6991 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT IDENTIFICATION PERMIT NUMBER
B11 ROM G Arthur Little Tenant APPLICATION & PERMIT
ADDREsa - 6991
Stevens Creek Blvd. � BUILDING-ELECTRICAL-PLUMBINGMECHANICAL
NAMERa Cupert3-no City ,Center PLAN CHECK VALIDATION
QTV� � ELECTRIC PERMIT 'FEE -
AssociatesB PHONE
COTRACTORS18798 48 OUTLETS-SWITCHES-RECEP 5.00/1.00 t]8,0
NRME
Pi m'Electric Inc.. LIB.NO. 323080 LIGHTING FIXTURES 5.00/1.00
oNTRAsCTOR5 p O BOX 2380 PPLIANCES-RESIDENTIAL 4.00
Alameda Ca.94501 PRON522-5335 PANELS 5.00 DATE OF APPLICATION
ARCHITECT SIGNS, S.00 PLAN CHECK FEE P.C.NO.
OR
ENGINEER -
' Llc.No. SIGNS TRANS. 3.00
1
ARCH.Ess E"G'•• ? - SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
zlp FEMP.METER OR POLE INS. 15.00
APPLICANT MOTORS S CH.
ADDRESS P.O.BQX 2380
Alameda Ca1:94501 SERVICE CHANGE 10.00 �.
0 o O LICENSED CONTRACTORS DECLARATIONNOV 211985
a v 1 hereby affirm that I am licensed under Provisions of Chapter 9 ISSUANCE DATE
H G m (cnmmcncing with Section 7000)of Division 3 of the Business and BLDG. ELECT. PLG. MECH.
F D z 1'rol'essions Co '.�yu y license is in full too, fi h 0
z o u, - I.icensf Cl:lt�{ll��'i1L��jr185_Lic.Numb �2LJy�(L;S
o N F o Dade_/_J/ Cnnlractor _Gl ._Ind.
r _ -
a m a OWNER-BUILDER DECLARATION BUILDING PERMIT'
E: °a " MISC.- REFER TO ORD *}' •INFORMA;T�ION
w3 u I hereby affirm(hat 1 am exempt from I he Contract or's License
u o st Law for Ole following reason.(Sec:7031.5,Business and Professions VALUATION $/FT.
_ PERMIT ISSUANCE 6.00
Code:
mpro Any city or county which%fracture Permit idcorosuanc alter,
Tic
improve,the applicant
or repair any Shit to M,prior asigneds tat crone that ELEC.CONTREle LID. 3 ELEC. /Q
DLL requires lI1e aPPhCan(I'Ofsuch Peltrllt to fllL'a5lgtl'd sWlCnlent that pita Elec.Ine. 323080 TOTAL ( PERMIT TO
u
to m he is licensed pursuant to the provisions of turn Contractor's Licenses, .+
i Law(Chapter 9(commencing with Section 7000)of Dovislon 3 ofth •- j; ;1zs
f 4 0 Business and Professions Code)or that he is exempt therefrom end QTY.`4 k p?'`P APLUMBING,P.ERMITA p v,FEE�
I['1-m the basis for the alleged exemption.Any violation of Section 7031.5 . STORIES TYPE CONSTR.
n by any applicant for a permit subjects the applicant to a civil Penalty ALTER-DRAIN -WATER (EA.) 4.00
ul'not more than five hundred dollars(85001.):
❑ Las owner of the properly,or my employees with wages as BACK FLOW PROTECT.DEVICE 200
their sole compensation,will d ,
o the work,and the structure is not - OCC.GROUP RES.UNITS
intended or offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,CON D. 4.00 -
'Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP 4,00 sG.Fr.FLooR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
ran is are Hot intended or offered for sale.If,however,the building GAS-EA.SYSTEM-I1NC.4OUTLETS 4.00
or improvement is sold within one yeitr 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 Tart.r inRES IND CON PB O%M1e,
prove dor purpose of sale.). INDUSTRIAL WASTE INTER '20:00
ElI,as owner O .f the property,am exclusively contracting with 1:1 ❑ ❑ 0 ❑
licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5'.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's-Liecow Low docs not apply -
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5 MAY 1.00 '
contracts for such projects with it contortions)licensed pursuant To
the Contractor's License Law, SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. •PARCEL NO.
❑ lumexemptumber .Sec. ,BAP.C.I'orthis WATER HEATER W/VENT 4.00
reason
Owner - Date WATER SYSTEM 4.00 ACC.DATE ACC.FILE NO.
WORKS RS'COMPI;NSATION DECLARATION WATER TREATING EQUIP. 4.00
I hereby affirm that I have a certificate rconsent Io relf-insure,
or a certificate Of Workers'Compensation Insurance,or a certified ZONING ENG.SITE NO.
Propy OieR`A±Ps.�yBO� TC.).
olicy No+w-••+k7G@efr.fprl%;y Royal Ins.
Q p Certified copy is hereby furnished. FIRE SPRINK ENERGY T 24
?9 CeNit�'P$��Q if rte IIsPM inspection division. MISC- REFER TO ORD.
Z p APPli call Lu"r1�'.ScT -�Ce.I-�fl Y E] N� Y C] N�
N CIi RTI PICAI'Is O I'I:X Ii M PT ION P ROM WO R K E RS' PERMIT ISSUANCE B.00 FLOODZONE A.L.U.C.
LU > COMPENSA'iION INSURANCE PLG.CONTE. LIC.NO. PLG. - Y� N� Y� N�
CL O ('Phis section need not be completed if the permit is for one TOTAL
Z) Z Immd.dd011ars(SI00)orlCss.) ? • -
V O I certify that In the performance of the work for which this per QTY. MECHANICAL PERMIT - FEE FEErSUMMARrYB� ziy
IL F not Is issued, I shall not employ any person in any manner so as to
O W become subject to the Workers'Compensation Laws of California.
a Date Applicant ALTER OR ADD TO MECH. 4.00 BUILDING
} w NOTICE TO APPLICANT: If,after making this Certificate of Ex
F Z emption,you should become subject to tire Workers'Compensation APPLIANCE 4.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
V such provisions or[his permit shall be deemed revoked. AIR HANDLING UNIT(TO 100DDC.F.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C F.M.) 5.00 SEISMIC FEE
I hereby affirm that there is a constoretitn leading agency for EXHAUST HOOD(WITH DUCT) 2.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Cir.C.). HEATING UNIT(TO 100,000 B.T.U.) 4.00
Lender's Address
HEATING UNIT(OVER 100,000 B.T.U.)7.50 O O7.
Lender's Address ELECTRIC
1 certify.that I have read thisi pplication and state that the above VENTILATION FAN (SINGLE) 3.00
information is correct.1 agree to comply with all city and countyPLUMBING'
ordinances and stale laws relating to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 4-.00
hereby authorize representatives-of' this city to enter upon.lhe BOILER-COMP IOwf1W,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned properly for inspection purposes.
(We) agree t0 save, inderom an keep harmless the City of MISC.-. REFER TO ORD.
Cupertino against liabilities,j gmc s, costs and expenses which '-CONST.TAX
may in y w y accrue ' st d City in consequence,of the PERMIT ISSUANCE. 3.00
gra tin this MECH,CONT. 't LIC.NO. MECH. e .G
85 TOTAL I k `'� 1
TOTAL
Signatum of Applicant/C tractor --Dale _s '
OFFICE,COPY "