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C 7076 APPLICANT TO FILL IN INFnRMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTI FIi .IONretere PERMIT NUMBER BUILDINGAPPLICATION & PL„MIT pORE55 J� BUILDING ELECTRICAL PLUMBING-MECHANI AL 7076 OwNER'S e • t ? fuJ Y ry� � Iy PLAN CHECK VALIDATION NAV *S. ' �'w�R y {rp!r,L a `f :',•' G QTM: zax' ( .ELECTRIC-PERM 11 S` �O" tj PHONE 242.-14Uv §4�.,sx„•ki.g d i` h:..+" CONTRACTORS NAME //�� ��gy,� �qlw�k UTLETS-SWITCHES-RECEP 5.00/1.00 s- C�17s�rxPc.rvo. 1/y LIGHTING FIXTURES 5.00/1,00 CONTRACTOR., DDS AcroR's PPLIANCES-RESIDENTIAL 4.00 ANM (`�SN��-53g5 PANELS 5.00 DATE OF APPLICATION ARCHITECTpA�� SIGNS 6.00 PLANCHECK FEE P.C.NO. OR ����11 E (NEER SIGNS TRANS. 3.00 No. ADDRES'NiSNM SPECIALCIRCUIT 5.00 PERMIT VALIDATION p EMP.METER OR POLE INS. 15.00 AGGRESS ADDRESS MOTORS SEE FEE SCH. / �`/ 4y SERVICE CHANGE 10.00 l/ w o O LICENSED CONTRACTORS DECLARATION a u v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE laonhmencin with Section 7000)of Division 3 of the Business and ¢ a g BLuUm ❑OG. ELECT. PL❑G. MECH. H i Prolessions CoJt�d my license is in full for oi w a License Ch�xsy�W�LU.Number_ m w Date_�//yr(.(^'eG_Conlmclor ��//��)) !'" :BUILDING-FERMI r'-4.M:; ¢ o a u OWNER BUILDER DEC ,av-ANFORMATIONci£:,"+' F ; r I hereby alfirm that I am exempt fr n mors License MISC.- REFER TO ORD - FLLoa Law for the following reason(Sec`703 . .B and Professions PERMIT ISSUANCE VALUATION SIFT. m Code:Any city or county which reyuiresapermit CconslrucLalteq 6.00 'a ¢ improve,demolish,or repair an structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ¢ ¢ O Y ELEC. O LL requires the applicant for such permit to file a signed statement that TOTAL PERMIJ,TO a,w m he is licensed pursuant to the provisions of the Contractor's License _ !., r z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe y .SJ !;<"*'.r QC LiQ-//yJVC s a: c Business and Prolessions Code?or that he is exempt therefrom and OTIC. F PLUMBING PERMIT ?e )„ ¢ PE-E ¢ r o the basis for the alleged exemption.Any violation of Section 7031.5 �=' ' " STORIES TYPE CONSTR: i 3 m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00 of not more than five hundred dollars($500).). ❑ 1,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 Contractors 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 himself or through his own employees,provided that such improve- mentsarenotintendedorofferedforsale.If,however.the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or im. GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE prove for purpose of sale.(. RES IND CON PB Other INDUSTRIAL WASTE INTER. 20.00 ❑ L as owner of the property,he exclusively contracting with ❑ ❑ Cl ❑ ❑ and Pro contractors to construct the project La 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. to Professions Code:The who Contractor's License Law does not apply to tr owner of properly who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractions)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-,B&PC.for this WATER HEATER W/VENT 4,00 reason Owner Date WATER SYSTEM -� 4.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 1 hereby alfirm that 1 have a certificate of consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Labf.). EwngMISE. Policy��'o. C top ❑yC rtified cop tl'' FIRE SPRINK ENERGY T"24 Z Z B'� Certified c rf6 the city inspection division. O pppdi"aRt T� MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ CC w CI: f F.MPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOODZONE A.L.U.C. W > TION INSURANCE PLG.CONTR. LIC.NO. PLG. y❑ N❑ v ❑ N❑ d o (This union necompleted if the permit is for one TOTAL Z h ndred dollars(S I ) r r ✓"c U dd} T 1L t.