3713 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BA L POINT P ONLY
+ BUILDING PROJECT IDENTI FICOCR Eas 4/_ FRMITNU�PRBG,Ln,NG . ' ' &'PE
x-21269 Stevens Creek Blvd,
BUILDING-.ELECTRICAL-PLUMBING-MECHANICA
OWNER'$ - - s PLAN CHECK VALIDATION .
"AME .
VIP Printing 1.0NE OTV. ELECTRIC PERMIT FEE '
CONTI
ACTOR'S a
�/� p3
NAME'
NAME OUTLETS SWITCHES 5.00/1.00 3 J '
Stoneson Constructi88N0. ' 198484a LIGHTING FIXTURES '5.0011.00' Q /,I -
ADDRESS R's APPLIANCES-RESIDENTIAL 4.00
21269 Stevens Cr. PHONE 253-1440 .PANELS 5.00 DATE OF'APPLICATION
ARCHITECTLunchan SIGNS,' 6.00 PLAN CHECK'FEE P.C.NO.
OR
ENGINEER PA
Associates uc.NO. SIGNS TRANS:- ` 3.00 'f
ARCH.OR ENG. PERMIT VALIDA N
ADDRESS SPECIALCIRCUIT '5.00
7.10 Sansome St.' - zIP 94111 TEMP. METER OR POLE INS, t" 15.00 U( 1 8 1983
APPLICANTS - - MOTORS SEE FEE SCH.
ADDRESS - - /
21269 Stevens Cr. Cupbertirio,Ca. SERVICE CHANGE. 10.00
a o o LICENSED CON'I'RAC'I'ORS DECLARATION
a U U I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
$ 1° (commencing with Section 7000)of Division 3-of the Business and, - - BLDG.. ELECT. PLG. - MECH..
wi Professions Cod ani my license is I full for e _
z i w License loss Lia umber - �-
pip
PVIL
_ IJatc �-Contract or
`a m 2 ' .* - ( BUILDING PERMIT
¢ ¢ OW [)I,
DECLARATION'
O u,u INFORMATION
D I. - - REFER TO ORD
w 3 LL h I hereby al(lowing I am exee,7Imhn the hoss.rdPoLicense MISC.,_ VALUATION $(FT.
r u 0 J Law for the following reason.(Sec.]031.5,Business and Professions PERMIT ISSUANCE 6.00
m Code:Any city or county which occuiresa permit m construct,aller, _, 30000 _
IL Q¢ O- improve,demolish,or repair any structure,prior 10 its ISSWOCC.also ELEC.CONVT..H, t• LI/sQ NO. I{pp ELEC. ./
i S O IY requires the applicant for Uch'pemtit to file a signed state tnent that W.E.Mason Inc• Cr10#8821 TOTAL-� PERMIT TO
w m u be is licensed pursuant to tlm.provisions of the Contractor's License ,
,FZs- Law(Chapter 9(commencingwith Section 7000)of Division 3 ofthe
F 4 o Business and Profession,Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE
a h- m the basis for toe alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
s3 _ by any applicant for a permit subjects the applicant In a civil penalty ALTER-DRAIN&,VENT-WATER (EA.) 4.00
of not more than five hundred dollars($500).):
'❑ I,-us owner,of lire property,or my employees with wages us BACK FLOW PROTECT.DEVICE 2.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and I'rofassions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 �- '
Cade:The Contractors License Law does not apply to an owner of
property who builds or improves thereon,and who Anes such work FIXTURES-PER TRAP - 4.00 SO.FT FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve- GAS-EA.SYSTEM-1 INC.4 OUTLETS 4.00
'inmds are not intended or offered for sale.IL however,the building
or improvement is sold 'within one year of completion,the owner- GAS-EA.SYSTEM.-OVER 4 (EA.) 1.00 BUILDING USE
builder will hive the holden of proving(hut he did not build or ire - RES .IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER:'." 20.00
❑ L its owner•of the property,ant exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business - LAWN SPRINKLERS- 1 INC 5 V.B. 5.00_ ASSESSORS PARCEL NO,
and Professions Coder The Contractor's License Law does not apply [ a./�j
to alrowner of propertywho'builds or improves thereon.anti whu LAWNSPRINKLERS-OVER 5 (EA:I 1A03.; Pi -31�
contracts'forsuch projects with a contractors)l icensed pursuant to /
the Contractor's Liccc Law. I ' 7 I. SEWER-SANITARY-STORM EA:200ft/8.00 TRACT NO. - PARCEL NO,
❑ 1 In.exempt under Sec. ,B.&P.C.for this, s
reason WATER HEATER W/VENT - 4.00
Due Owner WATER SYSTEM _ ,4.00 ACC.DATE ACC.FILE NO.
