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12342 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE ALL POINT PEN ONLY 41'0 BUILDING PROJECT IDENTI ION PERMIT NUMBER EDILDING zr E/y/ APPLICATION & MIT I �� ADDRESS �B JJ/j STE✓G�/�S Ci2EE.� �/ _BUILDING - ELECTRICAL-PLUMBING -MECHANICAL -I ' OWNER's I PLAN CHECK VALIDATION . NAME LU CIC .P'zoPgf QTY. ELECTRIC PERMIT FEE PHONE CONTRACTORS NAME UTLETS-SWITCHES-RECEP 10.00/1.00 NAME LIGHTING FIXTURES 10.00/1.00 CONTRACTORS - APPLIANCES-RESIDENTIAL 4.00 ADDRESS wit L PANELS 19.00 DATE OF APPLICATION ARCHITECT PANELS (OVER 200 AMP) 29.09 PLAN CHECK FEE P.C.NO. OR ENGINEER LIC.No, SIGNS TRANS. 3.00 ADDRESS Rea SPECIAL CIRCUIT 5.00 PERMIT VALIDATION ZIP TEMP. METER OR POLE INS. 20.00 APPLICANTS MOTORS SEE FEE SCH. ADDRESS ,J 6a.< ARS �-- .�• //sem SERVICE CHANGE 20.00 yl\ QQ Foo LICENSED CONTRACTORS 'CLARATION /xa a u w (commencing with Section 7000)of Division 3 of the Business and I hereby affirm that I am licensed under provisions o'Chapter 9 .ISSUANCE DATE BLDG. ELECT, PLG. MECH. F N i Professions Code�nd q�Y/licem,is in full forte omit efl'c. ❑ ❑ ❑ ❑ z o w - License Class_C'.=.7[Z Lic.Numher.y�� 4 z r � Date / �+ �Cnntruclor .o.a a x f a A i V BUILDING PERMIT ¢ S,w OWNER-BUILDER DECLA RAT N INFORMATION w;LL y I hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD r u o J Law for the following reason.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE 10.00 VALUATION $/FT, ,Ai Code:Any city or county which requires permit to construct,alter, li a, ¢ O improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. D M requires the applicant for such permit to file a Signed statement that TOTAL PERMIT TO o. wF2 he is licensed puneant to the provisions of the Contractor's License zi Law(Chapter9(commencing with Section 7000)of Division 3 ofthe i c Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMI FEE M 1-2the basis for the alleged exemption.Any violation of5ection 7031.5 STORIES TYPE CONSTR. i by any applicant for a permit subjects the applicant tea civil",many ALTER-DRAIN&VENT-WATER (EA.) 5.00 of not mom than five hundred dollars(S5000.): ❑ 1,as owner of the property,or my employees with wages as BACK FLOW PROTECT.DEVICE 4.00 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. 5.00 Code:The Contractor's License Law does not apply to an owner of • properly who M1oilds or improves thereon,and who does such work FIXTURES,PER TRAP 5.00 SO.FT.FLOOR AREA TOTALACREAGE himself or through his own employees,provided that such improve - mentsarenotintendedorofferedfor sale.If,however,the building GAS-EA.SYSTEM-11NC.4OUTLETS 6.00 or improvement is sold within one year of completion,the owner- GAS-EA.SVSTE R 4(EA.) 2.00 builder will have the burden of proving that he did not build or im- BUILDING USE prove for purpose of sale.). INDUSTRIAL NTER 30.00 RES IND CON PB usher ❑ I,as owner of the property,am exclusively contracting with ❑ Cl El ❑ 0 licensed contractors to construct the Project(Sec.7044,Business LAWN SPRINKLER LI .B. 6.00 ASSESSORS PARCEL NO, and Professions Code:The Contractor's License Law does not apply' to an owner of property who builds or improves thereon,unit who LAWN SPR IS OVER .) 1.00 contracts for such projects wills a contractors)licensed penuoN to the Contractor's License Law. SEWER-$A ARV-s o01t/10.0Q TRACT NO, PARCEL NO. ❑ lam exempt under Sec.-,B.&P.C.for this WATER HEATEMVtNT 6.00 reason Owner Date WATER SYSTEM 5.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION. WATER TREATING EQUIP. 5.00 1 hereby affirm that I have a certificate of consent to sell'�inwre, �� ZONING ENG.SITE N0. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.)../ gm4p S-AS-AS .E/s � �" Policy No. Company D�ylg/ 0 ❑ Certified copy is hereby furnished. pQ/ / h� FIRE SPRINK ENERGY T-Z4 Z Z "{Certified copy is filed gtall the city nspecdcm d' inion. F O Applicant eFlz�O� SEYZ✓- /iia --zn MISC- REF R ORD. Y E] N� Y ❑ N❑ _+ TPERMIT ISSUANCE 10.00 LU CERI FICATE OF EXEMPTION FROM WORK FLOOD ZONE A.L.u.C. W >_ COMPENSATION INSURANCE PLG.CONTR. LIC,NO. I.G.P C O (This section need not be completed if the permit is for one TOTAL J 0 W Y❑ No Y[:) N Z) Z hundred dollars IS 100)or less. U O I certify that in the performance of the work for which ill's per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY W U mit is issued,I shall not employ any person in any manner so as to _ become subject to the Workers'Compensation Laws of California. OIL Date ApplicaALTER OR A nt BUILDING >- N NOTICE TO APPLICANT: IL after making this Certificate or Ex- DD TO MECH. 5.00 F ? emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK proviions of the Labor Code, you must forthwith comply with a same provisions or Otis permit shall he deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00 FEE CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 140WOFM.) 6.00 SEISMIC FEE I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00 the performance of the work for which this permit is issued(Sec. MICROFILM 3097,Civ.C.). ' HEATING UNIT(TO 100,000 B.T.U.) 8.00 Lender's Name H EATI NG UNIT(OVER 100,000 B.T.U.)9.50 Lender's Address ELECTRIC I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 4.00 - information is correct. I agree to comply with all city and county PLUMBING JO GQ ordinances and state laws retailing to building construction, and BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL (we) agree to smvc, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 10.00 CONST.TAX may in any way accrue against said City in consequence of the grunting o is permit. MECH.CONT. LIC.NO. MECH. !' TOTAL TOTAL Ignition,of Applicant/Contractor Date O OFFICE COPY