}a.+:^k n 3 r,{ n>t: T`@+,. C"'.pr-•^,.i^"'.I ,P ., le I LL O I certify that h the performance of the work for which this per G. rly 7+J.d"pMF•I.NANIDAL"�PERMIf' y'i F1,PE1T` , r y F become is issued,I shall not employ any person in any manner so to O W haeme subject to the Workers'Compensation Laws of California.m a Date ApplicantALTER OR ADD TO MECH. q,00 BUILDING O S'v } on NOTICE TO APPLICANT: If,after making this Certificate of Ex. F Z emptier,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PMC.F.M.) 5.00 SEISMIC FEE I hereby affinn that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00 the 3097 eCv.0 ILM j°ce of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROF Lender's Name HEATING UNIT(OVER 100,000 B.T.U.P.50 // Lender's Address ELECTRIC �N t I certify that I have read this application and stale that 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-COPAP(3 H.P.Of 100,0008.T.U.) 4.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,010 BTU)SEE FEE SCH. MECHANICAL above mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 3.00 grunting of this permit MECH.CONT. LIC.NO. MECH. !}�L TOTAL Signature of ApplicanljContmctor Dale k"u .-`,.-Pn;a.N_-". ("' L� OFFICE COPY APPLICANT TO FILL IN INFnRMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUILDING PROJECT IDENTI FIi .IONretere PERMIT NUMBER BUILDINGAPPLICATION & PL„MIT pORE55 J� BUILDING ELECTRICAL PLUMBING-MECHANI AL 7076 OwNER'S e • t ? fuJ Y ry� � Iy PLAN CHECK VALIDATION NAV *S. ' �'w�R y {rp!r,L a `f :',•' G QTM: zax' ( .ELECTRIC-PERM 11 S` �O" tj PHONE 242.-14Uv §4�.,sx„•ki.g d i` h:..+" CONTRACTORS NAME //�� ��gy,� �qlw�k UTLETS-SWITCHES-RECEP 5.00/1.00 s- C�17s�rxPc.rvo. 1/y LIGHTING FIXTURES 5.00/1,00 CONTRACTOR., DDS AcroR's PPLIANCES-RESIDENTIAL 4.00 ANM (`�SN��-53g5 PANELS 5.00 DATE OF APPLICATION ARCHITECTpA�� SIGNS 6.00 PLANCHECK FEE P.C.NO. OR ����11 E (NEER SIGNS TRANS. 3.00 No. ADDRES'NiSNM SPECIALCIRCUIT 5.00 PERMIT VALIDATION p EMP.METER OR POLE INS. 15.00 AGGRESS ADDRESS MOTORS SEE FEE SCH. / �`/ 4y SERVICE CHANGE 10.00 l/ w o O LICENSED CONTRACTORS DECLARATION a u v I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE laonhmencin with Section 7000)of Division 3 of the Business and ¢ a g BLuUm ❑OG. ELECT. PL❑G. MECH. H i Prolessions CoJt�d my license is in full for oi w a License Ch�xsy�W�LU.Number_ m w Date_�//yr(.(^'eG_Conlmclor ��//��)) !'" :BUILDING-FERMI r'-4.M:; ¢ o a u OWNER BUILDER DEC ,av-ANFORMATIONci£:,"+' F ; r I hereby alfirm that I am exempt fr n mors License MISC.- REFER TO ORD - FLLoa Law for the following reason(Sec`703 . .B and Professions PERMIT ISSUANCE VALUATION SIFT. m Code:Any city or county which reyuiresapermit CconslrucLalteq 6.00 'a ¢ improve,demolish,or repair an structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ¢ ¢ O Y ELEC. O LL requires the applicant for such permit to file a signed statement that TOTAL PERMIJ,TO a,w m he is licensed pursuant to the provisions of the Contractor's License _ !., r z a Law(Chapter 9(commencing with Section 7000)of Division 3 ofthe y .SJ !;<"*'.r QC LiQ-//yJVC s a: c Business and Prolessions Code?or that he is exempt therefrom and OTIC. F PLUMBING PERMIT ?e )„ ¢ PE-E ¢ r o the basis for the alleged exemption.Any violation of Section 7031.5 �=' ' " STORIES TYPE CONSTR: i 3 m by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN&VENT-WATER (EA.) 4.00 of not more than five hundred dollars($500).). ❑ 1,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 Contractors 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 himself or through his own employees,provided that such improve- mentsarenotintendedorofferedforsale.If,however.the building GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or im. GAS-EA.SYSTEM-OVER 4 (EA.) 1.00 BUILDING USE prove for purpose of sale.(. RES IND CON PB Other INDUSTRIAL WASTE INTER. 20.00 ❑ L as owner of the property,he exclusively contracting with ❑ ❑ Cl ❑ ❑ and Pro contractors to construct the project La 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 5.00 ASSESSORS PARCEL NO. to Professions Code:The who Contractor's License Law does not apply to tr owner of properly who builds tr improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a contractions)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/8.00 TRACT NO. PARCEL NO. ❑ I am exempt under Sec.-,B&PC.for this WATER HEATER W/VENT 4,00 reason Owner Date WATER SYSTEM -� 4.00 ACC.DATE ACC.FILE NO. WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 1 hereby alfirm that 1 have a certificate of consent to self-insure, ZONING ENG.SITE NO. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Labf.). EwngMISE. Policy��'o. C top ❑yC rtified cop tl'' FIRE SPRINK ENERGY T"24 Z Z B'� Certified c rf6 the city inspection division. O pppdi"aRt T� MISC.- REFER TO ORD. Y ❑ N❑ Y ❑ N❑ CC w CI: f F.MPTION FROM WORKERS' PERMIT ISSUANCE 6.00 FLOODZONE A.L.U.C. W > TION INSURANCE PLG.CONTR. LIC.NO. PLG. y❑ N❑ v ❑ N❑ d o (This union necompleted if the permit is for one TOTAL Z h ndred dollars(S I ) r r ✓"c U dd} T 1L t.}a.+:^k n 3 r,{ n>t: T`@+,. C"'.pr-•^,.i^"'.I ,P ., le I LL O I certify that h the performance of the work for which this per G. rly 7+J.d"pMF•I.NANIDAL"�PERMIf' y'i F1,PE1T` , r y F become is issued,I shall not employ any person in any manner so to O W haeme subject to the Workers'Compensation Laws of California.m a Date ApplicantALTER OR ADD TO MECH. q,00 BUILDING O S'v } on NOTICE TO APPLICANT: If,after making this Certificate of Ex. F Z emptier,you should become subject to the Workers'Compensation APPLIANCE 4.00 PLAN CHECK provisions of the Labor Code, you must forthwith comply with FEE U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000C.F.M.) 3.00 CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10PMC.F.M.) 5.00 SEISMIC FEE I hereby affinn that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 2.00 the 3097 eCv.0 ILM j°ce of the work for which this permit is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROF Lender's Name HEATING UNIT(OVER 100,000 B.T.U.P.50 // Lender's Address ELECTRIC �N t I certify that I have read this application and stale that 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-COPAP(3 H.P.Of 100,0008.T.U.) 4.00 hereby authorize representatives of this city to enter upon the BOILER-COMP(Over 100,010 BTU)SEE FEE SCH. MECHANICAL above mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which CONST.TAX may in any way accrue against said City in consequence of the PERMIT ISSUANCE 3.00 grunting of this permit MECH.CONT. LIC.NO. MECH. !}�L TOTAL Signature of ApplicanljContmctor Dale k"u .-`,.-Pn;a.N_-". ("' L� OFFICE COPY