W'ORKERS'CONIPENSATION DECLARATION WATER TREATING EQUIP, '4.00 '
I hereby aRirm that 1 hove a'C"dic"In"CC
f C.T]et 10 scl Ginsure, - '"' - ZONING
or a certificate of Workers'Compenn:tion Insurance,or a certified - ENG.SITE NO.
copy theme (See 380�0,��,,a b.Cl.,�.� //p-��� /J�
Policy NnP_/ /�aQlbpaoy-O�-✓ ML& -
0 ❑ Curtilied copy is lmreby famished. '° , FIRE$PRINK `ENERGY T24
Z Z X Ccr r, I copy is d with-the ty nspecucnr division. MISC.- REFER TO ORD.O Applicant Y ❑ N❑ Y ❑ IN
CC w C17R1l EICAT1i01'Ii XIiMPTION 17ROM WOItK1?RS' PERMIT ISSUANCE'• 6.00 FLOOD ZONE A.L.U.C.
Lu > COpIPENSATION INSURANCE PLG.CONTR. ,.LIC.NO. PLG.
('This section need not be completed II' the-llermit is fur one TOTAL• v❑' N❑ Y❑ N❑
hundred denims(S 100).or less)
U O 1 certify that in the perl'oruirren of the work fonwhich this per. OTY. MECHANICAL PERMIT FEE FEE SUMMARY
U. F mit is issued,I shall not employ any person in any mammi so as to
U become subject to the Workers'Compensation Laws of C,difonoia.
Ow . - BUILDING
a Doc Applicant - ALTER OR ADD TO MECH: 4.00
} W
NOTICE TO APPLICANT: 1st after making this of Counters.,of Ex
Z Provision You should become subject to the Workers' cmplywith APPLIANCE _ 4.00 PLAN CHECK
SuProvisionsh ri io the this pe mit sir you must forthwith comply `.vial FEE
U such provisions or this permit shall he decried"revoked. AIR HANDLING UNIT(TO 10,000GF.M.) 3.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10)000C.F.M.) 5.00 SEISMIC FEE /0
•1 hereby affirm that there is a.Constnmtio,lending agency for .EXHAUST HOOD (WITH DUCT) 2.00
the performance of the work for which this permit isweJ(Sec
3097,Cie CA . HEATING UNIT(TO 100,000 B.T.U.) 4.00 MICROFILM - ..
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)7.50
Lender's Address ELECTRIC �SG 00.
I certify that l have read this application and state that the above VENTILATION FAN (SINGLE) 3.00'
't
ordinances
anti iso ret. I' N 'ct to budiith II itY'nd county PLUMBING
door.res is state laws relating tog nn huWith lconstruction,C.. amt BOILER-CAMP(3 H.P.Or 100,0008.T.U.) 4.00 /
hereby mthoni representatives of this city to nua upon the BOILER-COMP P:vnr 100,000BTUISEE FEESCH. MECHANICAL tp
above mhesnet 1 roperty for inspection purposes r _
/ (Wel agree to sieve, indemnify and keep Imnnless the Cuy 0Ij MISC.- REFER TO ORD:
j Cupertino against liabilities,judgments, costs and expenses•which - CONST.TAX -
m y in any way accrue. ain't said City in consequence of fire PERMIT ISSUANCE 3.00
g Filling ohis perm' . MEC H.CONT. MECH.
TOTAL TOTAL �r�o
smumreof Appli Arc.nM Date Nroiyaire Mechanical
t- OFFICE COPY -