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C 7133 APF ACANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY BUI LDI it PROJECT I DENTI FICATION PERMIT NUMBER LDINc APPLICATION & PERMIT 7133 DDR:55 JA:0 BUILDING-ELECTRICAL-PLUMBING-MECHANICAL ���/// OW R's �, ('•y9 PLAN CHECK LIGATION NAME 7 �✓ OTY. ELECTRIC PERMIT FEE I PHONE 7 VV Co TRACTOR'S - UTLETS-SWITCHES-RECEP 5.00I1.00 714 NPME L LIC.NO. LIGHTING FIXTURES 5.00/1.00 CONTRACTORS ADDRESS -APPLIANCES-RESIDENTIAL 4.00 PHONE PANELS 5.00 DATE OF APPLICATION ARCHITECT SIGNS 6.00 PLAN CHECK FEE P.C.NO. OR ENGINEER uc.No. SIGNS TRANS. 3.00 AIT C" OR ENG. - SPECIAL CIRCUIT $,QQ PERMIT VALIDATION ADORLSs ZIP TEMP. METER OR POLE INS. 15.00 APPLICANTS MOTORS - SEE FEE SCH. ADDRESS SERVICECHANGE 10.00 94L�� o o LICENSED CONTRACTORS DECLARATION ¢ I hereby aflinn that I am licensed under provisions of Chapter 9 ISSUANCE DATE w< w (commencing with Section 7000)of Division 3 of the Business and BL G. ELECT. PLG. MECH. H<z Pro@ssiuns Code d my license is in full force a f t z 0 m - License Gla s- Lic.Number C /y- ❑ ❑ ❑ . o F w Dutc_��_ Contractor - ` � a x BUILDING PERMIT E ¢ w u OWNER-BUILDER DECLARATION INFORMATION m3 u H 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD LLoa Law lirc the following reams.(Sec.7031.5,Businessand Professions PERMIT ISSUANCE VALUATION $/FT. L - Code:Any city or county whichrequimsapermittoconstfucLalter, 6.00 a ¢G 0 improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC. / D LL requires the applicant for such permit to file a signed statement that TOTAL PERMIT T A. w m he is licensed pursuant to the provisions of the Contractor's License F z a Low(Chapter 9(commencing with Section 7000)of Division 3 ofine /Zl1TEtZv <U/j %YdeI 4 o Business and Professions Code)or that he is exempt therefrom and QTY. PLUMBING PERMIT FEE ¢ r o the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR. o3m byanyapplieanl lot a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 4.00 of not more than five hundred dollars(8500).): CDI,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 Onactum is not intended or uICTed ]or sale (Sea 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 4.00 Code:The Con Tumor's License Law does not apply to an ownef of ` . properly who builds or Improves thereon,and who does such work F IXTUR ES-PER TRAP 4.00 SO.FT,FLOOR AREA TOTAL ACREAGE f himself or through his own employees,provided that such improve- mentsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-11NC.40UTLETS 4.00 or improvement is sold within one year of completion, the owner- GAS-EA.SYSTEM-OVER 4(EA.) 1.00 BUILDING USE bur lder will have the burden of proving that he did not build or im- RES IND CN vB Orher prove for purpose of sale.). INDUSTRIAL WASTE INTER. 20.00 ❑ 1,as owner of the properly,am exclusively contracting with ❑ ❑ ❑ ❑ licensed contractors to construct the project(Sec.7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 5.00 ASSESS RSP HCEL NO. .,of Professions Code:'1'lie Cuntraofor's License Law does not apply to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00 contracts for such projects with a comoaetor(s)licensed pursuant to the Contractor's License Law. SEWER-SANITARY-STORM EA.200f1/8.00 TRACT NO. PARCEL NO. ❑ 1 am exempt under Sec. .BAP.C.for this WATER HEATER W/V ENT 4.00 reason. Own - Date%,jf< WATER SYSTEM 4.00 ACC.DATE ACC-FILE NO. WORK FRS'COMPENSATION DECLARATION WATER TREATING EQUIP. 4.00 I hereby ulllrm that I have a certificate of consent to self-insure, ZONING ENG.SITE NO. if a certificate of Workers'Compensation Insurance,or a eI,ni6ed copy thereof(See.31400,Lab.C.). Policy No, Company Q (] CcrtilieA copy is hcreM1y lurnisheJ. FIRE SPRINK , ENERGY T-24 Z_ Z [D Certified copy is tiled with the city inspection division. MISC.- REFER TO ORD. Y Applicant E] NNC] Y ❑ N[_]F' � . PERMIT ISSUANCE 6.00 FLOOD ZONE A.L.U.C. C - CERI'IFICA'1'1:01'EXEMPTION FROM WORKERS' W > C04I7NSA1'ION INSURANCE PLG.CONTR. LIC.No. PLG. . O (Phis section n ed nit be completed if the permit is for ore TOTAL v❑ N❑ V ❑ N❑ D DZ hu id red dol ku,IS 100)it less.) U O 1 certily that in the performance of the work for which this per. DTV MECHANICAL PERMIT FEE FEE SUMMARY LL l- mit is issued, I shall not employ any person in any manner so as to lL 00 bccono subject to the Worker Compensation Laws of California. BUILDING �9y Date - Applicant ALTER OR ADD TO MECH. 4.00 U } tan NOTICE '10 APPIACAN'I': If,after making this Certificate of Ex- 2 eruption,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 of this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10,000 C.F.M.) 3.00 CONSTRUcr1ON LENDING AGENCY AIR HANDLINGUNIT(OVER 10=1C.F.M.) 5.00 SEISMIC FEE I hereby aflinn that there is a construction lending agency fur EXHAUST HOOD(WITH DUCT) 2.00 the performance of the work for which this permit is issued ISCC. HEATING UNIT(TO 100000 B.T.U.) 4.00 MICROFILM 3097.Civ.C.). , Lender's Name HEATING UNIT(OVER 100,000 B.T.U.P.50 ELECTRIC Lender's Address • I certify mat 1 have read this application and slate that the above VENTILATION FAN (SINGLE) 3.00 iolr oation is correct. I agree to comply with all city and counly BOILER-COMPI3 H.P.or 100,000 B.T.U.) 4.00 PLUMBING ordinances and stale laws relating to building construction, and hereby aumorue representatives of this city to enter upon the BOILER-COMP Over 100,000 BTU)SEE FEE SCH. MECHANICAL above property for inspection purposes. (we) agree to save, indenmity and keep harmless the City of MISC.- REFER TO ORD. Cupertino against liabilities,judgments, costs and expenses which PERMIT ISSUANCE 3.00 ECONST.may in any way accrue against said City in consequence of thegranting of ll a Pemil. MECH.CONT. LIC.NO. MECHTOTAL n.turC pl a n L't0 Dole OFFICE COPY