Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00
EDas owner of the property,am exclusively contracting with
licensed
wions constructire Project(Sec. 7044,ot appxs LAWN SPRINKLERS-1 INC6 V.B. 6.00 ASSESSORS PARCEL NO,
and Professions Code:The Contractor's a License'Law does not apply
to tr owner of property who builds t r improves thereon,and who LAWN SPRINKLERS'-OVER 5(EA.) 7.00
contracts for such projects with a contractor/s)licensed pursuant to
the Col am exempt under
Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec. ,B.&P.C.for this
R'Ils(111 WATER HEATER W/VENT 4.00
Owner Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPHNSATION DECLARATION WATER TREATING EQUIP. 4.00
1 hereby affirm that 1 have v certificate of consent to self-insure, ZONING ENG.SITE NO.
Or a certifflmicate yof Workers'Compensation Insurance,io a certifiml
rollry NoFa-�V23cYfeFi rnY.I Roy
a1_IR$-e
O ❑ Certified copy is hereby furnished.
Z Z K Ceny'fiaJ Is ty inspection division. FIRE SPRINK ENERGY T-Z4
O Appfleant vTm }Wr.l af� _s 1L`I• MISC.- REFER TO ORD. Y EJ N _] I v N[]
2N CERTIFICA'IT OF EXINPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C.
L COMPENSWION INSURANCE PLG.CONTR. LIC.NO, TOPLG.
CL Z (This Section .,cd not be Completed if the peril is for one TA
Y 0 NC3 Y 0 N0
hundred dollars IS 100)or less.)
U O 1 certify that in the performance of the work for which it"s per q r k " 4 'r%`1 a r �` )
LL I. HIT Is Issued,1 shall not employ any person in any manner so as to CITY.h;-- MECHANIC_AL`P,ERMITm .`2, h a FEE' x ""•,.' FEE�SUMMAflY
O W become subject to the Workers'Compensation Laws of Calilornia. k
Dale Applicant BUILDING
} Dai NOTICE TO APPLICANT: If,after making this Certificate of Ex- ALTER OR ADD TO MECH. 4.00
Z I- emotion,you should become subject to the Workers'Compensation'_ APPLIANCE - 4.00 PLAN CHECK
provisions o the Labor Cyou must forthwith comply with FEE
U such provisions or this permitit shall
shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) -3.00 '
CONSTRUCT ION L17NDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 5.00SEISMIC FEE
Ihereby affirm fail 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,Cie.CJ. HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Name H EATI NG UN IT(OVER 100,000 B.T.U.)7.50 017
Lender's Address ELECTRIC
I certify that Lhave read this application and state that the above VENTILATION FAN (SINGLE) 3.00
Information is %racer. I agree t0 comply with all city and CUUaty B01LER-COMP(3 H.P.or t00,000B.T.U.) 4.00 PLUMBING
ordinances and state laws relating to is cit ng construction, and
hereby authorise representatives of this city es enter upon The BOILER-COMP(0.,100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indc 'fy and keep hatless the City of MISC.- REFER TO ORD.
Cupertino against liabilities a gments, costs and expenses which --PERMIT ISSUANCE 3.00 CONST.TAX
may in any way acct v et said City in consequence of the
gamut f lh'' eon' MECH.CONT, LIC,N0, MECH.
G(- TOTAL TOTAL
Signa ora of Applicant( ontramor Dare Q-a�
OFFICE COPY